Dáil debates

Tuesday, 10 July 2012

Health Service Budget: Motion [Private Members]

 

8:00 pm

Photo of Barry CowenBarry Cowen (Laois-Offaly, Fianna Fail)

The health service has been used to taking a battering in this House over the years. Some of it has been justified but some of it has not been. Before the HSE was set up, not a day went by without an issue in one of the 11 health boards being raised or debated. The whole aim of setting up the HSE was that patients wherever they lived had access to the same type of service and that health outcomes would be the same whether one lived in Carndonagh or Cahirciveen. When the previous Government set up the HSE, it was actually welcomed by the Labour Party and Fine Gael. Obviously, since going into government both parties, as is the norm, found themselves to have short memories.

I am not saying the HSE did not have a very difficult start. I admit it took a while to bed all of the changes down but it must be acknowledged that the health service is one of the biggest employers in the State, has thousands of sites and numerous grades and different professions, so it was bound to take time to settle. Any expert in change management would tell one that. Let us take primary care, for instance. The Minister and Minister of State, Deputies Reilly and O'Sullivan never miss an opportunity to say nothing was done in this area before they came into office, even though on their own Department's website an update on progress on primary care teams that was posted in March 2011 tells a very different story. It outlines how there were 348 teams at an advanced functioning stage, that is, holding meetings on patients. A further 171 teams were in development. There were at that stage over 2,500 health care professionals on primary care teams. This illustrates that an enormous amount of work was done by the previous Government. Any objective commentator would confirm that. I wonder do the Minister and Minister of State agree.

What baffles me most is the audacity of the present Government. When elected, members of the Government made a conscious decision to rubbish all previous health policy as it was seen to be tarnished in some way. The mantra of universal health insurance was the answer to all our woes, nothing would be right until it was introduced. However, the Dutch model is no longer mentioned as it was found to increase the number of administrative staff and to cost the Dutch taxpayer more. It is now 16 months since the election and a White Paper on universal health insurance has not even been introduced. The Minister has said it is unlikely that it will be introduced in the lifetime of the Government, however long that will be.

In the meantime, insurance costs for families who can afford it have gone through the roof and an increasingly rapid number of people are leaving insurance schemes as they simply cannot afford them. Waiting times for processing medical cards are at a historic high, and not just for first time applicants. We all remember the story of Regina Kennedy who last December, at 29 years of age and battling chronic renal failure, said she could not afford life-saving medication while her medical card re-application was being considered. Even though she had a chronic illness and the date on her original medical card had expired she would have to wait months and pay for medication in the meantime. This is far from the Utopia of universal health insurance. The Minister is not in charge of his Department or the HSE. He is too busy pontificating and relabelling policies so that he can call them his own. This is not fooling anyone working in the health service and it is certainly not fooling the public.

The National Treatment Purchase Fund, which had treated more than 200,000 patients over the previous ten years was a real success story and, when surveyed, patients who had used it gave it a more than 95% satisfaction rate. Waiting times were considerably down, with the vast majority of procedures being done within a three month waiting period. Within a few months of taking office, the Minister, Deputy Reilly, dismissed the NTPF and set up the special delivery units, SDUs. The SDUs are now busy relabelling trolleys and waiting rooms in the country's hospitals so numbers in accident and emergency departments look better on paper.

As we speak tonight, there are 2,451 beds closed in our public hospital system and 277 patients on trolleys. While the Minister is taking praise for treating the longest waiters on the waiting list, very few people have copped that these are the least number of patients being treated compared to when the NTPF was in charge. Obviously, the spin of treating those waiting longest was the priority rather than the substance of comparing the total numbers being treated. The Minster is not being open and honest about the SDUs. I was surprised to see reports that two of his advisers on the SDU are paid through the UK and do not appear to pay tax in Ireland. If these reports are inaccurate they should be corrected immediately.

The Minister is also facing major challenges to ensure that his health Estimates are correct and in order. Indications so far do not lend any confidence. It is hard to ascertain the exact budget correction the health service is facing. It seems to be in a shambles.

The Minister got rid of the board of the HSE, an exercise in optics, and shamelessly has yet to bring forward legislation to replace it. This cynical exercise has led to this mess and brings with it a total lack of accountability. The Minister put Department of Health officials on the interim board of the HSE but when they met last week with the CEO of the HSE to discuss exact budget deficit figures they could not agree on them. This is farcical. It is like a pantomime. The deficit could be anything from €250 million to €300 million but as there is no functioning governing board the Minister will have to become directly involved himself to sort out this mess.

The Minister for Public Expenditure and Reform, Deputy Howlin, has recognised this. Ten days ago, he asked the Minister for Health to get personally involved, but there are no signs of this happening yet. Deputy Howlin even wrote to Deputy Reilly and outlined his concerns over the budget over-runs in a four page letter and added that he was concerned about the lack of governance structures. This is like a bad episode of "Killinaskully".

While the Minister pontificates about his universal health insurance plan, without producing any real plan, the health service as we knew it is falling apart, bit by bit. Morale is extremely low amongst staff, the service is facing massive cutbacks but the Minister is not even being honest about that. The CEO of the HSE is calling for direction. The Minister's own Department is saying the HSE is to blame. It is like a vicious circle of financial madness.

The Minister has only three Bills on the legislative list, not one of which has been published in this session. The first is on generic drugs where there were to be substantial savings, but to no avail. The second is to amend the Health and Social Health Care Professionals Act 2005, hardly a complex piece of legislation, but nothing has been done. The last is the HSE governance Bill. Despite repeated requests from Deputy Kelleher and many others on this side of the House, nothing has been produced. The Minister needs to take charge and to act now to prevent further damage being done to front line services. He is in danger of becoming the emperor with no clothes.

Time, patience and excuses are not enough. The Minister for Health, Deputy Reilly, and the Ministers of State are no longer acceptable. Labour and Fine Gael have been in office for 16 months. It is time for them to walk the walk. We have spent too long listening to them talking the talk, but there seems to be no cohesion, direction or control. The situation is spiralling out of control while the prospect of a €500 million over-run can only spell disaster for front line services.

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