Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

Yes. Go raibh maith agat.

I hope the Minister for Health, Deputy James Reilly, takes the opportunity tomorrow or on Thursday to come into the Dáil to address the very serious questions that have been raised concerning his involvement in the private nursing home sector. That involvement raises issues of conflict of interest and his suitability to take decisions regarding public and private nursing home care. This is directly relevant to the motion before us and the issue of health care funding and health care services.

Between January and May this year, 296 public residential care beds were shut by the Government and the Department of Health does not have a way of identifying the number of beds opened or closed in the private sector in the same period. There are more than 600 public hospital beds occupied by people whose treatment is complete but whose discharge is delayed, mainly because they are older people and there are no care home places or step-down facilities for them. With care home beds being closed and acute hospital beds also closed - more than 2,400 at present - the system is being contracted at both ends. Clearly, the Minister, Deputy Reilly, and his colleagues are continuing the failure of their predecessors and are driving the health service into deeper crisis.

It would be laughable if it were not so tragic that at this mid-point of 2012 we have a renewed panic within Government about the so-called spending over-run in the health budget. This was utterly predictable because the amount of money cut from the health budget for 2012 was totally unsustainable. We are told that the over-run for the year to the end of May 2012 was €280 million. It is no surprise that the HSE has exceeded its 2012 budget to this extent because, as we and many others have warned, the cuts imposed on health spending in budget 2012 simply cannot be sustained without the virtual collapse of services.

Some €750 million was taken out of health in the Fine Gael-Labour Party coalition Government's budget 2012. Now the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, is predicting that the over-run for 2012 will be €500 million. A total of €1 billion was taken out of health spending in 2011 and the Department of Health is talking about an overall reduction of €2 billion up to 2014. This is totally unsustainable without devastating already struggling front line services.

Last month we had the leaked correspondence from the Minister, Deputy Howlin, to the Minister, Deputy Reilly, on the over-run in health spending, apparently a public airing of the usual pre-budget manoeuvring within Government. We also had attempts to link the health funding crisis with the Croke Park agreement. The funding crisis in the public health services has its source in fundamentally flawed Government policy and not in the Croke Park agreement. We are seeing an effort to target the pay of people working in the health services as part of the austerity drive. If implemented, such pay cuts would be imposed alongside cuts in services for patients, not instead of them as the Minister, Deputy Reilly, has pretended.

The continuing recruitment embargo is a false economy as it has led to increased use of expensive agency staff and to more overtime working by existing staff. The Croke Park agreement provides for flexible working and this should be used to the maximum. Due to the continuing cuts and the recruitment embargo, staff are under severe pressure but have shown flexibility. One of the main drivers of costs in the health services is not the Croke Park agreement but the consultants' contracts, which keep pay for top earners in the health service at excessive levels and perpetuates the two-tier system with many consultants continuing to benefit from both the public and private sectors.

Alongside the reports of the €280 million over-run last weekend, we had speculation that the €35 million allocation for mental health services this year would be targeted to fill gaps elsewhere. Any such move would be scandalous and should be strongly resisted, and I depend on the Minister of State, Deputy Lynch, to do that. Only last week, on 4 July in this Chamber, she told us: "I listened to Deputy asking where was the €35 million and metaphorically, it is in my back pocket. [The Minister of State will remember saying that and I remember her saying that very well.] I still have the money, it still exists and it remains within the Department." I would ask her to give it a tap to make sure it is still there. I hope the Minister of State and her Cabinet colleagues ensure that funding remains in place and that it is allocated as agreed and as promised for mental health services in this State where it is so badly needed.

As we address this latest funding crisis in health, we are still in the dark about the Government's plans for major health care reform. The Minister, Deputy Reilly, and his colleagues have repeatedly told us that they are moving towards universal health insurance and a "money follows the patient" model of funding, but beyond these endlessly repeated headlines we have been given little detail of how these far-reaching changes are going to be achieved and how exactly they will work. One thing is certain, this system will not be based on the public service model of health care delivery. The emphasis will be on the purchase of services in both the private and the public health sector by health insurance companies. There is nothing to indicate that the two-tier public-private system will be dismantled.

The Minister has spoken of a single waiting list but, again, we have no detail about how this will work. For example, will hospital consultants still be able to work in and profit handsomely from both the public and the private systems? If not, then new consultants' contracts will be required. If there is to be a new and better way of working for consultants, and there certainly should be, then work on the new contracts would need to begin now to prepare for the throughput of new consultants coming into the system in the years ahead. We have also been told that hospitals will be grouped and that hospital trusts will be formed. Again, we have been given no detail. What guarantee do we have that this will not be yet more bureaucratic change?

At last month's quarterly meeting of the Joint Committee on Health and Children with the Minister and the CEO of the HSE, both of them painted a bleak picture of a health service in the midst of a deep economic recession. Billions of euros are being taken out of the health service budget. I have described this as austerity in action. One cannot take €2.5 billion out of the health service budget in the last three years and not seriously affect front line care of patients. This is admitted in the HSE 2012 service plan. This is the result of the fundamentally flawed economic strategy of this Government. At the Joint Committee on Health and Children I asked about the Minister's intention to take more billions out of the health budget. The Department of Health statement of strategy 2011-2014 states:

...total current expenditure for the public health service is being reduced by nearly €1.1 billion in nominal terms over the period 2011-2014 under the National Recovery Plan. However, in order to meet unavoidable pressures and Government commitments, in excess of €2 billion will have to be taken out of the health budget over the same period.

As my questions were not answered at the committee, I ask the Minister again, or any Minister who cares to respond in the course of this debate tonight and tomorrow night, for clarity on these figures.

The Minister stated that €2.5 billion was taken out over the past three years. His Department's strategy speaks of €1.1 billion in nominal terms, 2011 to 2014 and in excess of €2 billion over the same period. How does this translate in terms of 2013 and 2014? It is a very confusing picture. How many more billions of euro have to be taken out to meet what the strategy calls, "Government commitments"? I have to understand those Government commitments to mean bank bondholders' losses and other debts not incurred by the people. The Minister has repeatedly spoken of maximising the use of resources, including the skills and the time of health professionals. How does he reconcile this with the type of so-called savings being made now? For example, in Cavan General Hospital in my constituency, it is proposed to run the operating theatre on a week-on, week-off basis. Staff believe this will not make the targeted savings because it will mean more work done out of hours during the theatre's working week and that it will increase waiting lists. Undoubtedly it will. A fully equipped operating theatre will only be used at 50% of capacity, apart from emergencies. How does that make sense? I call on the Minister again to intervene to put a stop to this regressive and counter-productive cut.

Savings can be made in our health services by charging the real cost for the use of private beds in public hospitals, by targeting the excessive salaries of the highest earners in the health sector and by reducing the cost of medicines, where little progress has been made. This is recognised in the motion and Sinn Féin will support the motion in the name of the Fianna Fáil Deputies. However, it has to be recognised that, overall, the crisis in health spending is a product of the failed austerity strategy of the Fine Gael-Labour coalition and it cannot and will not be fully and properly addressed until that futile strategy is changed. I am under no illusion that this futile strategy is fully supported by Fianna Fáil and so its promotion of this motion is an example of double-standards.

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