Róisín Shortall (Dublin North West, Labour) | Oireachtas source

This Government faces a huge challenge, to manage and reform the health service when the health budget is being reduced. As part of that process the key question that arises for us all is who will bear the burden of the cuts. For example, do we increase prescription charges for medical card patients or reduce the drugs bill? Do we cut public health nurses or collect money owed by insurance companies? Do we cut home help services or impose a cap on consultants' pay? Our priority must be to protect front line services. We cannot cut our way out of problems. We must reform and that reform must happen quickly. Unless there is substantial reform there will be cuts and the poor will be hardest hit. Reform means reducing costs and changing the model of care to switch the focus from acute hospitals to community and primary care.

This will ensure early diagnosis, much better health outcomes and much better value for money. That is why the programme for Government prioritises primary care in the term of this Government. To deliver on the programme we need fully staffed primary care teams working from modern primary care centres. That is why we must recruit the 300 front-line primary care staff to areas of greatest need, staff such as public health nurses, speech and language therapists and occupational therapists, and for which staff funding was provided this year. Thousands of people, both children and adults, are on waiting lists for these services. It is time we started the recruitment.

Decisions on where staff are allocated and where primary care centres are located must be transparent and objective based on health need and no other consideration. Primary care centres, just like schools, are essential public infrastructure and should be provided on the same basis. The programme for Government commits to extending free GP care to all in this Government's term. We know that fees stop people attending their GPs so they eventually need more expensive hospital care. Private fees for GPs are just 2% of national health spending but their removal unlocks the potential for major reforms. The lack of priority afforded to producing the free GP care legislation has been very disappointing. Allocated funding must be restored to start this key initiative this year. We must also have a clear roadmap that charts the way forward and ends the uncertainty about the future.

These are just some of the questions that need to be resolved. Are we going to reform and strengthen our public health service or are we going to privatise large parts of it? How do we ensure access and equity in the health service? What model of universal health insurance best suits the situation here in Ireland? Should it be a commercial insurance model or a social insurance model?

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