Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on the Bill. Discussion has taken place in the Seanad where we did not oppose the Bill on Second Stage. However, having read it and given what has occurred in the intervening period since the Seanad debate and the position in terms of the provision of health care, I have some concerns. There was an issue with budgets last year involving a failure to address a budget deficit early in the year. This allowed an escalation to occur to the point where there were cuts to the numbers of home help hours and personal needs assistants. There was then a reversal of some of these cuts. However, everything that flowed from this leads me to being concerned about bringing responsibility for the delivery of health care services back into the Department under the Minister. I have grave concerns for several reasons.

I accept that any Minister of Health and the Government have an obligation, a duty and a right to set policy and the broad framework for health care provision. However, I am concerned that there could be politicisation of the delivery of health care services. This is an issue of concern for several reasons. Every Member in the Chamber will advocate for his or her constituents and those in surrounding areas; that is his or her duty as a representative. However, let us consider cancer care services and the national cancer strategy. It received political support, but it was not political in its implementation. Strategic decisions were based on best advice, best practice and best clinical outcomes. There was strong opposition in the Chamber and among the Government parties that supported the policy. Ministers held strong views on the matter. However, responsibility for implementation of the policy was taken from the hands of politicians, something about which I have major concerns. Now, it appears we will politicise the delivery of health care services rather than the policy, something which could have a detrimental impact on health care provision. What will happen? On several occasions the Minister has stated it is his right and entitlement and he can argue the case, but whoever is sitting opposite will have extensive powers in deciding on health care provision, where services should be located and the funding of same. This is an issue is of concern in the context of the Bill.

The Minister has stated this is a transitional arrangement, which I accept. He has referred to the abolition of the HSE in 2014 and subsuming the service into the Department and to a system of universal health insurance flowing from this. He has spoken about hospital trusts to be established, to be underpinned by the small hospital framework and universal primary care access. However, we are two years into the life of the Government.

The basic foundation block is funding, which we have yet to put in place. There are many legislative changes being made to subsume the HSE into the Department of Health, but we are no clearer on how the process will be funded. After two years, we have still not seen the White Paper on universal health insurance. The Minister made commitments on the Dutch model, which was in his view the ideal arrangement to fund health care. A cursory look at the Dutch model reveals that it is under significant stress with significant funding issues beginning to emerge. We have seen a drop in the number of health insurers and a concomitant reduction in competition. Insurers are finding it difficult to fund and provide primary care. We are deciding to go headlong into the stacking of building blocks without having laid the foundation of funding. It is to put the cart before the horse. If we were to support the legislation, it would have to be on faith in respect of many of its provisions.

The Minister alludes always to his mandate. He has had a mandate for many things. He had a mandate to introduce universal health insurance and, equally, free universal primary care. He had a mandate to maintain Roscommon County Hospital and Our Lady's Hospital, Navan. He had a mandate to abolish the prescription charge. While the Minister has decided to row back on certain of his mandates, he is rushing headlong in respect of others without outlining how they are to be funded. Funding is clearly the issue in respect of which I have significant concerns.

The legislation gives the Minister sweeping powers. The director general will be subservient to him. While it is right and democratic that the director general should be accountable to the House, the Minister will have sweeping powers over the implementation of policy, which will be politicised. Many people are concerned about that. If we had politicised the cancer care strategy, parts of which the Minister opposed in Opposition and parts of which he welcomed, it would not have been brought to fruition. While people in Letterkenny and Sligo have concerns about it, it was implemented with political support and without political interference. The Bill is in direct contrast. Not only does it provide sweeping powers to the Minister to decide policy, it empowers him to dictate the implementation and delivery of health services.

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