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

I welcome the opportunity to speak on the Bill. The consensual arrangement we had earlier in regard to the sunbeds legislation has to stop at this stage and we have to go into a more adversarial mode. I do that in the best interests of the need for us to have a very open debate on how we fund our health services in the years ahead.

Reference was made in the Minister's opening speech to universal health insurance, which is the Holy Grail of his policy in terms of how we are going to fund the health services in the years ahead. There has been an element of slippage with that commitment and, for example, the Minister is now talking about 2019 for the full implementation of universal health insurance, as envisaged by him. Our difficulty is that we are not actually sure what the Minister envisages because we are still waiting for the publication of the White Paper on universal health insurance. I know it is imminent because the Minister has informed the Dáil of that and the Taoiseach has also informed us it will be published in the very near future. However, because we are still waiting for it, we are speaking in the dark in terms of the funding model, whether that is a sustainable model and how we will fund the health services in the years ahead.

Our concern is that the Bill transfers substantial powers to the Minister of the day. I am obviously critical of the Minister of the day at present, and there will be other Ministers in the years ahead. I am not always critical, however, but on the funding of the health services I have been consistent because I look at the record and adjudicate in a fair manner. I believe that, to date, a strategic plan with regard to how we fund the health services has been lacking.

I am aware there is pressure on the public finances and the Minister is always trying to remind me, as if I need to be reminded, of why we are where we are. Of course, there is an inquiry to be set up in a non-biased way to assess that, but that is for another day. In the meantime, the obligation on the Minister for Health is to ensure there is a sustainable health service that is adequately funded and that can provide patients with the services they need in a safe environment. I do not believe that is in place at present.

One only has to listen to the reports today from Tullamore Hospital, where a large number of people are waiting on trolleys, trying to access the hospital, and it is in almost a crisis mode. I do not use such wording lightly from this side of the House. However, it is a fact the health service has huge pressure points. We are informed from time to time that there are seasonal factors, such as flu epidemics, adverse weather and so on, and this can have an impact and can build pressure points into the system, for various reasons. However, there is almost a consistency beginning to emanate in terms of pressure on our emergency departments and concerns about the fact that the recommendations of the Tallaght hospital report on overcrowding in emergency departments have not been fully rolled out across the country.

The point that will be made by the Minister is that this is what he is trying to resolve and that he is trying to take ownership from the HSE and bring it back into the Department under the auspices of the Minister of the day. However, I am not sure that will be beneficial to patients in the longer term. In my experience, while we all come in here with the best of intentions in terms of seeking a mandate from the public for our policies to be implemented, I believe the over-politicisation of our health services has had a corrosive effect on their delivery for many years. There has been an over-politicisation of the health services by every Government and every Opposition, which is, inherently, a difficulty we will further face if we go down his route of vesting further authority and more powers in the Minister of the day.

I have listened to and read many debates in this House over the years. I find that much of what is said is irrational in many ways. It is drummed up and what it advocates is not necessarily in the best interests of the patients but rather in the best interests of political parties and individuals. We must acknowledge this is clearly something that has had a damaging effect on the ability of the State to provide health services to the public.

The old health boards system was abolished in the context of developing the HSE in 2004. That was the first step in trying to bring forward a national health service that would have uniformity across the country, and that would provide and allocate resources based on what people needed in particular areas, as opposed to being based on the whims of politicians. When we have limited resources, it is clearly imperative that this money is provided for patients and the delivery of health care, as opposed to being provided for political purposes.

I have made accusations in the House before of pork barrel politics. It is not the first time that accusation has been made as it has been encountered many times across the floor of the House. However, I believe that when we actually vest all of this in one individual, it can have that impact, either intentionally or unintentionally. For example, on this matter the Bill states:

Insertion of sections 33A and 33B in Act of 2004

11. The Act of 2004 is amended by inserting the following sections after section 33:“Power of Minister to make grants to Executive 33A.

On and from 1 January 2015, the Minister shall, with the consent of the Minister for Public Expenditure and Reform [there are now two of them in it] out of moneys provided by the Oireachtas, make grants to the Executive.

Determination by Minister of capital funding and submission by Executive of capital plans

33B. (1) The Minister shall—

(a) subject to subsection (9) and with the consent of the Minister for Public Expenditure and Reform, in respect of each financial year of the Executive, determine the maximum amount of funding that the Minister will make available to the Executive in that year for capital expenditure, and

(b) notify the Executive in writing of that amount as soon as is practicable.

If we go down this road of allowing State funds to be distributed in a way that is not necessarily conducive to the delivery of health care itself it can happen in the context of Cabinet collegiality, for example, where Ministers may assist one another in terms of the provision of funding - in other words, I scratch your back and you scratch mine. There has already been evidence of this in terms of funding of hospitals located in the constituencies of certain ministerial colleagues. I am concerned that we could now have this corrosive element being brought back into our health services.

The suggestion is continually being made that the HSE and the Minister of the day would be a political puppet in the sense that there would be no real accountability to this House. The HSE has its own board of governance and is accountable to the Houses of the Oireachtas through the committee system but, at the end of the day, the Minister does not have full oversight of the HSE, which limits its accountability to this House. That is a valid point.

Certainly that is an area where amendments to the 2004 Act could have been made that would have obliged the HSE to report on a more regular basis. However, the committees had the authority to bring in the HSE. The HSE was obligated under the 2004 Act to explain decisions in the context of its budget, financial arrangements, management, planning and policy. All of those things were part and parcel of the Act. Perhaps Oireachtas committees and individual Members did not exercise that power to its fullest extent previously but there was certainly accountability in that form.

The Minister was at one remove and very often was the political figurehead but unable to decide the policy. One could argue about whether this was a good or bad thing. I have reservations about the Minister having absolute control over the health service for the reasons I have outlined today and on previous occasions in respect of decisions that are made without any clear reason as to why they were made. A Minister of State resigned because of the issue of favouritism towards constituencies. That is a fact. It actually happened in the context of a motion of no confidence in the Minister tabled by Fianna Fáil at the time. The Minister of State resigned on foot of the fact that she had such concerns about interference in a process that had been clearly established to identify and address a health need. Certainly, some health centres were expedited. We have tried, but we will never get to the bottom of it. I highlight this because it will happen again. There will be another Minister who may also have a tendency to decide things based on political reasons as opposed to absolute need in terms of health. That is why this Bill is of concern to us.

In respect of the broader issue of health and where we are regarding the provision of health care, the Minister says he has made reasonable efforts to address outpatient and inpatient waiting lists and the number of people on trolleys, that we are providing a reasonable service with €4 billion less and fewer staff and that everything is fine. However, everything is not fine because as late as last year, the Minister acknowledged that everything is far from fine when he tried to secure additional funding. At one stage, he told his Cabinet colleagues that he would be seeking almost €1 billion extra in the context of the budget deficit that was being carried forward and the requirement to provide an additional figure of over €600 million to maintain safe health services and guarantee patient safety. That is a fact. The Minister did not secure that funding so that is not being spent around the country this year but we already see evidence of difficulties in the provision of basic care through our emergency departments and in moving people from hospitals to step-down facilities and into community care settings. That is evidence.

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