Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

This Bill follows almost exactly a year after the introduction of the Health Service Executive (Governance) Bill 2012 and is part of the Government's claimed programme of change in the public health services. When the HSE was first established, we in Sinn Féin claimed it represented bureaucratic change rather than real reform. It was not the replacement of the inequitable and inefficient two-tier system with a truly equitable and efficient universal system based on need alone, something which we certainly want to see in place. We stated last year that the Health Service Executive (Governance) Bill 2012 represented more bureaucratic change, perhaps delivering a more streamlined bureaucracy but nothing more. We stated that that Bill might increase accountability to, and the powers and responsibilities of, the Minister. However, we asked at the time whether this particular Minister and this particular Cabinet were worthy of such responsibilities, and whether it would make the Minister more accountable to the Dail and to the people. Sadly, the past year has demonstrated that we were correct in answering "No" to both questions.

We have seen the debacle over health funding in the budget and in the HSE service plan, and the inevitable Supplementary Estimates as a result of underfunding, year on year. We have seen the memorandum to the Cabinet from the HSE director, admitting the reality that the 2014 budget funding means it will be impossible to provide the necessary services over the course of the year. Of course, this memorandum was suppressed and changed to try to disguise the unsustainability of the cuts being imposed this year. It is essentially a technicality whether budget funding for health services is voted, as it has been up to now, in separate HSE and health Department Votes, or as it will be under this Bill, in one Vote. What matters is that there is sufficient funding and that such funding is used to best effect. On both counts this Government is failing like its predecessors. By the end of 2014, under the HSE service plan, almost €4 billion will have been taken out of our public health services since 2008. In terms of staff numbers, a further 2,600 whole-time equivalents are to go in 2014, on top of the 12,500 that have gone since 2007.

Under the recently published HSE divisional plans, hospitals are expected not only to function as last year, but to perform better with a reduction of €200 million in their budgets. Already struggling acute hospitals face an average reduction of 4% in their funding. Front-line care is being affected, even by the HSE's own admission, with a projected drop of 25,000 in the number of day cases and 3,000 in the number of inpatient treatments during 2014. An example of how unrealistic these plans are is the target to reduce the delayed discharge of patients from acute hospitals by 4%. We addressed this issue in the House earlier today. However, the allocation for nursing home beds has been reduced this year, which will mean many more older people will spend longer in scarce hospital beds because there are insufficient nursing home places for those requiring residential care.

This Bill, therefore, is essentially technical legislation as it provides for the ending of the HSE's separate Vote in the budget. In future, it is to be funded through the Vote for the office of the Minister for Health. We have no issue with that. In reality, it amounts to the same thing. However, in light of what I have pointed out regarding budget underfunding in 2013 and the resultant necessary Supplementary Estimates and the underfunding in 2014, section 10 is a cause for concern. It would mean that an overspend in any one year would be carried over to the following year as a charge on the HSE budget. Is it the case that this would mean no more Supplementary Estimates in the health area? Perhaps the Minister can address this when summing up on Second Stage.

As with the Health Service Executive (Governance) Bill, we are debating this Bill in a vacuum of knowledge as far as the Government's overall health reform plans are concerned. The promised White Paper on financing universal health insurance has still not been published, even though it was supposed to appear early in the life of this Government. The Government's document, Future Health, stated the White Paper would be published in 2013. It has been reported in the media in recent days that a draft of the White Paper is in the Minister's hands and that he will circulate that draft to the Government in the coming weeks. Can he confirm that? It has also been reported that the Government is planning to consult the public through a citizens' health assembly about its health insurance plans. Is that the case? Is it also the case, as reported, that the White Paper refers to universal health insurance being introduced by 2019? The programme for Government states: "A system of Universal Health Insurance ... will be introduced by 2016, with the legislative and organisational groundwork for the system complete within this Government’s term of office." Is that now being pushed beyond 2016, which is the crucial watershed of a general election?

It is long past time we had clarity on the Government's plans for health reform. From the quite detailed media reports we have seen this past week, it seems journalists have had access to the draft White Paper on universal health insurance.

If that is the case, it is disgraceful. It is the elected representatives of the people in this House, not journalistic recipients of leaks, who should receive that information in the first instance.

This is essentially a technical Bill, which may well be a piece in a jigsaw. If so, it remains a puzzle to me as I cannot yet see a picture. If the Minister has such a picture, it is long past time that he made it known to the Opposition spokespersons on health.

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