Catherine Murphy (Kildare North, Independent) | Oireachtas source

I wish to share time with Deputy Joe Higgins. The reforms are intended to abolish the HSE budget and subsume it into the Department of Health budget. There will be a new financial governance model and a rule whereby if there is over-spending it will have to be rowed back in the next year. There are also new responsibilities for the director of the HSE. We know what the Bill is about but the question I am asking is whether this will solve the problem. Will this reconfigure it? How do we get the best value from the large amount of money that we spend on health services?

I do not dispute the value in there being one budget. In fact, it is useful to have some debate around the budget and it will be directly under the responsibility of the Parliament. However, I question whether it will achieve much in reality and I say as much for several reasons. Since the time the Health Service Executive was established I have been critical of the institutional arrangements and I believe these institutional arrangements are at the heart of the problem. Where there have been reforms I believe they have been rather superficial. The old health boards, more or less, still exist, the HSE is on top of them, there is a governance arrangement on top of it, in turn, and then there is the Minister. One need only look at the HSE website to see that there is chaos in the institutional arrangements. A look at any website tells us something about what is behind it. It is impossible to find telephone numbers on the site and generally it is very fragmented. It is guaranteed that when we see that pattern we will see duplication and confusion. It screams out to me that the institutional arrangements require significant amendment.

Within the HSE there are many good and dedicated people who are working hard and who feel rather put upon because of the constant criticism of the HSE, something these people all take to heart. They did not design the institutional arrangements. I do not believe it is only a matter of the financial arrangements. Addressing the financial arrangements will not solve the problem. It is a rather reactive approach. Having said that, I prefer to have oversight and those of us in the Dáil can have more direct oversight in respect of the shifting of those financial arrangements.

Clearly we need to get good value from the amount of money we expend on health care. Some of the points included in the service plan really jumped out at me. One particular example in the conclusions on page 7 states:

It will be very challenging in 2014 to fully meet all of the growing demands being placed on the health services. In particular, some service priorities and demographic pressures may not be met.

I always look for the reference to demographic pressures. Like the area the Minister represents, in my area the demographics have shifted remarkably. There has been a disproportionately young and growing population in recent decades. These are the areas that lose out because there is an opportunity cost. I wish to draw attention to one particular area to highlights this, that is, therapy posts for which the embargo was lifted. Approximately 220 new therapy staff were to be recruited. We looked at where they were to be spread throughout the country and above all two areas jumped out. One was Cork and the other was the area taking in Kildare, west Dublin and west Wicklow. In the latter area some 58 of the 220 posts were to be located. That really shone a light on the huge gap in services there. There was a guarantee that one year afterwards, all the people would be recruited but, according to the most recent information I have, they are still not all recruited. I asked about it early last year.

Let us suppose €20 million has been included in a budget for that recruitment but we do not recruit people until the tail end of the year. Then, the allocation is not being used for that purpose and the money will be reallocated elsewhere. Shifting the financial responsibility from the HSE to the Minister will not alter that. It may well give the Minister more scope to slow down the recruitment. Deputy Neville made a point about money allocated to mental health services that was not spent in the year for which it was allocated.

The Charter of Fundamental Rights is something we discussed as part of the Lisbon treaty referendum.

It states that everyone has the right of access to preventative health care and the right to benefit from medical treatment under the conditions established by national law and practices. It also states that a high level of human health protection shall be ensured in the definition and implementation of all union policies and activities.

When it comes to the enforcement of such rights, however, they almost have to be guaranteed by the courts. For example, Ireland would be fined by the EU if rivers were polluted and treatment plants were sub-standard. However, we do not seem to have guaranteed rights for minimum levels of health care. The HSE's governance arrangements will never produce an optimum result until they are fundamentally changed. Changing financial and budgetary arrangements will not alter a system that is fundamentally flawed and reactive.

It is a bit like a youngsters' football match. When their team is losing, the youngsters will run in, pull out the goalkeeper and blame that player for any goals that might result. Effectively, however, more than that is wrong in the health service. It is not just the financial measures that are wrong, the whole structure of the HSE is wrong. I do not see any vision to change that or any guarantee of a health system that will deliver what we signed up to as a country when people voted to include that element as part of the Charter of Fundamental Rights.

Health service delivery depends very much on what area of the country a person is living in. Three year olds may require speech and language therapy but if they are delayed for two years they will start school at a disadvantage and will continue to have that disadvantage right through primary school. Delaying expenditure on such services because of the way the budget must be structured in a given year does not save money in the longer term. There is a huge cost to individuals who are denied such services.

I would like to see a vision for the health services. We are told that a White Paper is on the way, which is really a Green Paper on how health services will be paid for. I do not see the broad vision or what might be described as an "NHS moment" for the Irish health care system. It is very much a piecemeal approach. I do not have an objection to having oversight on the budget but it will not make a fundamental difference unless the Minister deals with the institutional arrangements in a much more fundamental way.

See this speech in context