Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank the Ceann Comhairle for the opportunity to address the House on the budget and 2015 health Estimates. For the past seven years we have come into the Dáil on this day to debate the latest round of tax increases, pay cuts and cuts to public services. Today is very different. We have, for the first time since 2008, a budget that contains income tax reductions and more money for public services and investment in infrastructure. As a result of this budget, there will be more jobs, teachers, housing, investment and money for public services and welfare.

In January, people will see more take home pay in their pay slips and families will benefit from an increase in child benefit, but this is not a giveaway budget. Rather, it is a prudent one designed to secure the recovery. We have learned from the mistakes of other Governments and will not repeat them. The deficit target we are aiming for is 2.7% of GDP which is below the EU limit of 3%, and the measures in this budget will allow our national debt to be reduced next year, as a proportion of GDP. We do not find ourselves in this position by accident. We are here because of the sacrifices made by the Irish people and the tough decisions made by the Government, opposed by many on the Opposition benches, but which have now proven to be correct.

My first priority on coming into office as Minister for Health was to achieve a realistic budget for the health sector in 2015. I am pleased to announce that the Government is asking the Oireachtas to allocate additional Exchequer funding of €305 million for the health service in 2015. The gross budget for the health service for 2015 is €13.079 billion. This is equivalent to an increase of €305 million compared to the 2014 allocation of €12.774 million. When people examine the figures it is important that they bear in mind that €530 million was transferred from the Department of Health to the Department of Children and Youth Affairs last year. That has to be factored into any calculations which some people missed. There is a transfer of €530 million from the HSE to Tusla.

In addition, once-off revenue measures amounting to some €330 million have been identified which will support expenditure in 2015. Savings of €130 million have been identified in procurement, the cost of medicines and the cost of agency staff. These measures combined will allow us to develop a HSE service plan with in excess of €750 million more to spend on services than we had this time last year. It is, of course, correct to point out that this does not take account of service overruns of about €500 million this year, which will recur next year. However, no matter how one calculates it, it is an increase in funding for health services which will be reflected in the service plan.

Crucially, it will allow also us to progress commitments under the programme for Government in 2015, but we are not awash with cash. We still face major cost pressures arising from a rising population, more older people, more people being diagnosed with cancer and chronic diseases and new expensive medicines and treatments. The additional funding secured will ease the pressure on the health service and will allow it to provide safe services. However, next year will remain extremely challenging from a budgetary point of view and it is important that we continue with an unrelenting focus on cost containment and cost avoidance.

Most important, as our spending ceiling is now rising again any and all savings and efficiencies identified and achieved will be available to reinvest in improving health services. There is no longer a requirement to make savings to reduce the general Government deficit or pay down the debt. Savings will be made, but the money will remain within the system and will be reinvested efficiently. That is a key message I want all health service staff and managers to hear and understand. I am grateful to the Minister, Deputy Noonan, and the Minister, Deputy Howlin, both former Ministers for Health, for their support and understanding of the challenges we face in trying to deliver the kind of health services we want for the 21st century.

The funding in 2015 will be used to provide effective, safe, high quality personal and health services. The level of health services to be delivered within the available funding will be set out in the HSE service plan which will be published in three weeks or so. I am pleased to confirm that there will be no changes to hospital or prescription charges next year. The monthly DPS threshold remains unchanged and there will be no adjustments to income thresholds for eligibility for medical or GP visit cards. The health service will continue to deliver on important programme for Government measures with the allocation of a further €35 million for mental health services and the funding necessary to commence the first phase of universal GP services for children under 6 years of age and adults over 70 years of age. I am confident that it will be possible to come to an agreement with the Irish Medical Organisation soon. Nobody wants to see the money provided for primary care being sucked back into hospital services if there is no agreement, and we cannot allow that to happen.

Some 240,000 children aged 6 years and under and 10,000 senior citizens who do not currently have a GP visit card will benefit. At the end of the process 49% of the population will have access to a GP without having to pay fees, which is the highest level ever and a major step on the way to universal health care.

The budget provides an additional €35 million which is ring-fenced for mental health, bringing to €125 million the total investment by the Government in mental health in line with A Vision for Change.The Minister of State, Deputy Lynch, will speak about this in more detail in her contribution.

I am also pleased to announce the extension of the BreastCheck screening programme to women aged 65 to 69 years of age. It is expected that screening will be extended to this cohort by the end of 2015, with women aged 65 years being the first to receive an invitation. The age extension will be implemented on an incremental basis in line with the capacity of the system to manage the additional screening and follow-up workload. The number of women included in the age extension will be over 100,000. Breast cancer survival rates in Ireland have improved significantly in recent years through a combined approach of screening, symptomatic detection and improved treatment. I particularly want to acknowledge the contribution of Deputies and Senators on both sides of the Houses who campaigned on this issue. Their work impressed on us the importance of this matter.

There has been a continuing upward trend in delayed discharges since the beginning of the year, with 768 delayed discharges reported nationally as of last week. These are people who are well enough to leave hospital, but do not have a nursing home or home care package in place for them to do so. They are often elderly people and are citizens, not bed blockers. They should not be left in hospital, where they are at a higher risk of a fall or developing an infection. There will always be delayed discharges, but at its current level it is silting up the system resulting in more people on trollies and more people having elective admissions and surgery cancelled.

The HSE will take an integrated approach across the hospital and social care divisions to deal with this issue. It will involve a range of measures to provide an effective response, including the fair deal, short-term beds, home care packages and specific intensive packages for complex discharges. Funding will be targeted where the hospital and community services demonstrate that they can implement initiatives to address the specific needs of their delayed discharge patient profile in a way which will impact most positively on patient flow and, as a consequence, on waiting lists in scheduled and unscheduled care. Additional funding of €25 million is being provided for this.

Some €382 million is being provided for capital expenditure in 2015, compared to €390 million in 2014. The €8 million reduction relates to the fact that surplus assets have not occurred. More importantly, the capital budget for health will increase by €70 million from 2016 onwards, an increase of 18%, which will allow planning for more new primary care centres and community nursing units and new capital investments in the cancer facilities programme. It will also allow investments in ICT, where existing systems and the level of integration are not appropriate for a modern health service. The existing capital envelope already provides for the new children's hospital, new maternity hospital and the new Central Mental Hospital.

Although we have achieved a more realistic budget for the health sector in 2015, it remains a priority to focus on improving the way services are organised and delivered and to reduce costs in order to minimise any negative effect on service provision. The HSE service plan will make provision for the further development of hospital groups, among other things.

The budget was never about securing more money alone. When health spending peaked seven or eight years ago, under Fianna Fáil and the Green Party supported by Independents, waiting times were longer; there were more patients on trolleys and fewer people had medical cards. The health service needs more resources, but it is incorrect to argue or believe there is a direct correlation between resources and the quality of services. There is not. Much of it is down to best practice and good management, of which we need more. It is about being able to deliver meaningful change within a realistic budget. For that reason, I plan a robust efficiency and accountability framework to ensure resources are managed effectively.

It would be remiss of me not to mention the alternative budgets put forward by the main Opposition parties. The Fianna Fáil alternative budget provides only an extra €94 million for the health service, approximately €200 million less than what has been provided by the Government. It proposed only €10 million more for mental health services, as against the €35 million allocated by the Government. I have the documents which I can show to anyone who disputed these figures earlier or who has not read his or her party's policy document. Fianna Fáil, therefore, has no credibility when it comes to calling for more spending or resources for the health service. Between 2008 and 2011, it cut €1.5 billion from health spending, yet the Government has held health spending level for three years. Next year, if Fianna Fáil was in office, it would spend €200 million less. All of this information is contained in its document.

The Sinn Féin alternative budget is even harsher and has austerity written all over it for the health service. Sinn Féin proposes no increase in the Exchequer allocation for the health service, no provision for GP care for those over 70 years or children aged five and no mention at all of mental health. I have the document if Deputy Caoimhghín Ó Caoláin wishes to read it. For persons will private health insurance, Sinn Féin proposes that another €90 million be loaded on to their premiums - an extra €90 million of costs transferred from the public sector to the private health insurance sector and those who hold health insurance. The economy and the health service are safe with us. Under Fianna Fáil or Sinn Féin, they would be in jeopardy again.

I thank my colleagues in government who have been willing to support me, despite circumstances remaining difficult in their Departments. I pay a particular tribute to health care staff who have been through some very difficult years. It is due to their hard work and dedication that the health service has survived the most difficult period in its history. We still face many difficulties, but I hope matters will become a little more manageable next year. The Government is united in wanting to deliver a major change in health care. We are committed not just to spending and investing more but to using moneys more effectively in order that we have a health service that works for the benefit of all.

Yesterday the poet Robert Frost was quoted extensively in this Chamber. My favourite lines are from a poem he recited at the inauguration of John F. Kennedy in 1961. In "The Gift Outright" he spoke of his country "such as she was, such as she will become". With this budget, we have the opportunity to build on the recovery of the past three years and offer hope for a prosperous and healthy Ireland, "such as she was, such as she will become".

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