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

Missed opportunity after missed opportunity - that has been the reality of budget after budget for each of the past seven budgets and now we have yet another missed opportunity with budget 2015. It contains minimalist measures - tweaking here, tinkering there - yet, despite the Government’s efforts to sell the budget as a plus for those who have suffered so much during these years, there is a clear realisation among people, a sharp understanding, that they are going to be less well off and in even more straitened financial circumstances as and from January 2015, courtesy of the elephant in the room - the advent of water charges on top of the household tax. There is no getting away from this. That is what lies ahead in 2015 and no amount of Government spin will disguise that fact.

Health services have stumbled from one crisis to another for several years. They have been dealt blow after blow in a series of austerity budgets. They are management-heavy but front-line staff-light. The health budget has been cut year on year to an unsustainable level. A lack of funding has required a Supplementary Estimate each year and 2014 is no different. We are told that €13.1 billion will be the health budget in 2015. The Government suggests this represents an increase of €305 million. In reality, it is barely a neutral budget as in 2014 there is a projected overspend of €500 million and this sum and more will be required in 2015 to hold the current position.

The budget benefits the better-off, while it does nothing to improve the failing health service. In reality, the health service is being thrown a lifeline to help keep its head above water for another year, but it is not enough, as the Minister knows. It does nothing to address fundamental deficiencies in the health service. Furthermore, it does nothing to convince the population that the health policy of the Government is defendable. We have seen a backtracking on universal health insurance and all that was promised with it; it was an integral part of Fine Gael’s five point plan.

Once again, we are promised the roll-out of free GP coverage to the under-sixes and the over-70s, although this had already been promised for delivery this year. We are told by the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, about an unspecified number of additional staff in the mental health services, including psychologists and counsellors in primary care settings. An additional €25 million has been signalled to deal with delayed discharges from hospitals. Will more nursing staff be recruited? Will more beds, including step-down beds, be provided?

We have seen that a packet of cigarettes will cost an extra 40 cent after budget 2015. In addition, the price of a 25g pouch of roll-your-own tobacco will increase by a further 20 cent. However, nowhere are these measures presented from a health perspective.

At best, budget 2015 seeks to meet only the current cost of the existing configuration of health delivery systems, with an additional €305 million provided for health expenditure in 2015, coupled with a hope and a prayer that a further €330 million will be realised from speeded-up payments due. There is, as yet, no indication of any intent to recruit the much-needed additional front-line health staff, including consultants, NCHDs and nurses, nor any practical investment in emergency services, including additional ambulance and first responder staff. We welcome the Minister’s announcement that BreastCheck will be extended to women in the 65 to 69 year age group, but this will, I suspect, only commence in 2015 at best and take a number of years to complete a full roll-out.

There is no commitment to reduce, let alone do away with, prescription charges for medical card holders, a charge the Minister for Children and Youth Affairs, Deputy James Reilly, had previously railed against and promised to abolish.

Sinn Féin has laid out in its fully costed alternative budget measures showing how these gaps in services can be addressed. We had proposed increasing funding for disability services by €31.3 million for, among other things, the recruitment of community physiotherapists, speech and language therapists and occupational therapists and also putting in place an additional 1,000 nurse and midwife posts at a cost of €40 million. Sinn Féin had set aside an additional €18 million for suicide prevention and awareness measures and the roll-out of suicide crisis assessment nurses, counselling services in primary care and liaison nurses in accident and emergency departments. We had also recognised problems with ambulance response times, in rural areas in particular, and provided for increased emergency ambulance cover of two additional ambulances, including trained personnel in each of the four regions, at a cost of €6.67 million. We would also increase the budget for discretionary medical cards by €13 million.

We note that €35 million is to be ring-fenced for mental health services in budget 2015, but what about the €15 million shortfall in the current year? Surely this should be added to the 2015 commitment. The Oireachtas all-party group on mental health, of which I am a member, certainly believed it should and made it a key demand of its agreed all-party pre-budget submission. That said, we have seen in the past how ring-fenced funds can end up being swallowed up by the overall health budget, particularly so in the case of mental health services funding.

There is also the plan to recruit additional staff, including psychologists and counsellors, in primary care settings. Will the Minister, please, spell out exactly what is being committed to in this area?

We are told that free access to GP coverage will be extended to the under-sixes and the over-70s in 2015, but this was promised for delivery during the current year. We note that the Government promises this will happen "when negotiations conclude with the IMO". We need to see a clear timeline, given that the Government has already pushed back this commitment significantly. What about its roll-out across the rest of the population? What are the Minister’s plans for universal access to GP care free at the point of delivery?

The Government intends to spend €2.3 billion in prescription drugs in 2015. This is one of the areas in which real savings could be made, with improved efficiencies in prescribing. Has the Minister noted the proposals we have made in our alternative budget document? He suggests some knowledge, alleging that we have not included certain areas. Our proposals were based on the Minister for Finance, Deputy Michael Noonan's challenge, his premise, of a neutral budget, demonstrating what could be done without additional resources overall.

However, like his predecessor, Deputy Reilly, the Minister for Health, Deputy Varadkar, thinks he knows it all and heeds very little that the Opposition offers.

I am disappointed to note that the increased excise duty on cigarettes is viewed only as a revenue-generating measure. The Minister for Finance was salivating at the prospect of getting an additional €53 million from smokers. It would be better if such an increase led to a decrease in the level of smoking and not in an increased tax take. Regrettably, there is no mention of the illegal importation of tobacco products. In our alternative budget, we have provided for increased surveillance to ensure smuggling does not increase following an increase in excise duty on cigarettes. The black marketeers were likely dancing last evening at the prospect of more and more smokers being driven into their net.

Once again, there is no specific breakdown of the €3 billion for older people and disability services. It is not clear which part of this is new spending, if any. Will the Minister please advise? I note that nothing has been promised to target the increased waiting lists, including outpatient waiting lists that have been massaged by the HSE. There is also a great lack of specifics on preventative strategies in the sections relating to health. This is something we must invest in. The Government has decided against funding improved care for stroke patients, and there is little mention of health problems that will challenge our health service greatly in years to come, including obesity. This is something that will cost us in the long-term. Claims this week that childhood obesity has levelled out are premature in the extreme. I welcome the Government's suggestion that the recruitment embargo might be over. It remains to be seen whether more staff will actually be employed as a result. There is no clarity in the Minister's own contribution here this afternoon regarding this matter and there was very little detail in the contributions of the Ministers for Finance and Public Expenditure and Reform yesterday.

The Fine Gael-Labour Party Government is trying to sell this budget as something of a giveaway, but the vast majority of measures announced only go a little way towards reversing the deep cuts made earlier in the life of this Government and by the previous Government over the last seven austerity budgets. It is clear that the crisis in our health services is going to continue. We have a new face at the helm of the Department of Health, but the same old failed policies continue to hold sway. There has been much expectation with regard to the Minister taking up the reins at the Department of Health. I must say that there has been no substance whatsoever in either his utterances or, very particularly, his contribution to this budget. The Minister has not lived up to those expectations, and all we have heard is "It's not possible at this point in time," and "I can't do that at this moment in time." At the end of the day, we really do not know if the Minister represents anything other than what has been the case heretofore. The former Minister, Deputy Reilly, might as well be sitting there today. His contribution would have been no different from that of the current Minister. Cé go bhfuil an tAire Sláinte athraithe ní fheictear dom go bhfuil aon leigheas ag teacht ar ghalar chóras sláinte na hÉireann. Is mór an trua é sin.

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