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

At this time of the year, we tend to discuss the annual service plan of the Health Service Executive. I am not filled with a great deal of confidence with what I saw in the overall plan for next year which was published recently. I do not believe that will be changed with the soon-to-be published divisional and sectoral plans. We could have a philosophical and ideological debate on how we construct society and our priorities in this regard. It is very evident, however, from the HSE’s recently published overall service plan that the Government’s priorities are elsewhere other than in the area of health.

I am concerned the ability of front-line health service providers and staff to provide care in a meaningful manner will be further eroded by this service plan. I am not saying that for the sake of it. This has been stated by many of the stakeholders in the health services, reiterated many times by front-line service providers, those at the coalface of health care delivery. It was also stated by Mr. O’Brien, director general of the HSE, at the launch of the 2015 service plan that there would not be sufficient funding in place next year to provide care in the key areas where there are significant pressures because of demographics. He cited pressures on the whole area of caring for the elderly through the fair deal programme and the nursing home support scheme. The other key area, inpatient and outpatient day cases, has an inordinate number of people waiting extraordinary lengths of time to see a consultant or be treated.

The figures and statistics are quite alarming. The Minister for Health, Deputy Varadkar, went to great pains when he was appointed to explain that, first and foremost, he wanted a sustainable budget built on sound foundations, one that was honest and upfront in how funding would be provided in the year ahead. However, he also admitted the Department of Health would need €200 million just to address demographic changes every year. When one drills down, examines the extra allocation of funding along with projected savings to be accrued and the other opaque measures for HSE funding, one questions whether its budget is sustainable at all. Whatever way one does the figures, the Minister will be down €85 million.

All of this stems from many factors but primarily from the Government’s priorities. It has decided, regardless of whether the Minister of State, Deputy Kathleen Lynch, likes it, to go after other key areas concerning the electorate. When we debate our priorities in society, it is evident the Government’s are not in keeping with what is needed in our society. Up to 2,100 people are waiting a minimum of 15 weeks to be approved for the nursing home support scheme. These are people who are vulnerable, old and sick and who are now looking to the State for support. Several weeks ago I pointed out how not just the waiting time for approval had increased but also the numbers waiting for approval. We went from four weeks with 500 people waiting in January to 2,100 waiting for 15 weeks this month.

Today, a woman from Blarney, County Cork, informed me she had to take her husband out of a nursing home because she could not afford the costs she would incur between now and approval time for a fair deal nursing home support scheme bed. At the same time, we have the Taoiseach, whenever a microphone is put before him and he is willing to answer a question, talking consistently about one issue only: tax cuts. Every Member accepts there are significant pressures on working families and any alleviation of the burden on them is welcome. The priorities must also focus, however, on reducing the level of tax back to people earning substantial sums of money and reorienting it towards those who need the support of the State.

Up to €35 million was to be ring-fenced every year for the funding of mental health services, the Minister of State’s responsibility. On numerous occasions, Members on all sides of the House have described mental health services as the Cinderella of the health services in that it does not get its fair share of funding and is consistently neglected. Commitments were made in the programme for Government to improve mental health services. Every year, the HSE’s service plan has provided for the rolling out of improved funding for mental health services. From the funding allocated for mental health services in the HSE’s 2015 service plan, it is quite evident that much work still has to be done to ensure adequate resources are put in place for the area. I know the Minister of State has answered numerous questions on this issue in the House and that she has made the clarion call for progress to be made in this area. While I accept there has been an element of progress, judging it against the commitments the Government said it would honour, however, it is still very shy in increased recruitment and the adequate provision of funding for next year due to the shortfall this year. Year on year, the mental health services budget is in deficit, which creates significant pressure on community services to deliver care for those with mental illnesses. This is not just said on the Opposition side of the House. Issues have been raised by advocates and stakeholders involved in the provision of care in mental health services, yet the Government consistently ignores the pleas from those who see overloaded, overburdened and inadequate services to deal with the mental health crisis in our communities.

Free GP care is another central plank of the Government’s health policy. The programme for Government stated there would be free GP care available to everyone by the end of 2016. We are 16 months shy of the Government’s full term but no nearer to that commitment being honoured, other than the fact that the Minister for Health said he is in negotiations with the Irish Medical Organisation and hopes to have agreement some time on the framework for the roll-out of free GP care for those under six and the over-70s. However, there is the continued culling of medical cards for the over-70s. I remember the Taoiseach, when leader of Fine Gael in opposition, and the former Tánaiste, when leader of the Labour Party in opposition, on Kildare Street shouting shame on the then Fianna Fáil Government for attempting to reduce the number of medical cards for older people, exploiting anger and concerns among those affected. What has happened consistently since is that more medical cards have been taken off people. Not only that, the terms for qualification have been made so strenuous and onerous that the cut-off income point for a retired couple is now €900 gross a week.

It comes back to priorities. The fuel allowance, telephone allowance and other home packages, which were seen as de facto entitlements for older people, have been stripped away slowly but surely. I know Government party Deputies will tread carefully in their criticisms during these kinds of debates.

Reading between the lines, they can see the Government has reneged on commitments it made to the electorate prior to the last election to ensure adequate services for older people. In this regard I highlight the nursing homes support scheme, medical cards, household packages, fuel allowance, bereavement grants and so on. All of these things have been taken away slowly and by stealth so that people do not notice for some time. The Government uses spin and PR to cover its tracks on a U-turn of mammoth proportions on commitments for older people.

The details of the plan highlight many other deficiencies. More than 50,000 people are now waiting as inpatient day cases and over 200 consultant posts are vacant. Some 380,000 people are waiting to see a consultant through an outpatient appointment, and all of this means there has been an increasing backlog in the system in the past number of months. Mr. O'Brien, the director general of the HSE, stated this on the day of the launch.

The contents of this motion are simple and cannot be refuted, though the Government will obviously table an amendment and vote down the stated fact that the health service is under-funded. The 2015 Health Service Executive national plan is not sufficient to fully address increasing demands and demographic pressures that are being placed on the hospital system. The key targets in the plan are regarded as unrealistic by its authors, the Minister, the Department of Health and the HSE. Those who drafted the plan have stated that it will not achieve its targets as some of them are unrealistic. This motion is intended to highlight hypocrisy and, more important, the pain the HSE service plan will cause to ordinary people throughout the country due to the lack of priorities. The plan fails to emphasise key areas.

There has been a U-turn on discretionary medical cards, but issues persist every day. A recent blog post by a parent highlighted the disgraceful way his son was treated when it came to a discretionary medical card. The card was granted to the child and then taken away. I raised this matter with the Minister, Deputy Varadkar, in an interview last week. There is a pretence that all is now well with the primary care reimbursement scheme and the manner in which people are assessed and their concerns addressed. Spin and PR were used the other day to blame doctors for failing to issue cards. All of this is an effort to camouflage the obvious: the policies pursued by this Government on discretionary medical cards were disgraceful and distasteful, to say the least. For over two years, this side of the House has consistently highlighted the problem in a non-alarmist, matter-of-fact way through Private Members' motions and on Leaders' Questions. A perusal of parliamentary questions will show that this is a major problem in society. We will have to wait and see whether it has been addressed, but the signs are not encouraging. As late as last week we saw cases in which people with major challenges and illnesses had discretionary medical cards withdrawn. As I said, the problem was recently publicised by the parent of a child.

I have addressed waiting lists and the HSE service plan as it relates to the nursing homes support scheme. I will now address the broad issues in Government health policy. Universal health insurance was a key point in the five-point plan. At the moment a Minister is being applauded and feted as honest for performing a U-turn on one of the central planks of Government policy, as stated in the programme for Government. I am referring to the abolition of the HSE and the establishment of trusts, followed by a move towards a money-follows-the-patient model that leads, ultimately, to universal health insurance. The Taoiseach launched the White Paper on universal health insurance but, at the same time, the Department of Health advised anyone who would listen at a political level that universal health insurance was unworkable. The Department said it would involve the setting up of too many organisations and quangos and would not provide the level of care we were led to believe it would. Universal health care was not costed at that stage and it still has not been costed - we are still waiting to know what the universal health insurance model will cost taxpayers.

The former Minister for Health, Deputy Reilly, was fixated on the Dutch model of health care, but this was on a wing and a prayer because costings were not done. If one reads reports published by eminent authors on the cost of the Dutch model, one learns that the universal health insurance model pursued by Deputy Reilly would cost the average family €12,000 per year. The Government is still stated to be pursuing this policy, though the Minister, Deputy Varadkar, says he has abandoned it. The figure of €12,000 is reached by combining what a family would pay in general taxation with the fee for compulsory health insurance. The reports are widely available. According to one of the authors, Michael van den Berg, the figure of €12,000 figure relates to gross income and includes premiums and taxes but not out-of-pocket expenses and payments. If the latter costs - for dental care, over-the-counter medicines and so on - are included, the total figure is higher, including €6,000 for health insurance premiums and more than €5,000 for exceptional medical expenses.

It is clear that no thought went into this proposal for universal health care, which was proffered as a panacea and a utopian model to address all health service concerns. One thing is for sure in December 2014: we are pretending our health budget will address the huge challenges facing people in need of services in 2015. This pretence goes on year in, year out. There is a potential budget deficit of over €500 million in 2014, and this will be carried into 2015, so the Minister of State will start off at minus €85 million. Regardless of spin, palaver and pronouncements, I have little hope that the health service will deliver in the key areas that we know face major problems. We know this already because of demographic changes and the fact that the number of people over 80 years of age is growing at 4% per annum. These statistics are available for all to see, but the Government continues to prioritise other areas rather than putting money where it is most needed. Any fair and rational assessment would show that older people deserve the support of the State after all the years they have served it. People with profound physical and intellectual disabilities should be supported and so should those who are dependent on mental health services. People who should be entitled to access health care with a discretionary medical card are being denied this facility as we speak. The aim of this motion is to highlight all of these issues.

I hope that in the context of this debate people will have the honesty to say what they are experiencing with regard to the difficulties facing people, including front-line staff, representatives of front-line staff and those who are at the coalface on a daily basis. I ask that the Government listen to their pleadings and the pleadings of people who are dependent on the health service but get insufficient support.

For all these reasons I commend the motion to the House. I hope we have a robust and honest debate on the matter in which we can at least point to a different and fairer way of ensuring people have access to services when they most need them.

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