Micheál Martin (Cork South Central, Fianna Fail) | Oireachtas source

I appreciate that, a Leas-Cheann Comhairle. I thank the Taoiseach. I submitted this question because I have been puzzled for quite a long time about the enormous gap between the reality on the ground regarding the implementation of the programme for Government and the actual programme itself. Nowhere is this more evident than in the "health and mental health" section of the "fairness" chapter of the programme for Government, which begins by saying "this Government is the first in the history of the State that is committed to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income". That was supposed to happen under this programme during the duration of this Government. The programme for Government continues:

This Government will introduce Universal Health Insurance with equal access to care for all. Under this system there will be no discrimination between patients on the grounds of income or insurance status. The two-tier system of unequal access to hospital care will end. The Universal Health Insurance system will be designed according to the European principle of social solidarity: access will be according to need and payment will be according to ability to pay.

It contains a promise that the Government "will act speedily to reduce costs in the delivery of both public and private health care and in the administration of the health care system". I am sure the Taoiseach is aware that the cost of private health care has soared in the past four years. The programme for Government also promises that "a Special Delivery Unit will be established in the Department of Health". That was set up but has now been run down. The programme also talks about "reducing waiting lists". We saw today's survey across Europe, which illustrates that public faith in statistics pertaining to waiting lists has collapsed. The programme for Government states that "a Patient Safety Authority, incorporating HIQA, will be established" but the Taoiseach has informed me that this will not happen now. The programme also states:

The Health Service Executive will cease to exist over time. Its functions will return to the Minister for Health and the Department of Health and Children; or be taken over by the Universal Health Insurance system. Staff will be deployed accordingly.

There is a whole page of commitments in the programme for Government with respect to primary care. In light of the promise that "Universal Primary Care will remove fees for GP care and will be introduced within this Government’s term of office", the entire population should be looking forward to the removal of fees before the Government's term of office comes to an end. This section of the programme continues:

The legislative basis for Universal Primary Care will be established under a Universal Primary Care Act. Universal Primary Care will be introduced in phases so that additional doctors, nurses and other primary care professionals can be recruited. During the term of this Government, GP training places will be increased. GPs will be encouraged to defer retirement and will be recruited from abroad, and the number of practice nurses will be increased [and so on] ..... Access to primary care without fees will be extended in the first year to claimants of free drugs under the Long-Term Illness scheme ..... Access to primary care without fees will be extended in the second year to claimants of free drugs under the High-Tech Drugs scheme at a cost of €15 million.

None of this has happened, of course. The Government has reversed its position in respect of the latter two promises. The section of the programme dealing with the proposed new GP contract provides that "under Universal Primary Care, GPs will be paid primarily by capitation".

A full page of the programme for Government deals with universal hospital care. It promises that "a system of Universal Health Insurance (UHI) will be introduced by 2016, with the legislative and organisational groundwork for the system complete within this Government's term of office". I will not go through all the issues because I know others want to contribute. This section of the programme states that "Exchequer funding for hospital care will go into a Hospital Insurance Fund which will subsidise or pay insurance premia" and that "The legislative basis for UHI will be established by the Universal Health Insurance Act."

The next page of the programme, which deals with hospitals, refers again to the hospital insurance fund. I went through all of these matters with the Taoiseach previously. This section of the programme states that "the Minister for Health will be responsible for hospitals policy" and suggests that insurers will "take over the running of hospitals" and "negotiate directly with hospitals to help control costs". The programme also speaks about the pathway to universal hospital care and the "legislative basis" for it.

The next page of the programme for Government, page 6, deals with care of older people and community care. It states:

Investment in the supply of more and better care for older people in the community and in residential settings will be a priority of this Government. Additional funding will be provided each year for the care of older people. This funding will go to more residential places, more home care packages and the delivery of more home help and other professional community care services. The Fair Deal system of financing nursing home care will be reviewed.

This page of the programme for Government also sets out the Government's plans for integrated care, cost control and health administration. The following page deals with capital developments in health and mental health. It promises to "review the Mental Health Act 2001" and "end the practice of placing children and adolescents in adult psychiatric wards". That has happened in some instances, although much of that work was done before this Government came into office.

In terms of bioethics, there was to be legislation on assisted human reproduction and stem cell research. I have written to the Taoiseach and asked him during Leaders' Questions about the Government's implementation in this regard. The bottom line is that little has been implemented. There comes a point at which the Government needs to be honest with the people and the Oireachtas. There is no point in printing an Alice in Wonderland-type programme for Government that will never see the light of day in terms of implementation. We have had reversal after reversal, breach of promise after breach of promise and a shambles of a scenario, as witnessed in today's damning indictment by the European survey.

I asked the Taoiseach about one line in the programme for Government relating to Cabinet confidentiality and read a couple of pages in a short section dealing with health. None of this has happened and there has been no attempt to make it happen. When the Minister, Deputy Varadkar, took over for the former Minister, Deputy Reilly, the current Minister stated that he would ditch much of this. The Taoiseach then took him to task and told him that he should not and could not ditch it. Will the Taoiseach confirm that none of this will happen before the Government's term comes to an end? The vast majority of commitments in health simply will not happen. It makes a mockery of the concept of a programme for Government. It is meaningless, and this is only one section. I could go through sections on education and so on, but the health section is a disgrace in terms of what it says will be done compared with what has actually happened and what the Government is doing. One need only consider the crisis in accident and emergency, the 800 people in beds who could not be discharged because of the lack of home care packages and the fact that this year's Estimate has reduced the number of beds in the fair deal scheme by 1,400 compared with 2013's figure. Some 1,400 fewer beds will be provided in 2015 than were provided in 2013 despite what the programme for Government says about more beds and more packages. The thing is a complete farce and the Taoiseach should acknowledge that.

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