Clare Daly (Dublin Fingal, Independent) | Oireachtas source

With limited time, we have to cut to the chase. If we want to deal with the problems in our health service, the starting point has to be the disbandment of the HSE. It is now very much part of the problem and not in any way part of the solution. As an organisation, it is absolutely irreformable. I do not say that lightly or flippantly. From its inception it was what Maev-Ann Wren described as a reform of health administration.

However, it did not get to the problem at the heart of our health service which is its two-tier nature. Rather than addressing that, the previous Government added to the problem by frog-marching everybody over the age of 35 into a system of private health insurance whether they liked it or not. It is not the best outcome and our citizens are paying the price. The two-tier nature of our system is at the heart of problems that see nearly 500,000 people, 10% of the population, waiting for various forms of treatment or assessment in the public hospital system. More than 10,000 sick children are waiting for an appointment in the public system.

We know the figures that 300 to 350 Irish patients die every year because of overcrowding in accident and emergency departments. That is not to mention the people who might die by committing suicide because their mental health issues were not addressed previously, the obese people and the people with heart problems and so on because of the lack of attention at primary care level. The only solution is a single-tier publicly funded public health system. It gives the best value for money and the best outcomes for patients. It is somewhat ironic that 68% of health spending on public health in Ireland is way below the OECD average of 72.7%.

That said, I believe a considerable amount of money in our system is wasted. It is not going to the front line. We are not prepared to pay our nurses, but we are prepared to pay over the odds for agencies. We are not prepared to provide public nursing home beds, but we are prepared to give away a fortune in tax breaks and handouts to private nursing homes.

We have walked away from proper services for our citizens, young and old, who are disabled. There has been an explosion in organisations providing support for citizens with disabilities - each with its own CEO, director of finance, etc., and the plethora of offices that goes with it, but the money is not going to the front line. The middlemen problem that has existed in Irish society is very much alive and well in our health services.

A recent Trinity College paper stated that disability services in Ireland paint a consistent picture of poor or non-existent implementation over several decades by voluntary and statutory bodies of the changes that are required. As a result, more than 900 HIQA inspections into residential disability services found that 93% did not comply with national standards.

I am sure the Minister is aware that in his constituency, as in mine, there is now an acute crisis in the provision of services for young people with disabilities, particularly young people with autism who are transitioning from a school environment into after-school services. There is nothing there for them. Almost 100 young people on the north side of Dublin who had been told they would get access to services such as those of Gheel, have now been told there are no places in that organisation for them. That was a high quality of care that has been downgraded into other lesser-quality care - praxis, which does not give as much hands-on training.

No parent now knows the facilities into which their young people will transition. As the Minister knows, autistic young people need routine and reassurance. Anything that falls apart in the system has a massive impact on them. It is just not good enough. We are spending a fortune on these organisations that are to the side of the HSE. They are not being checked and are not providing the services to the individuals who need them. They are costing society more without addressing the person at the heart of it and it will only get worse while this model remains.

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