Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

Sometimes in periods of uncertainty comes opportunity. I believe that is the case with the health service at the moment. The new Dáil arithmetic certainly brings us uncertainty but when it comes to the health service and bringing much-needed improvements, there are opportunities to do real and meaningful things that would improve the quality of life for so many people who are dependent on the health service.

For once, it appears the Executive will be answerable to the Dáil if it wants to get through a programme of work, which is a very healthy development. No one party will have control of Government decisions and no one ideology can dominate. We will have the prospect of cross-party, evidence-based policy making, which can only be good. Some will say this will only bring stalemate, but as far as the health service is concerned I believe it represents a golden opportunity to set it on a defined path where it can become a valued public service of which we can be proud.

Currently, there is stalemate in health policy. There have been three major upheavals in the health service since the turn of the century, with different Ministers bringing different approaches. Deputy Micheál Martin brought the HSE; Ms Mary Harney brought co-location; and Dr. James Reilly brought universal health insurance with competing insurers. Each new Minister brought a new plan.

None of these has worked to deliver the quality health service that each of the Ministers claimed at the time. This constant state of flux has led to a great deal of uncertainty in the health service, along with significant change fatigue among many of the health service’s leaders, both in medicine and in administration, as well as most notably among front-line staff. There is utter frustration that the political system has not been able to address these issues, and it seriously undermines attempts to attract key staff back home. One key reason staff will not come home from the United States, the UK or Australia is because of this constant state of flux and huge uncertainty as to what the future holds. Why would any health service staff come back to a dysfunctional system when they can get jobs abroad where they are valued and they know their role and the direction of travel of the health service in which they work? While pay is one element of it, certainty about the shape and future of the health service is also critical, as well as that sense of being valued and being a key player within it. This is very much missing from our health service.

It seems that with every turn of the political cycle, the health service just gets turned on its head again. This means constant churn in the health service which very much militates against good quality care delivery. At present, the health service has no political leadership. Senior health officials are operating in what is effectively a policy vacuum. That is where there is the potential for the Dáil to play a key role. The election result should force every Member and political party to come to an informed decision, once and for all, on exactly what path we should take to develop the health service and make it one of which we can be proud.

There is actually much on which we agree and it is important that becomes the starting point. We agree that, despite significant public and private funding, our health service does not compare well with most other developed countries. Taking into account all public and private health spending at approximately €19 billion each year, we are on a par with most other European countries in health spend, yet we get very little value for money and certainly little in access to quality services or equity within it.

We all agree significant investment in primary care is vital in order that the model of care can be radically changed. We also all agree that this is in the interests of better health outcomes for citizens and the sustainability of health funding. We agree public waiting times in almost all health sectors are unacceptably high. We agree that, as a country, we are far too dependent on medication, as well as paying far too much for it. We agree access to diagnostics has to be prioritised. We agree the main chronic disease management programmes should be prioritised and implemented as soon as possible. There is so much more.

Critically, a majority of Members favour a single-tier health service which would serve people on the basis of need rather than on the current model of ability to pay. Ironically, it looks like the party that will lead the minority Government is probably the only one which does not agree we should have a single-tier health service. That may have been the case at the time of the election five years ago when there was talk about a single-tier, insurance-based health service. However, I recall asking the current Minister before the recent election whether he agreed there should be a single-tier health service but he did not quite answer it. That is a critical question. Every other political party in the House agrees we should be working towards a single-tier health service. The issue then is what is the funding model on which we should work.

If there is broad agreement across the House that there should be a single-tier health service, we must examine the best funding model to achieve this. This is the single most important decision on which the political system needs to agree. I would cite the example of Britain where, after the Second World War, the political system came to a shared understanding of what the future shape of the health service should be. Both Labour and the Tories agreed the funding model should be based on central taxation. Accordingly, they agreed upon the National Health Service, NHS. There have been many ups and downs with the NHS but it remains a highly valued public service in Britain, a source of pride for its people, even celebrated when it hosted the 2012 Olympic Games. Can one imagine holding up a tricolour and saying the Health Service Executive makes one proud to be Irish? In Ireland, there is no such cross-party agreement in place. The experience with the last Government was that, while it came up with a radical plan, it did not cost it until the final year of its term.

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