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

Thank you a Cheann Comhairle. To ensure we start the Thirty-second Dáil in good form I wish to congratulate you, a Cheann Comhairle. This is my first opportunity to speak in the Thirty-second Dáil.

It should also be an opportunity for us to start off this new Dáil with a little honesty about where we are in terms of health, the funding of health, what we expect as a people and who should and should not pay. We should be genuinely honest about what we can deliver to the citizens.

Let us be honest: in the past five years we have had a situation where there were extraordinary promises. Of course the promises brought expectations and in all that time we have seen a failure to deliver. I have no wish to be repetitive but it is important to look back at the start of the Thirty-first Dáil in the context of the programme for Government and what was offered, promised and actually delivered. We had a situation where universal health insurance was the central plank on which our health policy would be funded. We found out some time later that the plan in itself had no funding projections or foresight and no thought was put into it in terms of how it would actually deliver universality.

Universality is something most people aspire to in this context. Certainly, we have not wish to see people being put on waiting lists based on the fact that they do not have private health insurance or because our public health system simply cannot cope with the demand that exists. Our offering in this House should be to strive towards a situation where our public health system can cater for and deal with the capacity issues that are currently blighting it. Of course that is not what has happened in the past five years. We had an obsession with putting forward proposals for funding health care that were either unsustainable or not implementable or practical, i.e. universal health insurance. The obsession in this country with structures as opposed to the delivery of services is something we have to move on from. There was a certain mindset in place. Governments and political parties had an obsession with structures rather than dealing with the real issues on a daily basis.

Whether I liked it or otherwise, in 2003 the Brennan report recommended that there would be a unitary public health system. The Brennan report stated that there should be one national public health system. The HSE was set up on foot of the fact that we had a number of health boards through the country. There was a lack of uniformity in terms of policy formulation, accountability and delivery of services. The Brennan report recommended that there would be a unitary organisation to deliver health care in a uniform way throughout the country without fear or favour or political interference. Of course, we have not had that since then. We have had the HSE, which had an independent board and was to be able to bring in its own expertise. However, it was then subsumed in the last election by the previous Minister for Health, Mr. Reilly.

He got rid of the board and started to bring the executive back under the umbrella of the Department of Health. I do not mind which way we want to go in terms of accountability, whether it is to the Minister and then the HSE or that the HSE would have an independent board. It is critical that there be a unitary public health system committed to delivering health care for people who need it.

Of course, there is also private health insurance. There is a perception that those with private health insurance are somehow luxury yacht owners in far-flung parts of the world. These are ordinary hard-working people, by and large, who take out private health insurance. They do so not necessarily out of any patriotic duty in trying to lighten the burden of the public health system but rather fear and concern for themselves and their family that they will not be able to access diagnostic services or care in the event of a difficulty. The majority of our private health insurance policyholders are ordinary, hard-working families that have taken a decision to do so in the belief that in doing so, they have a reasonable chance of accessing diagnostic services and care. That is of course the failure of the public health system. There is no confidence among people that if something happens, particularly with elective procedures, there will be access to diagnostic services and treatments in a timely fashion.

That brings me to what we should do. Many of the policy decisions made by the Minister and his predecessor did not help. For example, we had many debates in the House about free GP care for those who are under six. Of course, giving free GP care to people should be something to aspire to in here. The difficulty is that when the Minister is rationing health services and there are insufficient budgets to underpin those health services, we have waiting lists and major numbers of elderly people waiting for home care packages. They are scratching around, trying to beg an extra hour of home help here and there from the public health nurse. Choices must be made. We have a limited and defined budget and into that the Minister is trying to fit elements that he thought would be to his and his party's electoral advantage. As it stands, our GP services are meant to be keeping people with chronic illness out of hospital by catering for them in the primary care setting. At the same time, the Government has not enhanced the capacity of primary care but has undermined the structure of GP services and supports. The free GP care for those under six has been put into the mix without expanding the capacity.

This only leads to one result, which is more people being referred to hospitals. The evidence is there already. The figures for our accident and emergency departments have increased 6.9% this year alone. It is quite obvious that the pressure on our GP services is causing those difficulties. One does not have to be a GP or any form of medical professional to see it day in and day out when visiting surgeries or speaking to GPs. People cannot get same day appointments with a family doctor and must wait a day or two. That was never the traditional case in this country and a GP would always have been able to see a patient on the same day if a case was deemed urgent. People are now waiting and appointments are not taken on the same day. There is a lack of capacity in the GP service and primary care setting, with only one place for a patient to go, which is accident and emergency units throughout the country.

Policy development has been based primarily on electoral gain. Of course, it would have been very suitable for us to criticise the Government when it proposed free GP care, not only for those under six but for those under 12, under 18 and everybody else. We in the House must be honest. It is simply not sustainable consistently to pretend that the health budget delivered by the Government in the Dáil can bring all the services promised by the Government. It has never done so in the five years since Fine Gael and the Labour Party took office. The budgets have been disingenuous and, one could say, dishonest. Time and again, the Minister and his predecessor came into the House in that way. That is why we must get away from the nonsense of producing Estimates and knowing full well that they have no capacity to deliver the services outlined in the service delivery plan.

In 2014, savings were identified from cutting discretionary medical cards and €113 million was identified in probity, but there was a deficit of €666 million before we started the year. We must be honest with ourselves when we talk about Dáil reform and how we will conduct business differently in the context of a new Dáil. However, we certainly have to address how we will project the HSE budget in the context of the following year. We cannot have a situation where the Minister states that he or she is standing up to the Minister for Finance and is making a hard case for health while at the same time the HSE, which is charged with delivering public health care, says in briefings that it has no way of delivering the health care expected by the Minister and the Government because of budgetary constraints. We need to have an honest, open and accountable budgetary process in this House to provide funding.

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