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

I congratulate the Minister and the Minister of State, Deputy Finian McGrath, and wish them success with their portfolios.

Fianna Fáil supports this motion because we believe we need a discussion at both parliamentary and societal level about how we should fund health care in the years ahead. We talk about universality and access to health care as a right and entitlement but we must acknowledge that the State's capacity to fund that creates difficulties in regard to achieving that goal and ambition.

Previously, rather than talk about the delivery of health care, we have talked about structural reforms. Our constant obsession with structural reforms, without knowing clearly and definitively what direction we intend to go, has undermined confidence and morale among those who provide health care services across the country and has sapped the ability of the organisation meant to deliver health care. If we are committed to a public health service, we need a public service that can deliver health care. Fianna Fáil is committed to a national public health system. Currently, the HSE has responsibility for delivering health care and while there have been many challenges in regard to its ability to manage and deliver health care, we must acknowledge that even if we change the name or structure, we will still require a national organisation to deliver health care. I hope that following the discussions and deliberations of this committee, we will be able to come to a political arrangement as to what direction we intend to go in terms of delivery of health care. I hope that once we have reached that consensus, regardless of political outcomes after general elections, there will be a single pathway towards our goal.

We must acknowledge the huge demographic pressures beginning to build in this country. I do not believe we are adequately prepared for these. The demographics show there will be a major increase in the number of people over 65, 75 and 85 in the next ten to 15 years. We must put clear strategies in place now to ensure we have the capacity, both in terms of physical infrastructure and clinical delivery, to cope with this in the years ahead. To date, we have been unable to consider how to put these structures in place. We talk about the issues but we have been unable to deliver. Take for example our deliberations on primary care. We have had a primary care strategy for more than ten years but as far back as 1988, when then Minister, Rory O'Hanlon, took on the health portfolio, he spoke about five key principles in the delivery of health care. The overriding import of what he said then was the importance of primary care. We have travelled a long way since then in terms of time but our primary and community care structures are not fit for purpose in terms of the delivery of modern, 21st century health care, medical and clinical outcomes. We must accept that is the case.

I welcome the fact the committee will discuss a ten year strategy and blueprint for how we will deliver health care. This is an ambitious undertaking as we have provided just a six month timeframe to meet all the stakeholders and come up with an interim report on the direction. The issue of how we will fund our health care service in the future will certainly arise. Currently, half of our population has private health care. Private health care and people who take out private health insurance make a significant contribution in the sense that they lighten the obligation of the State in regard to providing health care. Without private health insurance, if those now willing to pay for health care were all dependent on the public health system as it stands, the system would collapse. We must be honest and acknowledge that the public health system as it stands does not have the capacity to deliver health care for all 4.6 million citizens.

We need to talk about a sustainable health service. We should remove ourselves from ideological debate on the type of health service the various political parties and individuals want and focus on developing a clear pathway to universal health access and ensuring funding is put in place to provide that. Currently, the State does not have the financial wherewithal to deliver on this immediately, so we need a stepping stone process. Take for example the roll-out of free GP care. We debated this issue on many occasions in the previous Dáil. I am not opposed to the concept of universal, free access to GPs. However, we are going about it the wrong way if we prioritise one cohort over another and disadvantage those who most need health care in the stepping stone process towards that. The rolling-out of free GP access should be based first on those in greatest need and means tested to the point where by some stage in the future, everybody will have free access to GP services.

In talking about the capacity of primary care, we cannot expect a service to provide the best clinical outcomes when it is completely overwhelmed and incapable of delivering the care we wish to ensure. We have talked about moving the focus from the acute hospital setting to primary and community care but at the same time, we have not bolstered the capacity of personnel and infrastructure in these areas to ensure we have proper primary and community care services that will lighten the burden on acute hospitals. Day in, day out people are referred by GPs to acute hospitals throughout the State because they cannot access diagnostics in the normal course of events. People are consistently referred to emergency departments for X-rays, radiography services and other diagnostics. There must be another way to access diagnostics rather than through the acute hospital setting.

We have talked about the grand plans of hospital groups and this Government has focused on hospital trusts, something we have major concerns about. However, the practical changes we could make over the next number of months, which should not be too costly, could make a huge difference in regard to the capacity of the acute hospitals to deal with the issues they should be dealing with and the capacity of the primary and community care units to deal with issues they should be dealing with.

I hope the committee will not get caught up on addressing a strategy that has a ten-year outlook without first acknowledging that, in the meantime, we could make key structural changes, such as access to GP services for diagnostics without referral through the emergency departments. We should enhance the services as this is the best way to deliver health care in the years ahead.

I have been thinking about the fiscal rules for some time. A focus on preventative care will require front-loaded investment but there are fiscal rules relating to budget deficits and I believe there should be some discussion with the European Union with a view to showing that by front-loading investment in preventative medicine we will produce cost savings in the years thereafter. Within the strict budgetary parameters it will be difficult for any state to invest in preventative care without running huge surpluses. With investment in education programmes about lifestyle changes to address areas such as diabetes, obesity, cardiac problems, COPD and many others, we can create huge savings, both financially and in human terms, in the coming years. We have to look at this if we want to strategically invest in a preventative health care programme. We have spoken about health and well-being as constituting the new emphasis of how we deliver health care. In this context preventative medicine, while it comes with a front-loaded cost, does create potential savings.

Mental health has been described as the "Cinderella" of our health services for many years. We have to be honest with ourselves and question how much of A Vision for Change has been achieved. We have to admit that we have not grasped the issue of mental health and well-being in society in any serious or meaningful way. There are significant challenges in the area and the committee should also focus on them.

The other key area where society and policy makers have failed in the past few years is disability, especially in the case of getting people with disabilities into the workplace. Even during the Celtic tiger era when we had 4% unemployment we failed to move these people into the workplace.

See this speech in context