Stephen Donnelly (Wicklow, Social Democrats) | Oireachtas source

I thank all the parties and Independent Deputies who have signed up to the motion before us. There is much concern about the fact that we have a minority Government, and those concerns may, in time, prove to be well-founded. While I hope they do not, they may. However, the minority situation also provides the Dáil with a voice it has not had before. It provides the Dáil with the opportunity to table motions and legislation and build cross-party coalitions for good ideas. While the Social Democrats initiated the motion before the House, it is a motion of the Dáil, supported by all parties and groups. Hopefully, through this cross-party approach, we can achieve some important breakthroughs in health care.

The motion calls for the establishment of a committee to examine four specific health care challenges, namely, the existing and forecast demand for health services; how to progress a model of health care that advocates the principles of prevention and early intervention, self-management and primary care services, and integrated care; the different funding models available, which I imagine the committee will spend much time on; and how best to reorient the health service from an acute-based system towards an integrated, primary and community care system.

The motion outlines “the need to establish a universal single tier service where patients are treated on the basis of health need rather than on ability to pay”. It is a very serious statement for the Dáil to make. It is a cross-party statement signed up to by all the Independent Deputies. It is a major departure from today's health care system and I very much welcome the fact that the statement has got such agreement in the House.

There is more that most, if not all, Members agree on. They agree that our health care system should provide a high quality, modern and timely service which should be provided as close to the patient as practicable. They agree our health care system should be cost-effective and should invest in prevention and early detection. They agree our health care system should protect people’s dignity, which our clinicians try to do every day but which, sadly, they are not always able to provide, for a variety of reasons. They agree that our health care system should be a rewarding and exciting place for clinicians and non-clinicians to work in and that it should be open to change, responsive to concerns and accountable for its work. I, and many Members of the House, would argue that this is not the case.

It is important to recognise some of the successes we have had in health care, including the great success and progress in paediatric leukaemia treatment during recent years. However, the system is struggling. International comparisons do not suggest Ireland does very well. For example, the European Health Consumer Index ranks us 21st out of 35 countries, which puts us close to the bottom of the middle group. The index also found that we have the longest waiting times for emergency care in Europe, which we must take very seriously. Today, nearly 300 people are on trolleys. In west Wicklow and Kildare, more than 1,800 people are awaiting speech and language assessments. The vast majority of these are children, and the waiting time is 18 months to two years. By the time some of those children receive care, much of the opportunity to provide help has been missed. Over the weekend, we heard the bone density scanners in Galway University Hospital have been shut down. We have two high-tech machines that had been running five days a week, and both have been mothballed due to lack of staff. We cannot allow this.

The Cappagh National Orthopaedic Hospital has seven operating theatres which used to operate every day and a surgeon in a given eight hour list could do approximately seven procedures. Two of the operating theatres have been closed indefinitely and another two have been closed for refurbishment with no understanding as to when they will re-open. Only three of the seven operating theatres of the Cappagh National Orthopaedic Hospital are being used. It is worse than that. A given orthopaedic surgeon takes one of the three operating theatres for a given day. The surgeons are being told they can have a theatre only every second or third Monday, for example, given that only three are available. They are also being told not to do as many procedures as they could. For example, rather than doing seven procedures, they are told to do only four, and then go home. The HSE will still pay the €22 million it costs to run the hospital, and will pay the surgeons, theatre teams and all the costs. The reason the surgeons must go home is that the only thing the HSE will not pay for is the implants.

We have a hospital, surgeons, technicians, operating theatres, wards, a car park and insurance. We are going to pay for all of these, but we will just not pay for implants. Therefore, rather than having seven operating theatres within which six or seven procedures could be carried out each day, we have three within which perhaps four procedures are performed each day at more or less the same cost. We paid €22 million for the hospital and some of the €1.5 million for implants. That is the what is happening in the hospital system. Consequently, those who can afford it can avail of private care. The waiting time to see a surgeon to whom I spoke recently was 18 months in the case of his public list but only six months in the case of his private list. Therefore, there is a two-tier system. There is health care for those who can afford it but not for those who cannot.

What is frustrating is that it is not due to a lack of funding. It is not that there is not enough money going into the HSE. We have the second highest expenditure ratio on health care in the OECD. We spend money, but we do not get the service we should for it. The issue is not clinicians. We have some of the best trained clinicians on earth, as well as some of the best doctors, nurses and surgeons. We have the second highest expenditure ratio on health care, yet we are effectively telling the National Orthopaedic Hospital to close more than half of its operating theatres, not to carry out as many procedures as possible on patients with deteriorating conditions which will result in their ending up in wheelchairs because we do not have the money for implants. That is what is happening on a daily basis.

There are many reasons for the low performance rate in the health system. There is a lack of local autonomy for hospitals and there is a poor level of accountability and transparency in the HSE. There is little econometric analysis to show where we need to provide health care. We do not have integrated ICT systems for the management of patient records. In many places we have silos rather than continuous and holistic care pathways. We have a deep culture of mistrust between clinicians and managerial staff across the health care system. It is corrosive. However, such a culture does not prevail in other countries in which I have worked. There is little access for patients to clinical quality data. Consequently, they do not know which hospitals are good and which are bad. Some are good and others not so good, but we are not allowed to know which is which. There are also poor working conditions for clinicians. The list goes on.

Each of these operational challenges is solvable, but they are not being solved. Why? It is because behind it all there is a lack of vision. We cannot achieve success in health care because we have not agreed what it is. We cannot give managers and clinicians the tools they need to succeed because we have not told them what we want them to do to succeed. We need a unified strategy for health care, but for that we need to know what it is to achieve and right now we do not know what that is. That is why the motion is important. It will bring together a cross-party group to which we can all bring political ideas, but I hope it will not be used as a political football. We can bring the group together to ask some of the following questions.

What are the health care services we need and where are they needed? How do we support prevention and early detection programmes? How can we move to an integrated primary care system? How much money are we willing to spend on health care, as we can spend as much as we want to spend on it? How will we raise the money? If we can make progress on these questions, we can put a long-term system in place with agreement on what it is we are trying to achieve, how we are trying to achieve it and, critically, how we will pay for it.

We need to be honest about some uncomfortable political truths which the committee will have to examine. One is that a modern health care system requires an increasing amount of money because it is becoming more sophisticated and people are living longer. Another is that a modern health care system is of a scale which makes it impossible for all services to be delivered everywhere throughout the country. We will have to have a serious conversation about that issue. Another truth is that some hospitals are simply better than others and that people have a right to know which are doing well and which are doing badly.

We need a vision for health care for which we need cross-party support. We must also learn to start trusting clinicians and managers in primary care centres, hospitals and hospital groups.

I wish whoever will serve on the committee well. They will face some very difficult technical and political issues. If the committee can succeed in bringing back to the House a vision for health care and real options in terms of how much it will cost and how we can fund it, we can start to move on and accept that if we are to spend more on health care than almost any other country, let us have the best health care system in the world for that money.

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