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

We are here again - this time in June, rather than October - to discuss a Supplementary Estimate for the Department of Health and the HSE. We accepted in recent years that the accounting practices, the assessment of demand and the provision of the funding needed to meet that demand were under pressure because of the financial downturn. The budgeting system in the Department of Health and the HSE has been chaotic over the past five years. The only people who thought the health budgets that were being proposed were believable were the Ministers of the day and those who worked closely with them when they were presenting those budgets to the House. I suggest they were in denial. No one other than the Ministers and their senior officials in the Department of Health believed the budgets that were being presented. On several occasions, Mr. O'Brien of the HSE said publicly at Oireachtas committees that the budgets which had been provided were not sustainable for the delivery of the required services.

Those who talk about the new political dispensation have said there is a need to involve everybody in the compilation of a new health strategy. A committee is being established to consider the preparation of a ten-year plan. The Dáil and the existing health committee have a role in discussing the budgetary systems that are in place. I suggest the best thing to do would be to start with an honest debate about the type of health service we want, how much we are willing to pay for it and what we expect out of it. We have never had such a debate. People waltz around this place on a regular basis promising the creation of a free health care system. We could have a system that is free at the point of use, but there would be costs somewhere else. Who is going to access health care? Who is entitled to free health care? Who needs health care? These are fundamental issues that need to be discussed. Over the five-year term of the previous Government and indeed prior to that, this House consistently listened to spin and nonsense about sustainable health budgets and real investment in health services.

The bottom line is that we will be rationing health forever and a day. Any modern country in western Europe will always be rationing health. Somebody somewhere will be playing God with somebody's life when decisions are being made about where resources and funds should go and who should be prioritised. I will give a case in point. The Minister just said that free GP care for those under the age of six and over the age of 70 has been "successfully introduced". Of course that has been done. As a result of that scheme being "successfully" rolled out to people in those age groups, some of those between the ages of six and 70 are suffering. They cannot get the resources they desperately need because others have been prioritised. The successful roll-out of a scheme in one area can have profound implications for the lives of people in another cohort of the population or of society. When we talk about investment in health services, we must be clear that we are talking about prioritising one group over another group. We must acknowledge that in our public health system, accessibility is based on one's private health insurance or one's ability to pay, rather than one's clinical need.

Even though he supported the previous Government, the Minister, Deputy Harris, is in no way responsible for some of the policies that were pursued by that Government. The reality is that as soon as the then Government decided the same cost would be imposed on all private health insurance companies for public beds, it chose to prioritise the private patient over the public patient. Hospitals immediately saw this measure as something that could be used to raise revenue at a time when they were starved of resources and funding. Policies that were introduced during the previous Government's term prioritised the private patient over the public patient. It is still happening to this day. If two people are wheeled in, one of whom can pay and the other of whom cannot pay, of course the hospital will take the patient who can pay. We need to be very honest about what we want.

I wish the committee on the ten-year strategy well. Deputy Browne and I will be joined by one more Fianna Fáil Deputy on the committee. We will absolutely play our role. I want to make it clear that the committee faces a massive undertaking. This nation has spent 60 years trying to come up with a health strategy. We are still talking about coming up with a strategy. Fundamentally, I do not expect the committee to come up with a complete strategy for health care over the next ten years in just six months. We will need to have ideological debates on issues like how health care should be funded, who should be able to access health care, the role of private health care providers, the role of private health insurance and the obligations of the State. Such fundamental issues will need to be debated as we consider how to move towards a sustainable and affordable system of universality. Of course some people will have views on universality, which is a noble concept but comes at an inordinate cost and has significant implications.

We could throw an additional €3 billion or €4 billion into the health system this year. It is clear that the more one invests in health care, the better the outcomes should be. The funds being invested have to come from somewhere else, however. It is at that point that the competitiveness of the economy starts to be undermined. We are always trying to strike a balance and to ensure the decisions we make do not have profound implications somewhere else. Health care is always prioritised in that process. Over recent years, we have consistently pretended that we are always trying to look after the most vulnerable people in our society and ensure funding is directed at those who most need it. However, that has not been the case when numerous decisions have been made. Mental health service budgets have been raided on a continual basis. They have been pillaged year in, year out. At the same time, the Minister has come in here to say that medical cards or free GP cards have been successfully rolled out to people under the age of six. I do not believe this approach has been successful. It cannot be said to be successful if people who are suffering with mental health issues, or people who are waiting an inordinate length of time to access essential care, do not have all the resources they need available to them. One should not prioritise people for electoral purposes, but that is what the previous Government did. Nobody in this Dáil would argue that a healthy six year old has more entitlement to a free GP service than a nine year old child who is dying with leukaemia, but that is what has happened.

We have to be honest that, as a State, we are consistently rationing health care. We must prioritise the clinical needs of the individual over political expediency. We have been slow to admit it in recent times.

This particular Supplementary Estimate, which is €500 million, is essential and required because the budgetary proposition announced last October to fund health services was not sustainable. This was highlighted by the HSE's Mr. Tony O'Brien and accepted by most Members, except the former Minister who said it was the first realistic budget in several years. It was not a realistic budget, although there was an increase in the moneys required. However, all the needs assessments from the HSE's service plans identified the changing nature of medical provision due to demographic changes and that this was not a sustainable budget.

We have been talking about primary care since 1987 when the then Minister for Health, Dr. Rory O'Hanlon, spoke in this Chamber about the need to reconfigure our acute services and ensure primary care became the bulwark and the main mechanism for delivering health care. We are now in 2016 and still talking about it. We have done very little with primary care. We have opened buildings but have not opened people's minds to the concept of primary care being the major way of delivering health care. We need to actually turn our thoughts to how we deliver care. Home care packages, home helps, community nurse services and GP-led services have all been put under significant pressure in recent years. We wonder why a 92-year-old is lying on a trolley in hospital for three days when they should not have been there in the first place. They are not sick but elderly and dying. However, they are put in corridors and wards of our acute hospital services.

I hope the health strategy committee, first proposed by Deputy Shortall, can take the politics out of health. I hope it will allow us to be honest with ourselves as a society in what we value, what we prioritise and, more importantly, what we need to do to provide health care and how we are willing to pay for it. That will take a significant effort on everybody's part because of some strong ideological views people have on health care.

For the past several years, we have consistently pretended we are prioritising health care and the vulnerable when, in fact, the opposite is the case. This Supplementary Estimate is testimony of this again.

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