Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

Despite all of the marketing language of the budget for the health services, against the backdrop of the Supplementary Estimates for the past several years, there are serious problems not only for this year but for the years ahead. The position for acute hospital groups into the future is particularly challenging. The plans for hospital trusts in the programme for Government raise serious concerns. What we see there is not a blueprint for a public health system but a private health business. The programme for Government concerns us as a charter for privatisation of our health services, putting them further out of the reach of the people who need them the most. It is undeniable our public health system continues to suffer acute and chronic underfunding.

The annual deficits run up across the system every year, alongside lengthening waiting lists and numbers of patients on trolleys. These are a testament to the failure of successive governments to allocate adequate funds. Not only that, but it is a testament to how we have failed to develop a long-term vision for our health services.

I very much welcome the newly constituted committee. I want to record once again my appreciation to Deputy Róisín Shortall for proposing it. We will, of course, participate in this committee. We will be constructive and solutions-focused, as we always are. The fact is that we must become better stewards of our health spending. This is not about pursuing efficiencies in order to facilitate cuts to the overall health budget. Rather, it is about ensuring we deliver the best care possible from the funds available.

While I will touch on some of the specifics of the Estimates and the ministerial announcements made in the past week, I would like to take this opportunity to touch briefly on two areas where I believe there must be greater emphasis in terms of health spending. The first is reducing reliance on agency staff and the second is reining in the pharmaceutical bill. In the first instance, we all know that a moratorium on recruitment across all areas of the public sector was introduced in March 2009. Many Deputies may not be aware that the moratorium in the health service was, in fact, brought in years previously, in 2007, and it created a health system propped up by agency staff. We need to ensure that the HSE reduces reliance on expensive agency staff and makes permanent posts more attractive for qualified applicants.

The current approach is clearly costing us dearly, not alone financially. In financial terms, however, in the period from January to May, over €68 million was spent on agency staff, which amounts to 2,378 whole-time equivalents. If progress is being made on this, what progress has been made to date in the conversion of agency staff posts to permanent positions? How many posts have been converted in the last six, 12 and 18 months? What are the approximate savings to the Exchequer through converting these positions? The Minister has already agreed with me that agency staff do not represent good value for money, although we cannot deny they do very valuable work. We need to see exactly what the Minister is doing about this.

The second issue is one that has been topical in recent weeks and one which I believe will become more prevalent in the future. The undeniable fact is that the Irish taxpayer is still paying too much for on-patent medicines by international standards and, importantly, our system still uses far too much of them. On-patent drugs account for 78% of the State’s public health drug budget. It is clear the State health service has a limited and finite budget, and this will always be the case. Therefore, it is important that issues of cost effectiveness and value for money are considered.

Sinn Féin does not accept that these two policy objectives are mutually exclusive. We have proposed a range of measures in our "Better 4 Health" policy document that would address the serial impasses in regard to access to new medicines. The Minister, the Department of Health, the HSE and the pharmaceutical industry all have clear responsibilities in this regard. Indeed, the European Commission, on page 74 of the Commission working document that is part of the country-specific recommendations process, noted:

For medicines no longer patent-protected but which fall outside the system of interchangeable groups, no price benchmarking exercise has been performed. As before, the authorities seem reluctant to activate their pricing powers gained under the Health (Pricing and Supply of Medical Goods) Act.

The Government, the EU and the international community should not allow pharmaceutical companies to hold citizens or states to ransom. This is, in effect, what they are doing and what they will continue to do until such time as the structure for funding the research, development and commercialisation of new medicines is redirected towards the public good and the interests of citizens, and away from big global corporations. The Government needs to play a prominent role in calling for this much-needed change at EU level. Bulk buying, risk sharing, State funding of research and development and compulsory licensing are all possible options that must be considered. I would like to know if further engagements are intended with the Irish Pharmaceutical Healthcare Association in regard to proprietary drugs, and with the Association of Pharmaceutical Manufacturers in Ireland in regard to generic drugs. What further engagements does the Minister intend to have? Is he seeking to achieve new and increased savings through agreement with both of these bodies? On a very important point, has he identified targets in this area?

Before I come to the Estimates, I want to ask on one important detail in regard to the health Estimates. Has the Minister put money aside for compensating Amanda Mellet and any future women who will need compensation until the eighth amendment is removed? The UN found that our laws violated Ms Mellet's entitlement to freedom from cruel, inhuman or degrading treatment. The UN further found that Ireland, which is a State Party to the International Covenant on Civil and Political Rights, is obliged to provide Ms Mellet with an effective remedy, including adequate compensation and the psychological treatment she may need. We received the Estimates yesterday morning, and I apologise if I have missed it, but given the equivocation of this Government in dealing with this issue, which means it is almost certain that other women will be placed in the very unfortunate and tragic, but very avoidable, position in which we placed Ms Mellet, I have to ask whether the Minister has put money aside. The bills and the need for compensation will rack up until something is done in this regard. More women will be subject to cruel, inhuman and degrading treatment for which they will be entitled to compensation. It is a shame that we are here talking about compensation when we should be talking about real remedies. We should be talking about taking care of these women, not compensating them. Even on the issue of compensation, I see nothing in the Estimates to give me, as a woman, or Ms Mellet, as someone who has been through this, any comfort that money has been put aside to deal with these awful circumstances. This is an issue that will not go away. The Minister can dismiss it, kick it into a citizen's assembly and deny it, but it will not go away. It is very real and it needs to be addressed.

With regard to the Estimates, particularly the ministerial announcements this past week, I welcome that the €12 million plundered from the mental health budget earlier this year will be restored. I would take issue with references being made to this as restoration, which was said in some of the Minister's press releases, or as additional funding. This is not additional funding but funding that was callously removed from this area and that is now being replenished after a public outcry.

I read the Estimates in the short time allowed to us before this debate and I am not impressed. I fail to see any meaningful investment and it is clear to me that the publication of the Estimates spells bad news for those who are on waiting lists - those who will spend tonight on a trolley, those who will continue to wait for vital services, those families who will be diagnosed with a fatal foetal abnormality and those who are depending on this Government to respond to their very real needs.

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