Alan Kelly (Tipperary, Labour) | Oireachtas source

With regard to the Estimates, most of us who observe these things knew this day would come and the €500 million is obviously necessary now. This has been going on for decades under Fianna Fáil and other Governments. It is like a figure is picked from the sky for the health budget and it is constantly supplemented, as everyone knows. We cannot continue like this. Collectively, I hope all of us who deal with the issue of health care will come to a process by which we can support proper budgeting.

I note from the briefing document, for which I thank the Minister although unfortunately I received it only this morning, the Department states it is working towards the development of programme budgeting and changing the structure of the health Vote. It is incredible that in this day and age the process by which the vote is announced and the way in which it is segmented and structured does not work. We need to change this. The document states it will take time to do this but I find this strange. Why it cannot be changed quickly is, perhaps, something Deputy Harty will want to examine as part of the committee's work.

Later this year the Minister will seek more money. We all know this. That €500 million will do it will simply not happen. I will lay this bet with the Minister right now, and I guarantee him he will be looking for more money. It is a simple fact.

I welcome the comments the Minister made earlier about the prioritisation from a budgetary point of view of the management of the acute hospital network. It is the right way to go. With regard to the mid west and south east, to be frank, I could never accuse those managing non-acute areas of not managing their budgets well. They manage them particularly well. I am not convinced I could state this confidently about the acute side. This is not through the fault of management in these areas. Different circumstances exist, which we might get onto later, and I appreciate this.

I am very much taken by the committee, which I believe is a good idea, but I agree with Deputy Kelleher that we will have to be realistic. What will we achieve in six months? It will not be utopian. We will not be able to achieve everything. There are ideological differences in the House, which is why we are here, on health care and health care management, which we will not solve in six months. I ask that we identify what we will try to achieve as regards some form of pathway to a consistency of approach in health care. Somebody will replace the Minister eventually and that person will deal with the same issues. I hope we will have laid the foundations through the committee to create some form of pathway for managing a better health service, particularly with regard to how we manage funding the health care system.

It is necessary for all of us, particularly those who are spokespersons for various areas of health and the Minister, to make it above politics. I know this is a cliché but we must adopt a different approach not only because of the political nature of the House but in general we will have to do it differently to achieve results.

I have a number of questions about some of the specific provisions the Minister has brought forward. Many of these questions remain unanswered and I hope the Minister will be able to answer them. I do not expect he will be able to answer all of them today but he might do so in writing to me afterwards.

Will the Minister give us a breakdown of how the much vaunted accident and emergency department winter initiative will work? Where will the funding be allocated, in what measure and how will it be appropriated? It needs to be appropriated in various ways. I would like to see a breakdown of how it will work. I know the Minister was left in a position where the funding was not there but it cannot be just a case of throwing the money out there. It must be used in a quality way.

I lament the fact the post of Minister of State with responsibility for primary care was got rid of. According to the Irish Medical Times, which I presume is correct, the Minister stated he would personally take control of the primary care portfolio.

I am glad to hear that. He might explain how he will do that. During the term of the previous Government we rolled out 90 primary care centres and commenced the construction of 73 more, and they will go some way towards the provision of facilities for people into the future. How many will be funded over the duration of this Government? What are the Minister's projections in that regard? What is the target for primary health care provision and centres? How will he measure that? Is there a figure that he will stand over for the optimum number of primary care centres that we need across the board and the various jurisdictions?

Regarding free general practitioner care, I welcome what the Minister has said about moving on from care for under sixes towards later this year increasing that to under 12s, but when will that be delivered? When and at what time of the year will he commence doing this? How does he see it being rolled out? Has he abandoned the plan to extend GP care from over 65s to over 70s or is that something that he intends to do?

I wish the new Minister of State for Mental Health very well. In fairness, she has a hard act to follow. The previous Minister was a very good one. A Vision for Change, while a fine document and something that was broadly supported, is in an implementation phase that must continue rapidly. Will that happen? Does the Minister believe he has the resources to do that? It is not something that can be done piecemeal, stopped halfway through or not implemented to the level that was planned.

I welcome the funding allocation for home care packages. This is a bugbear of mine about which I have spoken to the Minister previously. I believe the allocation will only allow matters to stand still. I have made my own inquiries about this and believe the allocation only fills a gap that was previously filled by taking funding from other sides of the budget, particularly in mental health. The allocation will only ensure that existing home care packages will be funded. It will not allow for any more home care packages. It might allow for a few extra hours for a few people in various areas but I do not believe it will have a huge impact on the totality of people. The Minister's figure is €10.4 million. That is up from €10.3 million, I think. I would like to see how that figure will work. Ultimately, we must consider what home care packages cost, at approximately €639 per week, compared to €12,000 or €15,000 for a nursing home or multiple thousands for somebody in a hospital on an acute bed. It makes common financial sense and health sense that we fund this area appropriately because it helps with pathways to the management of people, it prevents bed-blocking and financially and from the point of view of health it is the best way. The Minister will hear as a common commentary from me in my time as spokesperson on health that I am a huge advocate for this. There are multiple wins in this regard, and I ask the Minister to prioritise home care packages and home help hours. I know of people who are simply sitting in hospitals and cannot be discharged, will not be discharged or are refusing to be discharged because the home help hours are not provided to deal with them.

Does the Minister have a timeline for the beginning and conclusion of negotiations on the new GP contract, which is obviously essential for the rolling out of GP care and enhanced primary care services? Has he met with GP representatives? If not, will he do so and when will he do so? They are asking to meet, as the Minister knows. A number of us in this House have a real concern about GPs in rural areas. There are serious issues in this regard and it is something that I would like the Minister to prioritise.

Has the Minister undertaken a cost-benefit analysis of the reactivation of the National Treatment Purchase Fund? It is prioritised in the programme for Government.

How will the accident and emergency and the emergency department, ED, task force, which I welcome, be managed? This is a priority. If one considers the situation in Limerick, Beaumont, Galway and many other hospitals, what we need regarding this task force is to see how pathways will be put in place for the management of people who are going through ED units. There needs to be new thinking around this, and it is a critical area. Will there be sufficient funding, given what the task force will have to come out with, to ensure that happens? Not all of this is bricks and mortar or funding for staff, by the way. It is about managing processes, pathways and people who come into ED units in the first place. How can we ensure the primary issue we should be ensuring, namely, that first, patients get a good service but second, that some of them who are going into EDs are treated somewhere else because they should not be there in the first place? I think we are all aware of this.

I have a number of specific questions which I want to rattle through and on which the Minister may come back to me. There is a cut in the budget in the drugs initiative and he is saying that that is a transfer to the community. Can we get figures for and transparency on that? There was a big hullabaloo when about 17,000 Ministers visited the north inner city in Dublin a few days ago, yet the communities will probably want to see an explanation for this.

The allocation for medical cards on day one was not correct. Is the Minister happy that the allocation that he has now specified will work? There has been a huge increase in legal fees, according to what we are hearing. Why is that?

I welcome what the Minister has said about scoliosis. This is something I have personally advocated for and I would appreciate if he would inform me of the details of what he is doing about this because it is something that has needed to be addressed for a long time.

I wish to raise two final issues. One of them does not relate to the Minister for Health directly but relates to the Minister for Finance, and I hope the Minister for Health will speak to him. We have a serious issue in this country regarding graduate doctors.

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