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

Fianna Fáil was part of the cross-party Oireachtas Committee on the Future of Healthcare and believes it provides a pathway on how the health services should be delivered. However, it needs substantial investment and will also require a large number of reform measures to be delivered. There is an obvious need to build capacity in our health services to meet both current and future demands and Fianna Fáil is committed to working to achieving this.

We fully support building up our public health system, funded primarily by general taxation. We acknowledge that the proposals in the report are ambitious and exceptionally challenging. The committee recommends investment in the region of €2.8 billion over ten years and states that to implement system change, there is a need for additional once-off transitional funding estimated at €3 billion. It is quite a challenge in terms of both the required reforms and the funding necessary to ensure we have a health service that can deliver care to the people when they need it.

On background, in June 2016, the Dáil established the Committee on the Future of Healthcare with the goal of achieving cross-party, political agreement on the future direction of the health service, and devising a ten year plan for reform. Specifically, the committee was to devise cross-party agreement on a single long-term vision for health care and direction of health policy in Ireland.

The terms of reference explicitly recognised the severe pressures on the Irish health service, the unacceptable waiting times that arise for public patients and the poor outcomes relative to cost; the need for consensus at political level on the health service funding model based on population health needs; the need to establish a universal single tier service where patients are treated on the basis of health need rather than ability to pay; that to maintain health and well-being and build a better health service we need to examine some of the operating assumptions on which health policy and health services are based; that the best health outcomes and value for money can be achieved by re-orientating the model of care towards primary and community care where the majority of people's health needs can be met locally; and the Oireachtas intention to develop and adopt a ten year plan for our health services, based on political consensus, that can deliver these changes.

The report recognises that the Irish health service as it stands is not providing the population with fair or equitable medical care and that our health services do not have the bed capacity to provide timely, urgent and planned care. The report emphasises the need to move decisively towards equitable access to a high-quality universal single-tier system. The Chair of the committee, Deputy Róisín Shortall, referred to the eight fundamental principles on which the committee deliberated to reach broad consensus. I wish to put on record my appreciation to the Chair, all the members, the staff of the committee and to those from outside the Houses of the Oireachtas who made presentations and oral and written submissions. This process was critical in engaging with the stakeholders.

We went through a journey over the past year. While we might have believed we knew a great deal about health services and health care, we learned that it is complex. There is considerable interdependence on the various specialties and professions within health care. Certainly, the fact there will be major challenges was exposed in the context of the change that is required, including legislative change and structural change, as well as in the context of funding.

Reference has been made to whether the costings in this report were accurate. I wish to put on record that I believe the costings in the report are as accurate as they could be in the context of what we are undertaking over the next ten years.

There are certain issues we have to accept. The demographic is changing rapidly and fundamentally in front of our eyes. That is something that collectively, as a society, Parliament and Government, we have to take on board quickly. While this report highlights the challenges over the horizon, this is something we have to address collectively in the context of the cost of health care and in respect of the question of pension provision. Both areas will put extraordinary strain on resources. We have improving life expectancy. We have better health outcomes. We are living longer. The complexities that are provided in the context of treatment and services in health care are continually improving, but all this comes with additional costs.

All these issues have to be taken into account when we try to implement the report. We need to ensure that, while we strive to go for universality, we do not go for universality of average outcomes. Universality must not mean diminishing returns. We need universality and excellence at the same time. I am concerned that if we do not commit the resources to this health care report and its recommendations, we will diminish the standards available to people in trying to roll out universality. There is need to provide the resourcing along with the structural changes and the legislative underpinning of same to ensure that does not arise.

Let us consider the broad issues in terms of health care. The report highlights that we have an unusual system in the context of the interdependence and intertwining of public and private health care. The report makes a recommendation to the effect that there is need for us to unwind private health care from the public health system over a period of years. The report also acknowledges that this change will be complex and difficult. The Minister referred to contractual arrangements and loss of income to the public system. However, if we are to enhance capacity in the public system, then a good start would be to start to unwind from the public health system the demands that the private system is currently taking up.

Private patients, by and large, should be treated in private health care facilities, as one might expect. Public patients and people who wish to go publicly should have an entitlement to know that there will be a bed for them as well as provision of treatment in a timely and accessible fashion. Unfortunately, that is not the case.

Reference was made to the fact we are starting from a poor base in the context of the capacity we have in our public health system, not only in hospitals but throughout the primary and community care systems as well as capacity for supports in the home as well. There is no doubt this challenge, regardless of the other areas of this report and the associated recommendations, is going to put extraordinary strain and drain on our public finances to fund same.

The Chair of the committee referred to how we spend a large sum of money in the provision of health care in this country. There is no point in pretending otherwise. We are going to have to commit additional resourcing in the coming years for several reasons. This is because we are coming from a low base in the context of our infrastructural capacity and bed capacity. Another reason is because of the changes in our demographic profile and the challenges that will come from same as well. These two things have to be addressed quickly.

The Minister referenced the bed capacity review. I look forward to that report. I have said previously that it should be independent, and I hope it will be. The last thing we need is to start basing assumptions and assessments on reports that are not fully independent or verifiable in that context. This is a critical part of the implementation plan. If we deny the challenges that exist, we will simply try continually to force more people into a system that simply cannot and will not be able to provide health care.

Almost 50% of the population have private health care in some form or another at the moment. I have said as much numerous times in the House, and commentators outside the House have said it as well. There is no doubt that if this 50% did not have private health care, our public health system would simply implode. It would not be able to cater for the demand placed on it if there were no private health care facilities providing health care to people with private health insurance. The reason many people have private health insurance is not because they want a nice room on their own but because of the fear they will not be able to access timely diagnosis or intervention when they require it. Often, the motivation for taking out private health care is based on fear that the public health system simply cannot or would not be able to accommodate their medical needs in a timely fashion. That is undermining and sapping the confidence people have in the public health system.

I urge for the report and the implementation plans to be taken on board and seriously assessed. We should have continual and incremental assessment of where we are in terms of the implementation of the report and the resources required in the short, medium and longer term to ensure the report is implemented in full over a ten-year timeframe.

Reference has been made to consideration of the plan. Many commentators asked whether it can be delivered next week or next month. The report is clear on the timeframes. We have referred to decisions to be made in years one, two, three and four right out to the final horizon of the ten-year plan.

I hope the broad political consensus arrived at in the committee will spread further afield into this Chamber and into various Governments that will take up office in the years ahead to ensure this report is implemented and to ensure the public will get a public health system of which we can all be proud.

See this speech in context