Mick Barry (Cork North Central, Solidarity) | Oireachtas source

Members of his party signed up to the report and if the Government does not implement it, groups campaigning on the issues in society will take the matter up and apply pressure.

I support the idea of an Irish national health service, the cornerstones of which would be public ownership of the hospitals and primary care centres, free at the point of use and funded from a steeply progressive tax system. I believe that the committee has missed a golden opportunity to advocate for such a system. What is the difference between this and the proposals before us? I do not have time to go into them all but will highlight a few key points. On the question of charging, the World Health Organization is unequivocal that the complete removal of all charging is the best way to deliver universal health care based on need rather than ability to pay. In its world health report 2010, Health systems financing: The path to universal coverage, it states that one of the reasons direct payment is unsuitable to the delivery and consumption of health care is that it inhibits access. This is especially true for poorer people who must often choose between paying for health and paying for other necessities such as food or rent.

It is true that the Sláintecare report advocates the abolition of some charges such as overnight hospital charges and general practitioner charges over a period of five to six years. However, it is not consistent and does not advocate for this across the board. It advocates maintaining the €100 charge for emergency departments for a full eight years and, crucially, recommends that drug payments currently set at €144 per month, so that the patient pays the first €144, be reduced to €100 but then maintained at that rate indefinitely. That is poor. Overall, the report allows for €437 million in charge reductions by the year 2028. In fact, that is actually less than 15% of the €3 billion spent by Irish people on out-of-pocket health expenses in the year 2014 alone.

The report also advocates achieving public health care goals through a very high reliance on for-profit market mechanisms. The proposed shift from acute hospital care to primary care in the communities is based around three pillars, namely, pharmacists - sole traders; general practitioners - also sole traders, although there is a proposal for salaried general practitioners which is not given sufficient emphasis, and new primary health care centres to be built by public-private partnerships on a for-profit basis. That is actually the most expensive way to build such centres. In 2001 there was a ratio of 80:20 between public and private nursing homes. Today that ratio has reversed completely to 20% public and 80% private, largely as a result of the tax incentives offered by right wing governments. The result is that nursing home care in the State is controlled by those who prioritise the maximisation of profit over the care of the elderly, and rely on a workforce which is in significant measure comprised of low-paid women workers and immigrant labour. Government policy is for 9,000 new nursing home places in the years ahead, 7,000 of which are to be privately provided and 2,000 publicly. The report does not challenge this. It expresses an aspiration for a certain change but refuses to back it up with concrete proposals. Some 9,000 publicly funded nursing home places would cost €360 million. No provision is made for that in the funding proposals. The same applies in respect of home help services.

We talk of integrated care, yet the Irish health system is divided up into silos. We have publicly owned HSE facilities, privately owned hospitals, section 38 facilities, many of which are church owned voluntary hospitals, and section 39 charitable facilities, with about 2,000 entities which in other countries would be covered by the health service. None of the non-HSE pillars could survive for any length of time without taxpayer and public support. This includes the private hospitals, which have benefitted from massive tax breaks and from colocation with the public hospitals that do the more difficult and less profitable work. The vast bulk of these entities should be taken into public ownership with compensation paid on the basis of proven need, so that all forces can be brought to the point of attack to benefit public health care.

That would involve, in part, the separation of church and State. The public is ready for that, as was shown by the controversy about the National Maternity Hospital. Those public hospitals should provide full IVF facilities, abortion facilities, and services for trans people such as gender reassignment and hormone therapy.

On the question of who pays, there is potential for enormous savings to households. In 2014, the average household in this State spent more than €5,000 in out-of-pocket expenses and private health insurance. There is potential for significant savings to the State by eliminating profiteering by the agencies that supply so many nurses to our hospitals and over-reliance on an insurance-based system with unnecessary administrative costs, competitive advertising and so on. Of course there would be a need for extra money and investment to implement a national health service of that kind. I can see no better way for the Apple €13 billion or €19 billion, whichever figure one chooses, could be spent.

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