John McGuinness (Carlow-Kilkenny, Fianna Fail) | Oireachtas source

I congratulate the Minister on his reappointment. I also congratulate Deputy Shortall, who is passionate about the whole area of health, the committee and all those who contributed to its work, including those outside the House who made their professional services available. That this report has ended up being debated in the House is a first step in recognising that politics needs to be taken out of health. We need to have one single focus and support whoever is the Minister for Health in achieving the type of reform that is necessary. As such, a lot rests on the Minister's shoulders because he is the one receiving this report and he is the one who will have to action it. While others have said that the Minister should make a statement on his intent regarding the report, and that is true, the Minister will be judged by his actions. The sooner he can act and take a step in the direction of keeping this cross-political approach to the delivery of a better health system, so much the better.

Political agreement is hard to reach in this place. Going back to 1997 and the period when Mary Harney was the Minister for Health, it was clear then that if political agreement had been reached, and if some kind of political peace were established in the area of health, we might have made far greater progress with the money then being allocated to health. It is never too late to start, and we have something now. However, as good as the report is, many other reports - hundreds of them, I am sure - have been put in place by various Ministers for Health that have never been acted upon and never will be. I hope this report does not end up on the same shelf as all of those reports.

What should the Minister do to act on this report? The HSE is dysfunctional. It does not have the capacity or ability to fulfil any part of this report. The Department of Health washed its hands of health a long time ago and it creates that distance between the HSE and the Department of Health. The Minister is the one who must drive the reform and, therefore, is the one who must find the method to be put in place to manage this change. I remember previous health reform packages that were talked about publicly, and it was Eddie Molloy who said change managers within the HSE are required to drive change on the policy and direction to which the Minister refers. This is where previous policy failed badly. Therefore, there is a need for a cohort within the Department of Health or the HSE that will drive this necessary change, pick the quick wins we can have out of this report, implement them and show, by leadership, not only that we have a report covering the next ten years, but also that the Minister will have the managers of change in place to insist that all the pieces that are agreed upon and can be funded immediately happen. All of us in this House must agree on it, health professionals must agree on it and the trade union movement must contribute to changing the culture of resistance and bringing about the necessary change in co-operating with this House and the general health management to ensure we get the best deal for the patients we are all talking about.

I would start with that change management, and then I would take the simple things. I would look at the parliamentary questions put to the Minister for Health every day and at the number of them that deal with single patients and the desire to get services for them and to bring about better outcomes. There are hundreds of such questions every single day, but what do we get? The Minister answers the questions by stating, "If you do not hear from the HSE within 15 days, give us a shout." One does not hear from the HSE within 15 days and one may as well be shouting in the middle of Croke Park because nothing happens. As a result, people have lost faith in their politicians, in the ability to change the system and the ability to get the services when and where they are needed. The Minister must stop this. I would like to see him take full charge of the parliamentary questions system in this House. As real accountability is introduced, we will get outcomes to our parliamentary questions.

The Minister should tell the HSE to start by telling the truth at Committee of Public Accounts meetings and health hearings in this House. He should tell the HSE to acknowledge the wrongs early and stop the prolonged established legal practice within the HSE of fighting every single case, only to end up making an apology and giving out a heap of taxpayers' money. Billions of euro are being paid out on mistakes made within the HSE. I accept that mistakes will be made, but do we learn from those mistakes? Judging by the amount of money I see paid out from year to year, we do not. It is a colossal amount of money. How many people could be taken off trolleys if only that culture within the HSE were sorted? The HSE seems to think it is grand to do it because the taxpayer is paying for it. I ask the Minister to answer the parliamentary questions, deal honestly with committees and insist on taking responsibility for the HSE and change management.

Primary care is essential to all of this. It is the cornerstone on which our better health services will be built. Every single statement from Minister states that services will be conducted in the primary health care sector, but there is no money attached to that sector. General practitioners, GPs, are leaving this country in droves. One practice got in touch with me to tell me that a GP of 30 years said the health system is going down the tubes and GPs are having to face more work in an ever-depleting workforce. We are educating our GPs to export them. That is essentially what is happening. GPs are pressed to their limits to try to deliver the services they provide, not to mention the services we, as politicians, want to see the primary health care sector provide.

Psychiatric services are at crisis point. They do not have the professionals to deal with the issues with which they are being confronted. Only recently, the Union of Students in Ireland made a presentation to us on health services and access for their students who are under pressure. If one family wishes to access health services privately over a three-month period, cover with VHI costs €90,000. No one could afford it. As a result, the cost of cover by VHI and other private health care providers is going through the roof. There is no control and there is no transparency to it. There is a duplication of waiting lists.

Best practice in orthodontics and dentistry, for example, was highlighted. The two most prominent consultants in the country recommended change to all of this, but what happened? They were deemed to be the people out of step. They were the ones who were sanctioned in the Department and they are the ones who suffer to this day for wanting to provide a better service. They had a proven model that worked perfectly but it did not suit the HSE or the Department of Health and they ended up in poor health themselves. We have all been asked about Lyme disease and many other diseases, but nothing happens. Protests are held outside the gates, but nothing happens. Therefore, it falls to the Minister.

I wish to mention the case of the sarcoma specialist, which is just incredible. There were two applicants for the job. Seventeen people were on the interview board for two applicants, and the foremost person in the world who was in situdid not get the job. It is incredible. That is our health service. They do it their way just because they want to. The same goes for scoliosis. How many times has the Minister been asked about scoliosis? How many times has he been asked to change treatment for scoliosis? How many young people are suffering because of it? Between now and the change in this ten-year plan, the Minister needs to do something. He needs to make sure that those who are being paid huge money within the HSE to manage actually do so. People will say that if one gets into care, it is the best care one can get, yet there is an imbalance in who is employed by the HSE. There has been an imbalance in terms of the number of managers for years. The Minister must seek their co-operation to change that. In the context of this change, I ask that he implement some kind of management between now and the time he takes his first step in the process of this ten-year plan. I commend everyone associated with the report.

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