Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

-----from January.

On the emergency cardiology issue - specifically 24-7 primary percutaneous coronary intervention, PCI, which I believe is what the Deputies mean - a report was done on that matter by Dr. Herity, a Northern Ireland-based cardiologist and expert in the field. He determined that it would not be safe or sustainable to provide 24-7 primary PCI in University Hospital Waterford. I am aware that the report has been rejected by many of the campaigners there and the clinicians working in the cardiology service there. Nonetheless, I believe all in the House would agree that decisions on where national or regional specialist units should be located must be based on scientific advice, not on politics. The Minister for Health plans a national review, which will be different to previous reviews. It will not simply be an expert review. There will be much more room in it to hear other voices such as the voices of patients and others.

On a more positive note, the second cath lab is now in place. It is a mobile cath lab at University Hospital Waterford and is working on elective cases. It seems to be having some success in reducing waiting times for people who need cardiac procedures. In the interim, we will have to give consideration to whether that second cath lab should be kept in place. While it may not be providing 24-7 primary PCI, it appears to be reducing waiting lists and waiting times for patients who need cardiac procedures on an elective basis. That has to be a positive.

Reference was made to scheduling of Cabinet sub-committee meetings. I believe I have explained this before. The Cabinet meets each week, sometimes twice per week now, and that is where most business is done. The Cabinet sub-committees meet every six weeks, not to crisis-manage but to deal with strategic planning, strategies, reviews and long-term policy thinking. I meet bilaterally with Ministers all the time, more often than I am able to keep records of.

The Government is committed to the implementation of the Sláintecare report but we do understand what it is. As I have already said, it is a plan for a plan, not an implementation plan. We are committed to the principles such as public health and the need to improve our health as a nation and as individuals. We will not deal with any of the long-term problems in health care or ever get on top of the costs if we do not deal with that. On the investment in capital and ICT, there is an increase in capital spending for health happening already and into the future. There is also a great emphasis on primary and community care, reducing out-of-pocket expenses and reviewing the public-private split in our hospitals. Those principles are very much accepted by the Government.

There are, however, issues. Deputy Martin asked what these are. There are issues around the costings, which need to be interrogated. I had one costing looked at within recent days. I believe we would all agree that there should be a lower threshold for individuals on the DPS. It is currently assessed on a household basis and this does not properly recognise that individuals - single people - can lose out under such a system. The costings in the report suggest that the threshold could be halved and it would cost only €7 million. After interrogation, however, nobody is actually able to come up with an estimate as to what it would cost because there are no records of whether people live in single-person households. As a result, that costing is certainly wrong. That gives just one small example of how costings in the report are definitely wrong and need to be interrogated further.

The report leaves open the question as to where the money will come from for its implementation. The report does not say, for example, that the funding should come solely from general taxation. It suggests a number of different sources as to where money could come from, including co-payments and social insurance. That would need to be teased out.

The report does not deal with one of the big questions we face in health care, which is why we spend so much and not get value for money for it. I have often said that spending on health in Ireland is in the top tier per head in the western world. We do not, however, have top-tier access. Any report about reform of our health service would have to deal comprehensively with that question.

The report does not come to conclusions; it recommends a number of different reviews. It recommends that further reviews be done on certain areas such as the public-private mix, which we have started.

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