Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I thank everyone who contributed to this debate, though I think it very disappointing that it was very quietly slipped in this morning. I think many Members were not even aware that this debate was taking place this morning as this was not signalled last week. The debate also clashes with a number of other events this morning, with committee meetings for example. This is unfortunate and I am not sure what the reason for this was.

I too wish to thank sincerely all 14 committee members who put huge time, effort and real commitment into this process. This was a once-off process, the like of which we had not seen before, of developing an agreed cross-party position on a very significant area of public concern.

Sláintecare was and is a once in a lifetime opportunity to do something of real importance in this country and should be grasped with both hands by Government. We have a cross-party consensus on health policy for the first time which is key to making progress. For the first time we can take the politics out of health and end the situation that has existed for so long where health was used as a political football, to score points against each other. Sláintecare gives us the opportunity to do this as it is a fully costed, phased plan. It deals with the issues that go to the heart of the problems within our health service, namely the dysfunction that arises as a consequence of Ireland's two-tier system. That system is inequitable, very inefficient and is a huge barrier to people being able to live a life free from illness and worry over what will happen in the event of their developing an illness.

Sláintecare is radical in Irish but not international terms. The committee was keen to learn from the experience of other countries, especially the successful health systems elsewhere, and how they might be replicated in Ireland. The question of how we might learn from best practice and ensure that Irish people have the same kind of entitlement to good quality universal health care that all our European neighbours have was always at the forefront of the committee's thinking. Ireland is alone in having a two-tier unfair health system which speaks volumes of the mistakes that have been made in this country. Sláintecare charts a clear path for how we can develop a really good public health system.

Cross-party agreement exists on the direction in which we need to go towards the final destination, which is a universal single-tier health service where people are treated on the basis of health needs rather than their ability to pay. This political agreement represents a huge step forward. It is the bedrock of Sláintecare which we are now challenged to deliver.

There are some critics of the report but no one has come forward to suggest a plan B. Sláintecare is now the only game in town. It is evidence-based and has full political support. Anyone who criticises elements of the report should be challenged. For instance, the Irish Hospital Consultants Association has been critical of the report and has suggested that we should have more consultants and hospital beds. Those things are important but the hospital consultants have failed to address the fundamental point about equity. How do we achieve equity in the system if the two-tier system continues? My question of the Irish Hospital Consultants Association is this: do they believe in equity? Do they believe in universal access to services? If they do, how do they propose that we will deliver on these two important principles?

I am increasingly concerned about the Government's commitment to Sláintecare. I do not like to say that and had not said so in the first part of this debate but the Government seems to be dragging its heels. The Minister, Deputy Harris, speaks very positively on the plan and expresses his full commitment, but his actions do not follow through. Undoubtedly, for the last 70 or 80 years, health reform in Ireland has been held back because it is so dominated by vested interests. These interests are wide-ranging, and include health insurance companies, the pharmaceutical industry, the private hospital sector and some hospital consultants. Various interests are doing okay from our health system, it is good for their business, but the Government has a duty to serve the concerns of patients, not those of vested interests. That requires political leadership which has not been evident here in the past but it is required now. We must put patients' interests first and be clear and categorical in so doing.

The Government needs to make up its mind. Does it enthusiastically support Sláintecare or not? If it supports the principles that underpin Sláintecare, we need to see delivery. Today the Minister of State, Deputy Jim Daly, outlined a number of steps the Government has indicated it is taking. It is strange that the Government would make its first announcement on an impact assessment on the separation of public and private. That is a core recommendation from Sláintecare and is fundamental to achieving the universal system. Considerable political pressure was put on members of the committee towards the end of the process, as well as commercial pressure, to block the recommendation to separate public and private. That lobbying was not successful but it did succeed in having a line written into the report that an impact assessment would be required. The impact assessment mentioned in the report refers specifically to public patients. It does not relate to vested interests, but to assessing the impact on public patients because that is where the key responsibility lies. It is strange that this would be the first thing on which the Government moved. I sincerely hope the Government will not use this process as an excuse to abandon this key recommendation because it is central to a universal health service.

I am also concerned by the lack of progress in establishing the implementation office. When I met the Taoiseach in August, he told me the Government was in the process of starting recruitment and it would commence shortly. In September, we were told exactly the same thing, and again in October. Now, in November, the Minister of State told us today that recruitment will commence shortly. I have to question the Government's sincerity and commitment to this if we have now wasted what is almost six months since the publication of the Sláintecare report. There seems to be no urgency in setting up the implementation office. The key thing which every member of the committee said from the outset was that we would not produce yet another report on health reform. We would not engage in this unless there was a very clear commitment on implementation which is why the report includes a strong recommendation to establish a fully-funded independent implementation office. What is the delay in recruiting the person to head the implementation office?

I am further concerned that yet again an attempt has been made by the Department of Health to capture any kind of change proposed in health. The committee recommended that the implementation office would be located in the Office of An Taoiseach because we wanted to avoid that departmental capture. I hear on the grapevine that attempts are being made in the Department of Health to slow down this whole process and put obstacles in its way.

The Government must not squander this opportunity to do something of real significance for the Irish people by at last introducing a universal single-tier health service. It must not allow the vested interests to get in the way. It must not let departmental interests slow this down and block progress. The responsibility of all Members is to the people who elect us, to the public.

It is not before time that this country finally started to introduce a universal single-tier health service because Irish people should have exactly the same entitlement to good quality public health care as have all other European citizens.

The Minister of State should bring back to the Minister the message that there is growing concern among former members of the Committee on the Future of Healthcare that the Government is not serious on this and that progress is so slow. Even though the committee has stood down, several of its members have requested that I ask the Minister to meet a representative group from the committee. We are keen to meet him to address what would seem to be a slowing down of the process. A slowing down would represent a very serious mistake by the Government. The Minister of State should ask the Minister to come back to us with an early date on which to engage on this.

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