John Brassil (Kerry, Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on the Sláintecare report having spent nine or ten months putting it together at weekly, and sometimes twice weekly, meetings. At the outset, I acknowledge the work of the chairperson of the committee, Deputy Róisín Shortall, who did an outstanding job and went far beyond the call of duty in respect of the time and effort she put in. I also acknowledge all the other committee members with whom I worked and the work done by the advice team from Trinity College we employed to help us in preparing the report, Dr. Steve Thomas and his team. Again, the team did wonderful work.

We acknowledged very early on in the debate that there is no such thing as a perfect health system. All we can do is try to improve what we have. Trying to model our system on those which other countries have or trying to implement those systems in Ireland does not work because every country's system is different. If one looks at world reports and indicators on health, one might find that Japan has the best system, that Singapore has a very good system and that Australia has a very good mental health system. Each individual country can provide some level of guidance on how to do things correctly. One could look at the values of universal health care in the UK. It has a very good value system but, as we know, that particular system is also currently in crisis. Israel has exceptional primary care. There are exceptional community services in Brazil. Australia tops the list in mental health and well-being. The Nordic countries are at the top of the list for health promotion. The US is strong on research and development and Singapore is strong on information and communications technology. If one was looking for choice, one would turn to France and if one was looking for funding one would go to Switzerland. If one was looking at care for the elderly, one would look to Japan. There is no one perfect system, but there are very good parts of systems. Looking elsewhere to try to find a solution for the Irish system is a waste of time. We need to adapt our system to work for the Irish population.

This report sets a blueprint whereby we can make significant progress over a ten-year period. It recognises that nothing can be solved overnight, but that ten years is a realistic timeframe. We have set out what needs to be done in each individual area and we have provided funding and costing models for those individual areas. We have asked for an implementation office, which is the key to the delivery of the Sláintecare report. The Minister will recall that at his party's conference last weekend the Taoiseach made specific reference to the Sláintecare report and its delivery. Using Sláintecare as part of a key address at an Ard-Fheis or a keynote conference speech is really not good enough anymore. We need delivery. We need the implementation office to be put in place. Some legislation is required which has not even been started.

As a newly elected Deputy, having spent a considerable amount of time and effort in the belief that the work I was doing was to be of benefit, I am very quickly becoming disillusioned. My eyes are being opened to the fact that we do a lot of hard work, a lot of talking and a lot of huffing and puffing, but when it comes down to it, there is zero delivery. If there is one key message in my contribution to the debate this morning it is that we need to deliver the recommendations. We need to set up the implementation office and start moving the report forward. Many of the contributions made indicated the disillusionment out there, particularly among staff, in trying to get people to come back and work in the system - doctors, nurses, consultants, GPs, physiotherapists, radiographers and so on. Until there is confidence in the Irish health system and people actually believe that they are coming back to work in a system which will give them job satisfaction and a good quality of life, they will not come back. This report has far more far-reaching consequences than might be seen at first.

One of the areas which we identified very early on was accountability. We keep repeating it. Who is accountable? We have set out a very clear pathway. We need legislation for a new HSE board. We need an accountability structure to be put in place so that, rather than passing the buck down the line time after time, people will be responsible for the area of expertise they are supposed to deliver. If there is not accountability in a system, it will never work correctly. We spent a considerable amount of time looking at expansion of primary care. If people only read the key recommendations of the report and nothing else, they will see that it is very succinct and shows a very clear pathway for improving our system. If we can get our primary care network working properly, we will take the pressure of the system further up the line and give our hospitals and care facilities a much better chance of functioning efficiently.

One of the key things the report focused on, and in which I was involved, was care of the elderly, home care packages and the fair deal scheme. At present, the budget line for home care is separate to that for the fair deal scheme.

A separate budget line for the fair deal scheme is needed. Unfortunately, the first thing a community welfare team asks an elderly patient who looks for a home care package is whether he or she would consider the fair deal scheme. The community welfare team wants the patients off its budget and onto another budget but the fair deal scheme costs ten times more. That makes no sense. The budgets for home care packages and the fair deal scheme should be part of the same offering because the financial incentive will then be to ensure that a person who wants to stay at home will remain there. That could happen very quickly with a minor adjustment in budgets. I am sure the Minister of State's office is inundated with people seeking home care packages, for five or ten hours a week, in order that they might care for elderly parents or relatives. There is a cost-neutral solution available and all that needs to be done is to implement it.

Another key aspect of the report is the principle of affordability. Those who can afford to pay now are treated first because they have private health insurance and those who do not go into the queue. Any fair society, no matter how it is viewed, must have a system that treats people on the basis of need as opposed to ability to pay. That key recommendation is in the report and it has been costed. Again, a very simple social objective could be achieved if we have the desire to deliver.

Rather than sing the praises of the report and point out all its good aspects, I ask that the Minister set up the implementation office, have the legislation that is needed to make the key changes in accountability drafted and get this report moving forward in order to give some semblance of hope that we can resolve the crisis in health care. We sat as one unit and worked together towards the goal of improving the health system. If a cross-party report does not get the hearing and respect it deserves, we will never get anywhere in the context of dealing with the crisis in the health service.

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