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

As I have said before in this House, the 2018 national service plan sets out a budget of almost €15 billion for the HSE. This is the largest budget for our public health service since the foundation of the State and it represents an increase of more than €600 million on 2017. This is a substantial increase in funding levels. This comes on top of a health service that was already well funded. When the total amount of health spend is divided by the number of people in the country, Ireland is among the top five countries in the world for health spend per head, and by some estimates Ireland is perhaps in the top one or two.

That comes after a period that included a recession and during which spending was above the average in the western world. The HSE produced its service plan in consultation with the Department of Health. The plan was approved by the HSE's leadership team in accordance with the law. It was noted by the Cabinet in December before publication. A number of measures and actions are under way to begin the process of turning the Sláintecare proposals into an implementation plan. As the Deputy is aware, the report of the all-party committee sets out a shared vision for our health service. It is a plan for a plan. It calls for an implementation plan and that is being worked on by the Minister for Health. We hope to have it ready in the next couple of months.

We have also completed the capacity review, which will feed into the ten-year infrastructure investment plan that is to be published in the next couple of weeks. A group has been established to look into the separation of public and private practice, as recommended in the Sláintecare report, and is meeting under the chairmanship of Dr. Donal de Buitléir. In addition, we have taken some steps towards the implementation of some of the things that are called for in the plan, such as the extension of the GP visit card scheme and reductions in prescription charges and in the cost of the drug payment scheme. All of these real and concrete actions are provided for in the budget.

I have often heard Deputy Micheál Martin calling for an honest debate about health care and health funding. I agree that we should have an honest debate. Fundamentally, if we are serious about facilitating real improvements in our health service, we all need to acknowledge the false proposition that is always put forward that there is somehow a direct connection between money and resources, on the one hand, and outcomes for patients, on the other. We know it is not the case that there is such a connection. The Irish Government Economic and Evaluation Service's report on the funding of our hospitals shows that in one year when there was no increase in funding for hospitals, activity increased by 7%, and that in another year when there was an increase in funding for hospitals, activity decreased.

If we want to have an honest debate about a health service that works and provides patients with the standard of care and the outcomes they deserve, we need to get away from the false analysis that there is a direct connection between money and resources, on the one hand, and patient outcomes and services, on the other. I would mention as evidence of my contention that it is a very indirect connection, at best, the fact that we spend so much but do not get the return we need. It seems to me that the difficulty we have had for many years with the running of our health service is that rather than trying to manage health services within an ever-expanding budget, as other agencies do, the HSE does something very different - it monetises every problem and passes it on to the Department of Health in the full knowledge that those documents will either be released under freedom of information or will be leaked, usually to the journalist Deputy Micheál Martin mentioned.

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