Michael Harty (Clare, Independent) | Oireachtas source

I move:

That Dáil Éireann:

recognises:

— that it has been 12 months since the publication of the cross-party consensus report by the Committee on the Future of Healthcare entitled 'Sláintecare Report', regarding reform of the health service over a ten-year period into an effective and efficient health service;

— the failure of Government to deliver a response to the 'Sláintecare Report' in spite of committing to do so by December 2017;

— the failure of Government to develop a new funding model for the health service including multi-annual budgets to deliver universal healthcare;

— the failure to fulfil commitments in the Programme for a Partnership Government to:— reduce waiting lists and overcrowding in our hospitals;

— provide new contracts for consultants and general practitioners;

— recruit additional nursing staff to support increased bed capacity;

— reduce delayed discharges; and

— introduce hospital avoidance measures;— the failure of Government to develop the Emergency Aeromedical Service (air ambulance) and its extension to a night-time service;

— the failure of Government to develop a humane approach to the provision of discretionary medical cards to those who are undergoing treatment for cancer and end-of-life care;

— the failure of Government to fully implement the strategy document 'A Vision for Change', including building capacity into Child and Adolescent Mental Health Services (CAMHS), the provision of counselling and psychological services in primary care, and fully populating community psychiatric teams;

— the lack of equal opportunity and quality of life for people with disabilities by the failure to implement personalised budgets together with a comprehensive employment strategy to aid independent living and social integration;

— the failure of Government to legislate for a statutory scheme for home care, to enable our elderly population to live within their community;

— the important role that carers play in maintaining family members at home, supporting their needs by providing respite services, financial support and disability services;

— that acute hospital bed numbers, hospital consultant numbers and general practitioner numbers per head of population are below the Organisation for Economic Cooperation and Development (OECD) average and need to be increased to meet that average;

— that Emergency Department services are struggling to meet the increased demands for acute and complex care, particularly given our increasing population and ageing profile, and waiting times for out-patient assessments continue to grow and waiting times for elective and planned surgery are unacceptably prolonged; and

— the lack of coherent comprehensive planning to address these issues, lack of governance and accountability to underpin meaningful reform and lack of statutory requirements to meet acceptable targets, for waiting times and annual performance targets as committed to in the Programme for a Partnership Government; and

calls on the Government to:

— work towards the 'Sláintecare Report' proposal for a universal single-tier public health service based on need, not on the ability to pay;

— ensure a coherent implementation plan is immediately actioned to address the increasing lack of capacity and unmet need in our health service;

— immediately introduce legislation to ensure the delivery of entitlements to services on a phased, income-based criteria until universal public access is achieved;

— deliver expanded entitlements on income grounds only when capacity is available to deliver services;

- ensure immediate actions are taken to address recruitment and retention of front-line staff by improving working conditions, career progression and job satisfaction;

— work towards expanding diagnostic service availability to seven-day access, for both in-patients and out-patients, to speed patient diagnosis and treatment in a timely manner;

— immediately provide resources and recruit staff in order to open beds in hospitals which have been closed during austerity years;

— immediately commence a building programme to expand bed capacity to reach the OECD average per head of population in order to eliminate overcrowding and deal with unmet need;

— immediately complete negotiations on a new modern contract with general practitioners which recognises their central role in delivering prevention, health promotion and continuing care in the community;

— immediately enter negotiations on a new consultant contract, to recognise their value and role in delivering public care in our public hospitals;

— recognise the value of fostering and encouraging our nursing staff by improving working conditions, promoting career progression and further education;

— commit to meaningful and continuing health reform to take into account the continuing changes that are developing in modern medical practice;

— review the de-congregation model of care as it is clear that a one-size-fits-all model of care is not adequate; and

— establish that all service users who have been transferred from congregated settings to independent living are progressing positively.

The purpose of the motion is to examine progress to date on health reform. It is two years since the formation of the Government on 6 May 2016 yet here we are on 8 May 2018 with no meaningful reform in our health service. The establishment of the Committee on the Future of Healthcare was viewed as a positive expression of the Government's interest in reforming our health service. One year after the committee published its report on 30 May 2017, however, the Government has yet to respond to it, never mind implement any of its fundamental recommendations. The report recommended: the development of a single-tier health service, delivered on the basis of need rather than ability to pay; the initiation of a fundamental shift of emphasis towards primary care; commencement of the integration of primary, secondary and tertiary care services; and legislation to ensure accountability and answerability in the management of our health service. The need to guard against implementation deficit was recognised by the committee, which committed a full chapter of its report to the subject of implementation. We recognised that an extremely important component of Sláintecare was that it should not languish, as so many health reports have, without implementation.

Health reform is not optional; it is essential. Sláintecare is a once-in-a-lifetime opportunity to tackle the disjointed and fragmented nature of our health service. Sláintecare talks about fundamental cultural change, not only in our health service but within the Department of Health, the HSE and all of its layers of management. The Minister, however, has failed to act to implement any meaningful health reform. He will be remembered as the Minister who had a plan but did nothing about it. So many of his predecessors had no plan. They did not have the luxury of a cross-party committee report produced following 11 months of sittings to deliver a blueprint for health care reform. He is the only Minister who has had that luxury but he has not acted on it in any meaningful way. I accept that Sláintecare is challenging to the health institutions of the State, the Department of Health and the HSE. They cannot cope with the challenge Sláintecare presents.

I am afraid that, rather than implement Sláintecare, the Government has spent the last year moulding it to suit its own policy. Sláintecare, however, recommended that Government policy should change. Sláintecare's recommendations on reform are far broader and wide-ranging than existing Government policy. The Minister must accept that we need fundamental change in how we run our health services. That is something which goes way beyond Government policy. The Government is taking over the implementation process to suit its own objectives rather than setting up an independent implementation body to develop the implementation plan Sláintecare recommends. This is contrary to the vision of Sláintecare. The Government is deconstructing Sláintecare to suit its own policies. That was never the intention.

We accept that many areas of the health service work well. However, those excellent areas work in isolation and there is no uniformity across the health service. Many areas of the health service struggle to prosper and deliver quality care. This is because management structures in the HSE are disjointed and dysfunctional. The most fundamental legislative provisions required include provisions to reinstate the HSE's board. A slimmed-down board would provide proper governance. One year after the publication of Sláintecare and seven months since the Taoiseach announced in the Dáil that he would reconstitute the board, the legislation has yet to come forward. It is one of the most fundamental underpinnings of Sláintecare.

The health service should not be about process, it should be about the patient. The difficulty we have is that our health service is all about process while the patient gets lost in the bureaucratic procrastination of that service's decision-making. The HSE has too many managers and too few leaders. The Minister has heard this on many occasions I am sure. One of the prospective candidates for the position of HSE CEO looked at it and declared it to be overmanaged and under-led. That is a fundamental issue. To make an analogy, our health service is like a Swiss watch in that it has many moving parts. All of those parts must be interlocked so that they move in unison, otherwise one does not get the correct time. We have a disjointed and dysfunctional health service which is not delivering to its full potential. The lack of integration is the problem and inhibits the delivery of quality services.

Taking the CervicalCheck scandal as an example, one sees how a lack of open disclosure, governance and leadership have led to the problem. This is at the core of so many of our health service's problems. We do not have proper governance and leadership. Too many layers of management get in the way of correct and logical decisions. Tied up in endless bureaucracy, the process trumps the patient who gets left behind. In addition to mandatory disclosure legislation, we need mandatory accountability legislation to guarantee accountability regarding decisions in the health service. People must be answerable for the decisions they make. We must create a proper management infrastructure to underpin a new and reformed health service. Legislative changes creating statutory powers, statutory targets and statutorily underpinned quality assurance will not cost money. They will not be a charge on the State. Rather, they will be the fundamental framework on which our health service is built. That legislation is outlined in the Sláintecare report but it has not been discussed or introduced in the House.

The development of a GP-led primary care service is critical to the development of Sláintecare. The countries with the strongest primary care services have the least pressure on their secondary services, shorter waiting lists and better outcomes for patients. This is critical and one of the fundamental recommendations of Sláintecare. We talk here about GP-led primary care teams. If we had those, we could keep people out of hospital and treat their chronic disease conditions within the community. The benefit would be the release of pressure on secondary care. Failing to invest in primary care makes no economic sense. We must concentrate on those who need the most care.

People spend less than a fraction of 1% of their time in hospital, yet the hospital service consumes most of the budget. I am not proposing that we take money away from the hospital service, but we must develop our primary care services. They attract 4% of the budget. It should be at least 10%, as is the case in other European countries. In the committee we often spoke about the inverse care law - the people who need the care most get it least. The Minister must take a fundamental look at how our health services are structured in that regard.

Austerity was universally applied across the health service and the public service, but the unwinding of austerity and of the Financial Emergency Measures in the Public Interest Act, FEMPI, has been uneven and unfair, particularly with regard to general practice and primary care. It was applied to other services, of course, but it was disproportionately applied to general practice. If the Minister allows general practice to wither on the vine he will reap as a reward a huge cost in secondary and tertiary care by not supporting primary care.

We must speak about recruitment of doctors and nurses, the retention of those staff and look at the reasons for the issues there. They have very poor working conditions. They are educated in a system that is very poor and which does not offer them career opportunities and career progression. They are the reasons staff are leaving the country. It is not because of pay, although pay is important. The average trolley count in 2013 was 247. It increased to 310 and last year it was 396. All the measures the Minister has instituted have not affected the trolley crisis. It is a crude measurement of the quality of our health service but it is a real-time measurement.

The Minister must address health reform. I hope to hear in his response to the motion how he will address it, how quickly he will do so and how urgently he is undertaking it.

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