Joan Collins (Dublin South Central, Independent) | Oireachtas source

I thank the Rural Independent Group for moving this Private Members' motion. It was obvious from the start that Deputy Harty was the main driver behind the medical aspect of it given his role in the Oireachtas Joint Committee on Health.

We have dysfunctional crisis-ridden health service which is simply not fit for purpose. We are an exception in Europe in that we never moved to a modern NHS-type model of public healthcare. In 1942 the Beveridge report recommended the introduction of the National Health Service in the UK as part of a welfare state. The NHS was seen as a stand-alone measure to improve people's health. It was part of the concept of the welfare state with social welfare payments, child support, better state pension provision and a major programme of public housing. This was because of an understanding that when it comes to health and life expectancy, inequality and poverty are key factors.

Those from a lower income group or who are working class or unskilled are three times more likely to die younger than someone from the top end of society. Some 47% of the consistently poor have chronic health problems and we have completely unacceptable levels of poverty. Poor diet, poor housing, low educational achievement and stress are key factors affecting general health. We live in a very unequal society and this is compounded by the inequality of a two-tier health system.

After the Beveridge report, a Government White Paper was produced here, outlining an Irish NHS and social welfare system. It was met by fierce opposition from the medical professions, the Catholic Church and the Department of Finance. The proposals were quietly dropped. We have continued since then with what is essentially a poor service for poor people and a better service for those who can pay. We have a hotchpotch of charities, NGOs, religious bodies and State agencies providing an expensive service, but as the current scandal over cervical smear testing shows, no one is really in charge. There is a huge democratic deficit and a huge accountability deficit.

Someone has to be held responsible for the wilful deliberate withholding of medical information from women. Calling for the dismissal of people, who will leave the service in about 12 weeks and have about six weeks' holiday due which they will take in the meantime, is not good enough. We should be calling people to account. When someone in that position is on a board for five hours every month getting money for it and then he withdraws from that, it is obvious that is where he is going and that is his path for the future or some pharmaceutical company. Mary Harney did the same when she got her gold-plated pension. She is on the board of pharmaceutical companies as well.

That is the problem here; no one is held accountable. Following the blood-transfusion scandal, the CEO of the Blood Transfusion Board got a gold-plated pension. He was not touched or held accountable for any of those women's deaths, including people I knew who had to campaign to try to get recognition and get money from the State over the period of time they would have to face huge medical costs.

When the same blood-transfusion problem happened in France, the CEO there was brought to trial and jailed for what happened in France's service. Women died and the situation there nearly mirrored what happened here in Ireland. We had a huge problem with holding people accountable for situations happening here in institutions like the HSE and Government.

The question of outsourcing is crucial from the point of view of Government policy. In 2008 it was outsourced on the basis of, "We don't know really what it is". I asked questions to be put forward for the scoping report. Were the minutes discussed with Tony O'Brien who was then CEO of the cancer screening programme? Were there minutes of doctors explaining to him, "We have a problem on this"? They noticed differences in the method of the screening. We must have accountability somewhere. I will be dogged in ensuring that will happen. I am sure other Deputies will do the same thing.

Sláintecare is the way forward and we really have to push it. It is the essence of the Private Members' motion and I agree fully with the thrust of the motion. Despite the Minister's declaration of support for Sláintecare, the Government is certainly dragging its feet. Sláintecare will not be implemented by the Department of Health and certainly not by the HSE. That is why a fundamental element of the report was a recommendation for an implementation body, not in the Department of Health, but independent and located in the Department of the Taoiseach. The Government has sidestepped this key element of the report by planning to place the implementation office in the Department of Health.

The implementation of Sláintecare will require increased funding over and above the annual health budget. The report calls for a €3 billion investment over six years. Will the October budget make provision for this funding? If not, the Minister's commitment is useless. In addition we also need a major increase in funding for capital development, as the Minister mentioned in his speech, and also day-to-day spending.

In the 1980s the Fianna Fáil Government cut hospital beds by 3,000. The service is still struggling and reeling from those cuts. I hope to see the 2,600 acute hospital beds the Minister mentioned and the health service capacity review. I want to see them coming through. I want dates for when they will be brought into the system along with the staff needed to facilitate these beds.

From 2009 to 2014 we had five years of cuts to services and staff numbers, including pay cuts and an embargo on recruitment.

The service is now faced with the consequences of an inability to recruit staff due to extremely stressful working conditions and low pay, including a two-tier pay scale for nursing staff. We need a health budget of at least €20 billion a year plus the multi-annual fund advocated in the Sláintecare report. We also need the political commitment and the determination to face down the vested interests who will no doubt oppose this report. A first step would be the establishment of the independent implementation office as recommended in the report. We are 80 years behind the European norm. We cannot afford to wait any longer.

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