Michael Harty (Clare, Independent) | Oireachtas source

I am very disappointed with the references in the budget to the health service. There is no appreciation of the health reality that faces ordinary people on endless waiting lists that are stretching and increasing year on year. This year, health spending has gone over budget by €700 million and a Supplementary Estimate will have to be introduced to cover it. We will add €1.05 billion to the health budget next year. Without meaningful reform, undoubtedly there will be an overrun in excess of €700 million next year.

Sláintecare is a plan to attempt to address these issues but there was scant reference to it in the Minister's statement, which was most disappointing. One must remember what Sláintecare is attempting to do, which is to reorient the health service towards primary and community care and deliver a single-tier health service that can be accessed not by finance, but by need, so that money should not inhibit people seeking a health service and they should receive treatment in a timely fashion. Sláintecare also attempts to move towards universal healthcare, particularly universal primary care. It attempts to integrate our primary care services with our hospital services.

Sláintecare outlined a funding model, which was completely ignored in the implementation strategy, of establishing a ring-fenced national fund that would be a single buyer for all health services. Of course, Sláintecare had an implementation plan. The Government is now using Sláintecare as a fig leaf for all of the ills of the health service and it is turning to Sláintecare as the solution to everything. Of course, it has the solutions to everything but only if there is funding. The budget did not outline how Sláintecare would be funded or how the transitional funding necessary to implement it would be put into place.

The budget has put the cart before the horse. It has expanded eligibility for free care before expanding the capacity to deliver it. It has given 100,000 people free access to primary care. This is welcome and it is in line with the Sláintecare recommendations but Sláintecare stated this could not, and should not, happen unless there is an expansion in capacity of general practice to deliver it. Tomorrow, the Department will go into negotiations with the representative organisations on GP contractual matters.

It offers 100,000 people free care without general practice having the capacity to deliver that. What will it mean? People will end up in out-of-hours services or the accident and emergency department seeking care because general practice does not have the required capacity. Ireland has 64 GPs for every 100,000 of population and in Australia there are 120 GPs per 100,000 of population. Many GPs in Australia are Irish, with over 1,000 doctors in Australia who were trained in Ireland. Taking it as a given that it takes €250,000 to train a doctor, with 1,000 Irish doctors in Australia, it means there has been a gift to the Australian exchequer of €250 million. Taking the number of doctors in Australia, New Zealand, Canada and the UK and extrapolating the cost of educating them, it seems odd that our health service is repelling those doctors and causing them to emigrate. Billions of euro in Exchequer funding goes towards educating doctors who are going to work in different health services because those services provide opportunities to develop career options and give better working conditions and a quality of life.

We will see the waiting times to see GPs lengthening and the amount of time a GP can spend with a patient will shorten. We know 20% of our graduates work outside Ireland, 40% work part-time and 50% are unwilling to take up the responsibility of running a general practice. We can educate as many GPs as we like but the same proportion will emigrate, work part-time or not take up general medical service lists. We know 35% of GPs are over the age of 55 and 20% of those wish to work part-time. These are startling figures and unless we change our system, we will lose those GPs. In last year's budget speech, the Minister stated €40 million would be provided for primary care development, which would allow a number of initiatives to be progressed. He said that in particular, the Government looked forward to further progress on GP contracts and was hopeful agreement could be reached with the implementation of additional services in 2018. However, in that one year, only three meetings took place on the negotiation of GP contracts and nothing happened. I do not know what happened to that €40 million but it certainly did not go to general practice.

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