Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

On behalf of the Social Democrats, I extend our condolences and deepest sympathy to the family and friends of the late Ms Emma Mhic Mhathúna. We pay tribute to her on the extraordinary work she did during her short life in improving the health services for everybody in this country, and women in particular. It really has been quite amazing.

The two big crises facing the country relate to housing and health, and it should be said that yesterday's budget fell very far short of what was required on both of those counts. I will concentrate my comments on the implications of yesterday's budget for the health service and the fact that it was extremely disappointing when it came to making provision for health and health reform in particular. That is especially the case in the context of a position where we have a fully costed ten-year reform programme that has cross-party support called Sláintecare. The Government has squandered this unique opportunity to do something of real consequence with the health service and ensure we bring about the kind of reforms that would guarantee access and efficiency in our public health service. This means people living in Ireland could avail of similar access, accountability and affordability in our health services. That is available in all other European countries for their citizens. We are an outlier in this regard because of the very poor quality of our public health service and the major problems relating to a lack of access.

It is a squandered opportunity with respect to health. The Government has been extremely disingenuous in the need for reform of the health sector. Over the past 15 months or so we have seen the Government paying lip service to Sláintecare. Many of us involved in the hard work over the course of a year that went into producing the Sláintecare have had serious concerns that the Government would not be serious about it and it would engage in cherry-picking the elements of Sláintecare that suited its own agenda or ideology. Unfortunately, that is what happened. The Government and the Minister, Deputy Harris, in particular have been very cynical about Sláintecare, using its "brand" to cover their shortcomings in respect of their inability to commit fully to the reform programme. Rather than committing wholeheartedly to Sláintecare, they have used the brand, taking every opportunity to name-check it without being serious about ensuring its delivery. We need from the Minister and the Government the courage to commit to Sláintecare but, regrettably, it was not evident in yesterday's budget.

As many feared, the Government has failed to fund the Sláintecare programme. Much has been made of the €17 billion that is the highest ever allocation to health, representing a €2.25 billion increase on the 2018 Estimate. The Government spoke about it as if additional funding in itself is enough. The provision of additional funding without a reform programme is to yet again throw money into the black hole that is our health service. What matters is how the money is spent rather than the amount allocated. The recent €700 million overspend saw no discussion; there was no discussion about how it arose or how it would be funded. The Irish Fiscal Advisory Council drew attention to the fact in recent weeks that the Government just happened to find an extra €1 billion from corporation tax to give to the Health Service Executive. They will take it now and next year as well but the Government will not ask any questions and there are no strings attached. There are no proposals for control of funding and this is an example of extraordinary profligacy with taxpayers' money on behalf of the Government. They are putting that money into the black hole again without any controls whatever. It seems the Government intends to keep chasing the deficit in health. It is a zero-sum game. Where will we be at the end, and will the budget continue to increase by €1 billion every year while no reforms are implemented and we get very poor value for money?

Where is the accountability? I note the word "accountability" was used in the Minister's speech yesterday, when he stated "I will continue to look at choices that we have to make in healthcare regarding how we can accompany all-time high levels of investment with improved governance, accountability, effectiveness and value for money." In essence, the Minister has said that even with an overspend of €700 million, we will continue to look at choices to ensure accountability and value for money. Those measures are included in the Sláintecare report but the Minister has merely said he will continue to look at choices. One must wonder about the name of the Department of Public Expenditure and Reform, as where is the reform in this regard? The Department seems to be asleep at the wheel when it comes to accountability, value for money and so on in the health budget. It is an extraordinary shift away from the kind of demanding figures it would have insisted on just a few years ago. The Government likes to claim it is responsible in the use of taxpayers' money but it is anything but with the health budget.

The whole purpose of Sláintecare is to change the way we deliver services so we move to a lower-cost model of care. There was no effort to do this in yesterday's budget. Sláintecare provided for a transition fund of €500 million. This was to provide for that shift away from the expensive hospital model to the community and primary care model and was for things like extra primary care centres; the e-health programme, which would result in considerable changes and savings in how we deliver care; training for additional primary care staff; and hospital beds. There is no indication the Minister gets it when it comes to the transition fund. As it is not in the implementation plan, the national development plan and the budget yesterday, it seems that fears about departmental capture of Sláintecare are very well founded. It appears that "implementation deficit disorder", the disease that has dogged the Civil Service for many years, impacts what has happened to Sláintecare. Many of us were concerned that there would be departmental capture of Sláintecare, which is what has happened. It took the Sláintecare implementation programme and changed it to its own departmental implementation programme which, of course, ignores the requirement for that transition fund. The transition fund aimed to ensure we got savings from implementing the full e-health programme in six years rather than 15 years. There was an allocation of €175 million for e-health. What did we get yesterday? We got a mere €25 million. We were talking about the need to ensure we have better services in the community for those 6,000 people on waiting lists for home care packages so we have better services in the community for the 600 people who are in acute hospital beds. Again, the idea was to move from the expensive model of care in our acute hospitals to community and primary care services. That needed to be funded but, of course, it was not funded. There was no additional funding for home care packages. There was no funding for community diagnostics. The idea was that there was to be a €500 million implementation transition fund but what we got yesterday was less than €200 million. When the Minister was asked about this yesterday, he said that the transition fund is a €200 million allocation. This is less than half of what was required but, of course, it is not even €200 million. It is actually €20 million under the specific heading of Sláintecare for pilot projects. At this stage, we should have moved way beyond pilot projects. What we needed was real and radical change and a shift in the way we provide health services.

Other aspects concern the package of care. They are about how we should improve access to health services and move away from that two-tier discriminatory system we have at the moment or how we should fully fund services for people so that cost is not a barrier to accessing timely care, particularly with regard to inpatient charges in hospitals and ensuring there is an adequate supply of home care packages. When it comes to Sláintecare, it seems the Government is merely tinkering around the edges and there is no real commitment to the kind of large-scale and radical reform set out in the Sláintecare programme. Undoubtedly, this is a missed opportunity.

A total of €70 million will be provided to the NTPF next year - an additional €20 million announced yesterday. Fianna Fáil has made a lot of this figure. The NTPF compounds the dysfunction that is in our two-tier health service. We have a public service that is supposed to provide services but rather than ensuring we get good value for money for those services, deal with the blockages that are holding up throughput of patients for their elective surgeries and introduce the reforms that are necessary in terms of hospital stays and the length of time of consultants spend working on their public contracts, we have said that we should leave things as they are and incentivise more work in the private service. This, effectively, is what the NTPF is doing. In many respects, it is paying people on the double for doing work that should be done in the public service and incentivising more of that work to be done in the private service. Again, this is not about reform. I wish Fianna Fáil would get that message. It participated in the Sláintecare committee and should have got that message loud and clear. The NTPF actually works against reform of the health service. It is a perverse incentive and we should not be promoting it further. We should implement the kind of reforms set out clearly in Sláintecare. What we need is more concentration on tackling those long delays and ensuring that the kind of reforms set out in Sláintecare are implemented.

I have serious questions about some of the accounts that were used yesterday. One would have to ask whether the health budget figures are already wrong because they simply do not add up. Two examples of that involve the NTPF. There has been all this talk about the extra €20 million but when one actually looks at the accounts on page 16, one will see that a mere €10 million in additional funding has been provided. Where is the other €10 million and where is it coming from? There is a figure of €491 million in the Estimates involving net pension costs for 2019. This is almost a half a billion euro. What is that about? There is no explanation of that and no comparative figure for the current year. How did we come up with that figure? Where has it come from? What does it represent? There is no detail on it whatsoever.

I note the comments of the leader of Fianna Fáil this morning on "Morning Ireland". It would seem that very late in the day, he started to express concern about the health budget. He said the health budget in respect of Sláintecare needs to be part of a review. It is a bit late in the day to review the allocation in respect of Sláintecare. Fianna Fáil claims it has its fingerprints on this budget. As it was in negotiations with the Government, it is a bit late to be talking about Sláintecare at this stage. Why did Fianna Fáil not put it front and centre in respect of the health budget months ago?

We have a choice. Do we continue as the only country in Europe that denies universal access to timely healthcare to a large number of our citizens and do we continue using health as a political football? It seems this is the desire of Fianna Fáil and Fine Gael. We are going to continue with an un-reformed, divided and two-tier public health service that denies so many people access to care and will continue to have the knockabout with regard to health. It will continue being a political football. We had the choice to do that or do something of real consequence in terms of the health service and bring about the kind of reform that will make a difference to the current generation and future generations and bring us into line with the rest of Europe. Sadly, it seems that the Government squandered the opportunity to do that in yesterday's budget.

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