John Brassil (Kerry, Fianna Fail) | Oireachtas source

As Fianna Fáil spokesperson on primary care and community services I will concentrate mainly on the health service, but I will also refer to tourism and the VAT rate and briefly comment on housing. I understood that the Minister for Health, Deputy Harris, would be present but I am sure the Ministers of State, Deputies Kyne and Cannon, will beat a track to his door in the morning to report to him on my contribution.

First, I welcome the spend of €17 billion that is planned for the health service next year. That puts Ireland very high in the OECD list for spend per capita, which must be welcomed. However, we are not good at getting value for the money we spend. If I saw a Supplementary Estimate for €700 million coming across my desk it would set alarm bells ringing. Some Departments are run on less than that amount. The reason for such Supplementary Estimates is the total lack of accountability and governance in the HSE at present. We must get to grips with that.

What disappoints me most about the budget for health is that, according to my reading of the figures, there is only €20 million allocated for the implementation of Sláintecare. Sláintecare is the blueprint by which we can improve our health services. I am not asking for more money to be spent on Sláintecare as an add-on to the budget but that we examine how we can spend our money better.

The Minister should examine something that I have had an issue with for some time. It is an example of how business is done in the HSE and how it could be done better. The budgets for the home care package and the fair deal scheme are in separate silos. If an elderly person is discharged from hospital and their relative goes to the community health nurse seeking home care, that person will have to fight on his or her knees to get ten hours, perhaps, will not get weekend support and often will not get enough to keep their elderly relative at home. The recommendation from the community health nurse will be to consider the fair deal option. Many families will do that, get accepted for the fair deal and their loved ones will go into a nursing home. The cost of each fair deal to the State is approximately €1,000 per week, at its lowest. The cost to the State of keeping somebody at home would be half of that and probably a good deal less. If one department was dealing with those two budgets together, the Minister would automatically get better value for money. I do not understand how the HSE operates its expenditure sometimes.

Another issue is the roll-out of e-health. Each time I have visited a hospital with a relative the triage nurse first takes the information, which takes 15 minutes. Then a junior health nurse does the same, as does the junior doctor, the house officer and the consultant. Up to five people are getting the same information and wasting an hour. If one person gets the information electronically and sends it to everybody else there is an automatic saving.

With regard to the roll out of primary care and the new GP contract, I welcome, and hope it is true, that the new GP contract and the reversal of FEMPI for GPs are back on the table. We must have a new GP contract to deliver Sláintecare and to attract and keep new GPs. Currently, the Irish Medical Organisation, IMO, is negotiating. However, there is another body, the National Association of General Practitioners, NAGP, that represents many doctors but it is not at the negotiating table. The Department tolerates that. I do not understand why they are not told to get their heads together, get around the table and work together to sort out the contract. The protectionism that takes place is unacceptable and must be resolved.

My profession, the pharmacy profession, is hugely underutilised and has much to offer the health system. Its members suffered FEMPI cuts as well and there has been no talk about their reversal. Pharmacists should be treated with the same dignity and respect as other health care professionals. On matters such as minor ailments, vaccinations and women's health issues the pharmacy profession has a huge amount to offer and is hugely underutilised. The Minister, Deputy Harris, has a personal interest in pharmacy so I ask him to examine this and build on it.

I am not sure whether the Minister for Health realises the opportunity that Sláintecare represents. It is an all-party report. Delivery and implementation of the report over a ten-year timeframe would have the full backing of this House. This is a once-in-a-lifetime opportunity for a Minister for Health. I am not sure if the Minister understands that; I hope he does. It is only through implementing Sláintecare that we will solve the crisis in our health service and rebuild confidence in it. We need to work together to ensure that the report is implemented. It is easy for me to refer to waiting times, trolley crises and so on but that is not going to solve the problem. Most Deputies are interested in sorting out the health service. Sláintecare presents us with the opportunity do that. I hope that opportunity will be taken.

On the 13% VAT rate for the hospitality sector, the argument for retaining the 9% rate has been lost. Coming from Kerry, which is hugely dependent in the context of tourism, I fought very hard for the 9% rate to be retained. Starting from now, I ask that quarterly reviews in respect of the impact the increased rate on the industry be conducted. If the finding is such that we are losing jobs and visitors, the net impact of the 13% VAT rate will be a loss in revenue to the State. If, as the industry fears and as we have been predicting, this happens, the increase should be reversed. There is no point in pursuing a policy that is going to cost us money and valuable employment.

I welcome the €40 million additional spending for tourism but I ask that it be spent wisely, particularly on the development of walkways. There are three such projects in Kerry, namely, the Tralee to Fenit walkway, the county bounds of Limerick to Listowel walkway and the south Kerry greenway. These are three huge projects that have my full backing. I am not saying one thing to one person and something else to another. I am not saying one thing to the farming organisations and something else to others. I support these projects. They are bigger than any one organisation or individual and they need to be brought across the line.

I welcome the €300 million investment in the affordable housing scheme, which was promoted by Fianna Fáil. I hope that the increased spend will result in the delivery of units. For far too long we have heard the excuse that houses cannot be delivered overnight. However, overnight has now become four or five years. I hope that the renewed effort will deliver in address of the housing crisis. The Minister of State, Deputy English, is in the Chamber. In 2016, we spent €230 million on the housing assistance payment, HAP, scheme and the rental accommodation scheme, RAS, acquiring approximately 36,000 units, but these are only temporary solutions. At today's rates one could service a €1.2 billion loan with €230 million every year and for €1.2 billion we could build 38,000 houses. A refocusing of our efforts on building units will free up this money.

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