Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

When healthcare is discussed in politics and in the media, the focus is almost exclusively on what is going wrong. This relates to the numbers waiting to see doctors or to receive treatment, the number of people lying on trolleys in emergency departments, the number of people who cannot access mental health supports and the fact that the Government’s response to the crisis is all talk and no action. Patients, their families and their friends are exhausted. Many conclude that nothing can be done and that the problems they see in health are normal and inevitable. One regularly hears people say "Sure, is that not just how health care is?" . As we look to 2019, it is essential to challenge this conclusion and demand better. These failures, waiting lists and cost overruns are not inevitable and they do not exist in other countries. They did not exist in the past in Ireland in the way they do now and there is no reason that they should exist in future.

In the 2000s, incredible progress was made. The nursing degree was introduced and the number of nursing student posts was doubled. The smoking ban was introduced and healthcare investment grew substantially. Some 53 separate healthcare bodies were consolidated into one, the national screening services were launched and 1,600 additional hospital beds were provided. The number of consultant posts grew by 40% and the Health Information and Quality Authority was established. There was a massive increase in home-care provision, the national cancer strategy was rolled out and so on and so forth. These initiatives supported our healthcare professionals to make extraordinary progress in patient care in Ireland. Waiting times fell from years to months and weeks. The rate of death from cancer fell by 11% over the past ten years, while the rate of death from stroke fell by one third in the same period. Infant mortality fell by a third while cardiovascular disease rates fell by 40%. Deaths from heart attack fell by half and three in every four eligible women were screened for breast cancer. These are amazing accomplishments, the credit for which belongs not to any political party here but to our healthcare clinicians who were able and were supported to do an extraordinary job. We have some of the best trained healthcare professionals anywhere in the world. The provide an outstanding level of care. They mind us, heal us and save our lives every day. They continue to make incredible progress to improve patient care in Ireland. What, then, is the problem? Why are there so many things on which we here, the media and patients focus?

Ireland has one of the highest healthcare spends in the world. In spite of that, we have, somehow, among the fewest hospital beds in Europe and the lowest number of consultants per capita. We have the longest waiting lists. During the 2000s, waiting list times were reduced from years to months but notwithstanding the many billions in additional annual funding now provided, those waiting lists have gone back up from months to years. Waiting times are longer than they have been at any time since we started to record them. In some areas, children with special needs must wait three and a half years for treatment. There are 35,000 people who have been waiting more than six months for a hospital appointment. It was less than one third of that in 2010. More than 3,000 children nationally are awaiting mental health appointments. Last year, the number of people on trolleys in emergency departments hit 10,000 for the first time in the history of the State. If one adds up the numbers on the lists of those waiting for appointments, therapy, diagnostics and mental health supports, one gets to 1 million. It had topped 1 million by September. Nothing like that has ever been seen before and nothing like it exists in any other European country. There are 72,000 people waiting for in-patient hospital treatment.

For every person who was waiting in 2010, when much less money was in the system than there is today, there are 16 people waiting at the start of 2019. That is how bad things have got. We compared the situation to that in the United Kingdom and found that when one accounts for population size, there are 200 people on waiting lists in Ireland for every one person waiting in the UK. We are 200 times worse than the UK at getting people treated before a year has elapsed. The current out-patient list stands at over 500,000 while the number of those waiting over one year stands at more than 150,000. That would fill the Aviva Stadium three times over. The one exception to this trend is where the national treatment purchase fund has been deployed. The Government talks regularly about the improvements that have been made and I do not blame it for that, but they are targeted. What the Government does not say, of course, is that the National Treatment Purchase Fund, which it resisted for years, came about on foot of the confidence and supply agreement. General practice is on its knees and nurses and midwives are looking at a national strike for only the second time in 100 years. There is an unprecedented recruitment crisis in the context of hospital consultants. Mental health services are falling apart in many areas. Health overruns are now consistently above €600 million a year, which never happened before.

The national children's hospital is an interesting case study. It was meant to cost less than €500 million but the latest figure is over €1.7 billion. In December, the Taoiseach told us the cost had risen to €1.4 billion and we have gone up by €300 million in the three or four weeks since.

How expensive is that? The most expensive hospital ever built anywhere in the world is the New Royal Adelaide Hospital in Australia. That facility was built at a cost of approximately €1.5 billion and has 800 beds. The new children's hospital will cost significantly more than the most expensive hospital ever built anywhere in the world, even though it will have a little more than half the number of beds. This means that when the national children's hospital has been built, the people will have paid approximately twice as much per bed as the cost of the most expensive hospital ever built anywhere in the world. That requires a staggering level of incompetence and systems failure to pull off.

What is going on? How is Ireland spending more public money than ever before on healthcare? We are spending more than most countries on Earth. At the same time, we are suffering from the longest waiting lists in Europe, the longest waiting lists we have ever had and a series of enormous overspends. How is this happening? How is so much valuable money being so badly wasted? Much of the blame rests with actions taken or not taken by this Government since 2011. It has managed to alienate pretty much the entire healthcare workforce, including general practitioners, consultants, non-consultant hospital doctors, therapists, nurses and midwives. The implementation of new initiatives like the national children's hospital has been incredibly poor, as have been the efforts to control costs.

The Government has wrought organisational chaos on the system. In 2011, it announced that the HSE was to be scrapped. It said that in the future, healthcare in Ireland would be funded by universal health insurance. That was the big idea. In 2012, in front of all the national cameras, the Government disbanded the board of the HSE. It marched the board out publicly in front of the cameras for everyone to watch on the news that evening. In 2014, the Government reiterated that it would disband the HSE and gave a date for this. The then Minister for Health and current Taoiseach, Deputy Varadkar, stated that the HSE would be gone by 2020. The Government had no idea what it would replace the HSE with. In 2016, the Government said it was no longer planning to abolish the HSE or to pursue the universal health insurance model of funding.

The only long-term strategy is not a Government strategy. An Oireachtas committee came up with the Sláintecare plan. The latter may have various flaws but is the only game in town. As a vision document, it is pretty good and quite ambitious. It was recommended in the Sláintecare plan that the board of the HSE should be put back in place. The Bill before the House has not resulted from a Government initiative. The Government did not wake up and realise that it should not have marched the board of the HSE out and destroyed governance in our healthcare system. It did not come up with the idea of bringing the board back. It was made clear in a report drawn up by this House that the biggest, most important, most complicated and most expensive system in our country self-evidently needs a board.

Unfortunately, every single Sláintecare implementation deadline has been missed so far. By my reckoning, approximately €20 million, in real terms, was allocated for Sláintecare in budget 2019. The Government said on budget day that €200 million was being provided for Sláintecare, but that was not the case. That money was being provided for various initiatives. The Government said that all of them were Sláintecare initiatives, but that was not the case. The money was being provided for doing a bunch of sensible things, like scaling up, as part of usual business. The actual money for Sláintecare in the budget was approximately €20 million. It is estimated in the Sláintecare plan that approximately €1 billion is needed for Sláintecare. Conservatively, it would probably be possible to get Sláintecare off the ground for approximately €500 million in any given year. It is probable that progress could be made on that basis. For every €1 that the Government has attributed to Sláintecare for this year, between €25 and €50 is probably needed. That is how seriously Sláintecare is being taken.

The former director general of the HSE, Tony O'Brien, appeared before various Oireachtas committees last year in the heat of the CervicalCheck scandal. He was under a lot of pressure from various Members of this House not just in respect of CervicalCheck but also on the performance of the HSE and on waiting lists. He repeatedly made the point that when he was hired by the Government in 2011 or 2012, he was instructed that his job was to dismantle the HSE. That is what he was told his job was. He said that he never received any further instructions. He was told that in the future, funding would be provided through universal health insurance. He never received any further instructions.

The Scally report pointed out the implications of the lack of a HSE board. It directly linked the lack of proper governance and the lack of a HSE board to the catastrophic governance failures that were a feature of the CervicalCheck scandal. Getting rid of the board was not just a mistake, it was an extraordinary mistake. The guy who was hired was told that his job was to dismantle the HSE. His board was taken away and he was not given any further instructions on the HSE. This extraordinary mistake has led to massive cost overruns, including an overrun of between €700 million and €750 million last year. Nothing like that had ever happened before. The spending overruns on the national children's hospital mean that this project is probably unlike any healthcare project that has been pursued anywhere in the world. We are going to pay twice as much per bed as the most expensive hospital ever built.

The lack of a board, coupled with this organisational chaos, goes a long way towards explaining how the same managers with the same doctors, nurses and other healthcare professionals, but with way more money, are providing a service that is much more difficult to access. It should not be more difficult to access. If the same doctors, nurses and managers are given way more money, they should be able to provide a more accessible service. Instead, chaos has been wrought throughout the HSE. Fianna Fáil will be supporting this Bill, which takes one small but important step towards reversing that damage by reinstating the board.

As we face into 2019, we should be under no illusions about the scale of the challenge before us. Organisational stability within the HSE has been lost. It has to be re-established. Financial control has been completely lost and must be regained. The HSE is on fire in terms of financial control. Our healthcare professionals - nurses, midwives, doctors and dentists - must be engaged with. They have been systematically alienated. They are not being engaged with. The Government is due to announce a new oral health strategy in the next two or three weeks. The Irish Dental Association made it clear in yesterday's newspapers that dentists have not been consulted on the upcoming oral health strategy. That is where matters stand.

This has to stop. Within the HSE, the Department and this House, there needs to be a culture of actively engaging with and listening to our clinicians. We should respect them and treat them properly, but that has not been happening. If we can stabilise the HSE as an organisation, if we can somehow get control of funding and financing, which has spiralled completely out of control, if we can begin to understand that the people who lead our healthcare system are the clinicians and if we can listen to, engage with and respect those clinicians, we can start to rebuild the healthcare system that patients, the public, clinicians and everyone working within the HSE deserve.

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