Dáil debates

Tuesday, 8 October 2019

Financial Resolutions - Budget Statement 2020


7:25 pm

Photo of Michael HartyMichael Harty (Clare, Independent) | Oireachtas source

I thank the Leas-Cheann Comhairle and the Minister of State.

This is the fourth budget of this Government. It is shaped with Brexit in mind. It does not, however, give this Government a free card nor would they expect one. There are many critical issues facing our country at the moment and I would like to address some of them in the context of the budget. One is the health service in which I have a particular interest. The others are housing, the sustainability of rural Ireland and balanced regional development. None of these have been addressed during this Government's tenure in office and many of them have in fact worsened.

On health, there is lack of joined-up thinking. That is reflected in the way health is addressed in this budget. There is a lack of focus on urgent health reform as outlined in the Sláintecare report. The Government refers to Sláintecare at every opportunity and this is almost used as a fig leaf to explain its inaction.

Each change in health in this budget is very difficult to criticise because they are all worthwhile changes. They are designed to attract votes and are politically expedient rather than actually delivering a coherent health reform.

The Independent Alliance is claiming that they have achieved the full medical card for up to 56,000 patients by expanding the financial criteria for qualification. Fianna Fáil is claiming that it has delivered an increase in the National Treatment Purchase Fund, NTPF, and Fine Gael is claiming that it is going to deliver free GP care to under 12's and under eights by next September, as well as many of the other changes. Each component of the confidence and supply agreement of Government is claiming to have obtained concessions in health. When one looks at those concessions in the round, they are not delivering sustainable reform to our health service.

If one looks at the National Treatment Purchase Fund, an extra €25 million has been added to bring it from €75 million to €100 million. This is an admission of failure to provide proper public services but using the NTPF as a core part of health care delivery is not going to deliver real sustainable health reform and it is not addressing the core problem that is underpinning our poor public health funding. If this €100 million was invested in our public service it would give year-on-year improvement in public services and if €100 million or more was invested every year, the benefits would be compounded and cumulative. As it is this €100 million is lost to the public service as all previous investment in NTPF has been, year-on-year. The National Treatment Purchase Fund has been used to hide the lack of capacity in our public service.

This budget is not addressing the core challenges to our health service which is lack of bed capacity for acute care. We are short 2,600 to stand still, without taking demographic changes into account.

Next year we are also going to have a lack of bed capacity for elective care. Currently, our acute services are not able to deliver acute care, elective care is being pushed to the side and the only elective care that is being delivered is urgent care and cancer care. There is a lack of capacity for elective care, for step down and long term care in our public services. Finally, there is lack of funding for step-down care and long-term care in our private system and for the nursing home subvention scheme.

There is also a lack of permanent consultant posts. There are 500 such vacant posts. These vacancies are inhibiting the delivery of acute public services. The reasons for the lack of consultants is that there is a lack of pay parity for new entrants, the working conditions under which consultants have to work and the fact they do not have access to acute beds, diagnostics or to support services. Consultants who have worked in other health services and have had access to all those facilities are not going to come home to a service which is failing to give them even basic support. We have a lack of diagnostics and MRI scanning which has been spoken about recently in the health committee and here in the Dáil which is the case in all of our acute hospitals but in particular in University Hospital Limerick.

All of these issues contribute to long outpatient waiting lists, waiting lists for elective care, and waiting times for acute care where patients are treated on trolleys in casualty, on corridors and in extra beds on wards, which does not give them optimal care and which is usually delivered to frail and elderly people who will experience worse hospital outcomes and longer hospital stays detrimental to their independence in the future. The Government cannot pour two pints of milk into a one-pint jug. Patients do not just go away. If they are waiting on an outpatient waiting list or for elective care for a long time, eventually they will end up in emergency departments because their conditions will have deteriorated.

It is difficult to argue against full medical cards for people over the age of 70. In the context of health reform, however, it does not address the core issue that faces patients aged over 70. They will get improved care within general practice but they will not get improved care in the hospital system by delivering a free medical card to them. It would be much more effective if that money was invested in our hospital services. Let us consider cross-Border care, to which Deputy Mattie McGrath referred, and the busloads of people travelling to the North to have simple procedures carried out that should be carried out in this country. If that money was added to the €100 million going into the NTPF and the allocation to provide free care for under 12s, it would fund the substantial, long-term health reform promoted by Sláintecare. A total of €32 million is provided in this budget for specific Sláintecare programmes. Sláintecare envisaged 20 times that amount going into reforming our health service to bring it up to a level we can be proud of.

Home help hours are essential and it is difficult to argue against an increase of 1 million hours. I am certainly not doing that. There is, however, a problem in the delivery of home help. People cannot be found to deliver that service. The restrictions applied through the social welfare system restrict people in receipt of social welfare who want to contribute to society. They want to provide home care but cannot because they will lose their benefits. Those who may wish to have a full-time career working in home care cannot access a career path in delivering home help. There needs to be a complete restructuring of how home help is delivered but this is not addressed in this budget. Funding 1 million additional hours does not provide the people to deliver the service.

This year, there is a budgetary overrun of €335 million, as opposed to €445 million last year. Our population is increasing and ageing and, therefore, there is increased demand. Unmet need has increased but there appears to have been a saving of €110 million. I would like this to be explained. Hopefully, this saving does not result from a reduction in services. Perhaps the Minister for Health will address this in the House later this week.

This budget will not address the pressure areas in our health service. Greater engagement is needed with front-line staff who can identify areas where long-term efficiencies can be developed. It also needs to be emphasised that we must support our section 39 organisations, which provide the most effective and value-for-money services in our communities and in our health services. These organisations are underfunded and, as a result, the services they deliver are not at the level they would like. I cannot address the other issues now but I might get an opportunity later in the week.


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