Paul Murphy (Dublin South West, Solidarity) | Oireachtas source

The Minister focused on two themes. First was the argument that Fianna Fáil did it first and, second, there is the notion that no policy change will alter the situation facing people who are waiting on outpatient lists or on trolleys in hospitals. The first thesis is accurate. Fianna Fáil did indeed do it first, but that does not reduce the responsibility of the Minister or of this and the previous Fine Gael Government for the current state of the health service. There has been almost a doubling of the numbers of patients on trolleys over the eight years of Fine Gael rule. It is true that we are still struggling with the legacy of the horrific cuts in the 1980s, when 3,000 beds were lost. Despite there being some subsequent movement towards recovery and improvement, that deficit was never dealt with properly. The onset of the economic crisis saw the introduction of a massive programme of austerity by Fianna Fáil and the Green Party, which was continued by Fine Gael when it entered office.

A 2014 study conducted by Trinity College showed that €2.7 billion was taken out of the health service between 2009 and 2014, resulting in 12,000 fewer staff, 21,000 fewer inpatient appointments, 30,000 fewer day cases and almost 1,000 fewer beds. We have had decades of under-resourcing, which is the responsibility primarily of Fianna Fáil and secondarily of Fine Gael, compounded by austerity since the crash. Fianna Fáil and Fine Gael have continued to pursue the same policies. The consequences of those austerity policies are seen in the huge waiting lists and the patients on trolleys but also in the entrenchment of the two-tier nature of the health service, which is at the root of many of its problems. Public hospitals were forced into financial dependence on income from private patients who were allowed to jump the queue ahead of poorer and sicker public patients. Even when the latter finally access treatment, the care they receive is generally inferior.

The second theme the Minister set out is the idea that there is no single policy change that can turn things around. It is part of the propaganda and argumentation of successive Governments and Ministers to suggest there is nothing that can be done about the health sector. No matter who goes in and what they do, it will always be in crisis. No matter how much money is spent, it will remain a funding black hole. In fact, there is a simple policy change that would transform the situation, which is to adopt a policy of building a properly-funded national health service. That service would have one tier rather than two, would not require people to pay out of pocket for medical expenses or private medical insurance and would ensure that everybody has equality of access to the health services they need. That is the policy change we require and it would transform people's lives. Unfortunately, Government policy points in the opposite direction.

I will focus on a discrete area of the health service, the ambulance service, to illustrate the point I am making. I got an answer from the HSE last week to a question regarding its expenditure on private ambulance services in the first eight months of 2019. I was informed that €7 million was spent filling the gap in hospital transfers, which involves the use of taxis.

4 o’clock

It is there. It is relatively small in the grand scheme of the health service but it is a clear example of an underfunded ambulance service, made up for by paying for private operators to step in. That happens at the same time as the disgraceful union busting treatment of the ambulance workers, personally directed by the Minister for Health against those who want to be members of the National Ambulance Service Representative Association, NASRA, and who are told after seven days of strike action they cannot join NASRA and the HSE will not deal with NASRA. Every time they protest outside the Dáil, we raise it in here and we get the same answer from the Minister every time, which is basically saying the Government thinks there are enough unions currently organising for ambulance workers and paramedics and therefore they should not be entitled to have a union of their choice. It is utterly scandalous but it is replicated in the treatment of workers across the health service.

That is one area but I mention the creeping privatisation, although the word "creeping" might understate it at this stage. The expansive but not openly declared privatisation of our health service takes place throughout the service. It takes place in the National Treatment Purchase Fund, the payment of agency nurses as opposed to employing people directly to work as part of the health service, private consultants using public hospitals, and people being able to jump queues and so on. It is everywhere. The alternative is to invest in a national health service. That would make a huge difference in people's lives and health outcomes and in equality in our society. Health inequality is huge in Ireland and statistics continually come out about that.

It would also make a difference to people's pockets. I got an answer from the Minister this week about the amount an average household spends on private healthcare and private health insurance each year. The Minister confirmed the average household spends €960 per year on medical expenses, covering things like GP, dentist and hospital visits etc. The household budget survey gives a combined figure for medical and dental insurance in the same period of more than €1,200 annually. As we do not have a national health service, households in this State are already spending over €2,000 on average to try to access the healthcare they need.

The consequences for this underfunding are very clear. They are spelled out by Phil Ní Sheaghdha and the Irish Nurses and Midwives Organisation, INMO, in the various press releases put out about the coming winter crisis. The HSE predicts nearly 4% more patients will attend emergency departments, but that will be with 400 fewer staff nurses and midwives in the coming crisis if the recruitment pause is not ended and if there is no proper staffing of our health service. The most extreme consequence of this underfunding is the estimated 300 to 350 people who will die as a consequence of overcrowding and of being stuck on trolleys etc. between now and next year. It is horrific, and that goes on top of the experience of sitting on a trolley, the experience of a family member being on a trolley, and the experience of one in ten of the population sitting on outpatient lists, unable to access the healthcare they need. We need a national health service. A national health service is a part of a green new deal for Ireland. Employing the proper number of staff to resource our health services properly means creating thousands more jobs, and those are low carbon jobs. They are low carbon, high quality and high value jobs for our society.

It also means taking on the power of the pharmaceutical companies. We regularly deal with scandals here with people seeking to access necessary pharmaceuticals and medicines, often for their children, and being unable to do so because of the ransom these pharmaceutical companies are attempting to extract from people. It points to the need for public ownership of the pharmaceutical companies, and in the meantime there is a need for a programme of generic production through publicly owned pharmaceutical companies to ensure life-saving drugs can be accessible to all. It means taking private hospitals and healthcare companies out of the hands of profiteers, and in that way building a national health service that is equitably accessible to all who live here.

See this speech in context