Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

We will share our time ten minutes with five minutes apiece. Within the confines of my ten minutes, I wish to allow a minute or two for the Minister to respond, if that is okay.

Like others, I will take the opportunity to wish him the very best in his new role. It is a great honour not just for him, but for his family and friends, to serve as the head of the health services for the coming years. Having sat on the Opposition benches and the health committee with him, I know that he has an understanding of the issues and the crises facing the health services. While we might disagree on the required solutions, he is aware of the level of work that is needed to rectify the many strands of the health services that have been forced to struggle due to the actions of his predecessors and previous Governments.

The new Minister can be sure that, as I did with his predecessor on repeal, Covid and other significant healthcare matters, I will work constructively with him and offer solutions. Although I will be constructive, I take my role as the lead Opposition spokesperson seriously. I will work and engage constructively with those on the Opposition benches as well as the Government benches for the improvement of health services for patients and healthcare workers alike. I say this notwithstanding any signal that came from others on the Opposition benches at the weekend. The Minister can be sure that, while I will be constructive, I will also hold him to account. It is no more than he would expect.

With those formalities out of the way, I will turn to the Revised Estimate. I welcome the questions and answers format. It is a new departure and a good idea, and I will divide my segment into seven minutes and three minutes.

I have to be critical of the presentation of the Revised Estimate. This is not intended in any way to be critical of the Minister or how he will run the Department in future, given that this Estimate came to us last week when the Department was still the responsibility of the previous Minister, Deputy Harris. It was only a few hours before we came to the Chamber to review an estimated spend of €20 billion on the health services that we received a briefing document. That document did not offer much in the way of clarity or definitive detail as to where exactly the additional Covid-19 spending would go and how it would be spent. I thank the Minister and his office for the briefing, but it was scant on detail. I hope that this is not a sign of what is to come and that we can expect more detail in future. I also hope that he will ensure that, under his stewardship, the presentation of Estimates will change substantially, incorporate greater detail and be open to scrutiny by the health committee.

I remind the Minister that it was only last year that he called on the then Minister and the departmental officials to read the Parliamentary Budget Office's report on the Revised Estimates. He stated that it was "impossible to conduct decent scrutiny because the numbers are not comparable" and "there are a number of challenges in undertaking effective scrutiny of this money ... [because we are not able] to compare the figures from today to the figures from December ... because the [figures] are not like for like." Unfortunately, the same applies today, but we have the added complication of additional figures being inserted because of Covid-19. In this Estimate, we have subheads such as Primary Care Reimbursement Services Covid 19 Actions at €110 million, HSE - Covid 19 Actions at €1.6 billion and Capital Covid 19 Actions, including ICT, at €220 million. The briefing document that we received a few hours ago tries to give additional information, but it falls short of presenting a detailed breakdown of where and how the money will be spent beyond the inclusion of micro-subheadings. I will cover this matter more in my questions at the end.

There are many questions that we have to ask of the Minister and the Estimate is an opportunity to do so. Will this money be used to retain the bed capacity that was secured to prepare for a surge in the pandemic? Hundreds of beds were reopened, yet we hear today that there are 192 people on trolleys. For years, I pleaded with the then Minister to open closed beds only to be told that there was none available in the system. The Government magicked up 1,000 beds, though. We need to keep them open.

While we are on the subject of trolleys, will the Minister continue to refer, as he did in opposition, to the INMO trolley figures, which are taken every day? It is ridiculous that successive Ministers get into a row with the organisation that compiles these figures. Can we settle on using the INMO figures from here on out?

How is it possible that some parts of this Revised Estimate have not changed since the Revised Estimate in December? It is unbelievable that the Department would produce this Estimate and maintain that some areas of spending outside of Covid-19 will not increase or decrease by virtue of the new dynamic facing the health service. It is also probable that there will be a slower than usual provision of treatments and procedures due to the new ICPs. Such a situation may result in changed figures from those included in the Estimate. Consequently, I do not know how the parts of today's Estimate that are outside of Covid-19 changes can show the same spending as December's Estimate. Deputies and the general public take into account that the deferral of treatments may result in increased costs when treatment is ultimately delivered. An analysis of basic health economics shows us that delayed care can mean an increase in costs, as diagnostic tests may need to be retaken and illnesses might become more advanced, necessitating more intensive treatments and longer inpatient stays. Depending on the scale of the effective reduction in the use of the public health service, there may be increased waiting times for inpatient and outpatient procedures post the pandemic. All of these effects are likely to result in a significant knock-on effect on non-pandemic public healthcare spending late in 2020 and into 2021. This has not been factored into the Revised Estimate. I am also cognisant of the fact that, unless and until an effective Covid-19 vaccine is developed, increased costs for PPE, contact tracing and so on will continue to put spending pressures on Vote 38. This means that we may well be back debating Supplementary Estimates later in the year.

My questions relate to areas where there should be more detail from the Department. For example, beyond stating that sanction for the €110 million under the Primary Care Reimbursement Services Covid 19 Actions subhead was provided to the HSE on 16 March in respect of GP services and is included in the funding approved by the Government, we have no further breakdown of how that amount was distributed, who received it and for what. Other procurement accounts for €89 million, which is the estimated cost to date. What does that incorporate exactly? Similarly, will the Minister clarify whether the planned €62 million relating to absenteeism relates to sickness due to Covid-19? There is a planned cost of €74 million on ventilators, with €18 million already spent. Can we get additional details on the number of ventilators procured and do we now have a sufficient quantity, including to cope with a potential second wave?

Some €9 million has been spent on the Citywest isolation facility to date. I understand that the contract has been cancelled. Is the State liable for the remaining €16 million outlined in the planned costs section of the departmental briefing?

Approximately €320 million has been spent on PPE, as outlined in the report of the Parliamentary Budget Office. Despite that, we have consistently been told that the HSE has spent €1 billion on PPE. Which is it? Who is correct and how much has been spent?

The private hospital deal is estimated to cost €258 million by 12 July. Will the total spend equal the planned gross cost of €426 million? Will the Minister provide some clarity on this matter? We do not have additional information on what we have got so far for the €258 million. What use has been made of the capacity? How many procedures have been carried out? Does it represent value for money? Has the Department considered these matters?

It is disappointing that we do not have a further breakdown of the information. The Minister would share my disappointment were he sitting over here on the Opposition benches. He has promised a new departure in the Department of Health.

Will the Minister examine, where the capacity exists, the purchase not of services from the private sector but actually the purchase of the facilities themselves, if they come up for sale? It has been done in other jurisdictions, it makes a lot of sense and it represents good value for money. Rather than paying in to the private sector which has to take a profit off the top, if the opportunity arose would the Minister consider purchasing those facilities from the private sector?

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