Ossian Smyth (Dún Laoghaire, Green Party) | Oireachtas source

I would like to sincerely welcome Deputy Donnelly to his new role as Minister for Health. In opposition, he was both insightful and constructive. I hope and expect that the Minister will bring that insight and expertise to the continuing reform of our health services. I would also like to take this opportunity to thank the former Minister for Health, Deputy Harris, for his service. The real character of a man is sometimes revealed when he is under stress and the stress was unique during the pandemic.

We are here today to assess the additional budgetary requirements for the health service for the remainder of 2020. We recognise that apart from the pandemic, there continues to be underlying pressure on health service costs arising from inflation in a variety of areas, including the areas of drugs, salaries, high-tech diagnostics and treatment options. We are clearly examining a large incremental budget from the health service today. We recognise that the structure of the budget and the way it is reported make it difficult to scrutinise this ask in great detail. Paul Reid has said on the record on multiple occasions that he expects to be in front of subcommittees in this House explaining and defending the additional HSE funding and we look forward to having an opportunity to investigate that further. Can the Minister confirm that it continues to be our intention to engage with the HSE on the detail of the incremental Covid-19 spending, while recognising the reality that much of the expenditure was battlefield spending with decisions rightly made at great speed and sometimes without the level of scrutiny we would have applied in normal times?

Clearly, the additional expenditure on PPE will represent a major line item for the HSE for the foreseeable future. It is right and appropriate that we seek to protect our front-line healthcare personnel. We have all stood at our front doors and clapped for our front-line workers but sufficient investment in PPE is the first and most practicable way we can demonstrate that support. What is the Minister's view on the likely long-term trajectory and strategy on PPE? Does he expect it to be a permanently substantial budget line item? Assuming he expects it to be permanent, does he have a view on how we should optimise the long-term supply chain for such PPE? Specifically, should we negotiate longer-term arrangements or options for international supply or should we seek to build national capacity, a national stockpile of PPE, or both? We do this with our oil reserves so should we do the same thing with PPE? We all watched with bated breath as aeroplanes took off from China carrying emergency supplies that we did not have time to check through and not all of it suited. It is important to have a long-term strategy about how our PPE supplies should be kept in reserve and delivered and to examine the question of whether they should be manufactured in Ireland.

Another major item in the budget reflects the costs that were incurred in securing private hospital capacity as an insurance policy against a large surge in acute hospital or ICU capacity during the pandemic. I note the Green Party's support in government for this initiative, as we voiced our support when we were in opposition. The open book accounting arrangement was a reasonable way to conduct the transactions at short notice. It should be no surprise to anyone who has read these budgets that the costs of owning and running a major acute hospital are substantial. Having this kind of surge capacity access going into the future will be a major asset in our strategic pandemic planning. What is the Minister's view on whether and how we should continue to hold an option over exercising a similar, fair and fairly compensated takeover of private hospital capacity during any future pandemic?

The original 2020 operating metrics, targets and service level agreements have not been updated in this Estimate to reflect the impact of the pandemic, which is completely understandable. The Parliamentary Budget Office considers the failure to estimate the impact of the pandemic on existing metrics, context and impact indicators to be a matter of serious concern. I can understand this sentiment but not in the short term. That normal business, including most medical business, was suspended for four months clearly means some targets will inevitably be missed by a wide margin. It is not fair or reasonable to expect that the Department of Health and the HSE should have fully updated their metrics by now. There are two reasons for this. First, we are still in a pandemic and it is fair to say that all our healthcare professionals, including administrative staff, continue to be focused on saving lives rather than updating metrics. Second, if they were to attempt a short-term update, the huge uncertainties would render such updates completely meaningless. We do not know how outpatient and inpatient diagnostic rates will be affected as we emerge from the pandemic. Guesswork in the guise of diligence is not helpful. That said, we want to ensure that over time meaningful metrics in the light of the steady-state post-Covid situation are defined, and that the structure of the health budget and Vote is changed so that it is amenable to meaningful and transparent scrutiny in this House. Will the Minister commit to updating the performance metrics for the different programme areas for the 2020-21 financial year? Will he investigate how we might be able to restructure the reporting of the budget in future so that we can more meaningfully scrutinise it?

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