Alan Kelly (Tipperary, Labour) | Oireachtas source

I want sincerely to wish the Minister the best. I have done so in a private capacity but I want to do so publicly also. We need him to do well, so I ask him, please, to do as well as he physically can. He has inherited a very tough job but he was a spokesperson representing Fianna Fáil for a number of years. I sat with him for many hours in committees and in the Dáil and I heard him speak with great analysis. He studied his subject matters and often put forward solutions, some of which I agreed with and some of which I did not, but he put them forward with an analytic mind. He spoke often of his previous work as a consultant and brought that through in his analysis. I would like to see that coming through again. I respect that. However, there is a big difference between being in opposition and in government, and he will find that out very quickly.

I analysed many of the Minister's commitments, statements, and what he supports and does not support, some of which I agree with and some of which I do not, and I respectfully say to him that he needs to look at them also to see what is realisable, because he is on the record substantially with regard to many areas of health, and if he is not going to be able to deliver on them, he needs to tell us. Do not tell us in six months or a year. Tell us out straight. I will accept it, but he needs to manage the relationships with others also who have a feeling that he will be able to deliver with regard to their areas. It is important that the Minister sets expectations. I accept that the world has changed, although some of the commitments and commentary he made were with regard to Covid-19 but, by and large, I accept the world has changed. I accept that the position of the Minister for Health is a different one from what it was a few months ago, but the Minister put forward various policies and strategies and made commitments relating to resources. He needs to state his position on them now, what will happen during his term in office and his plan, because people are waiting.

I also want to say publicly that we need to see a visible Minister for Health. In fairness, the Minister has been reading into his Department brief and his portfolio over recent weeks, but we really need to see more of him. I had many a row, probably more so than most, with the previous Minister, Deputy Harris, but he was very visible. We need to see more visibility from the Minister. I was talking to some people over the weekend and they asked me to share that with the Minister.

In a situation like the Covid-19 pandemic, they want to hear from him as a stabilising voice who can allay their concerns.

We will support this Bill. I think everybody will do so. However, the Bill does not go far enough. We believe it should cover everyone under 18 years of age. We support the threshold changes. The three-phase structure leaves a bit to be desired. If the Minister was in opposition, he would ask for data to explain why it is being done this way. He would also question the value for money achieved by negotiating with GPs on three separate levels. As such, I need to ask him those questions. Here is a question the Opposition Deputy Stephen Donnelly might asked the then Minister for Health. Why is this being introduced in three different phases? Are there value-for-money issues with the hop, skip and jump arrangement leading up to the age of 13? The Minister might answer those questions when he gets a chance.

Covid-19 is the biggest crisis this country has faced in 100 years or more. It is also a disrupter that creates the capacity to change the way we think and the way we do things. It creates opportunity. A window of opportunity is open to the Minister. It will remain open for long and he needs to act to exploit the opportunity that exists. He has made very quick decisions, such as that relating to private hospitals, which, in my view, was the wrong one. Like my colleagues in this House, I have spent whole days talking about bed capacity. One can see how difficult it will be to pursue construction projects. I have no idea how we will create public bed capacity in the short term without nationalising at least one large hospital. The window of opportunity seems to have closed because of the decisions of this Government. I think that is wrong. We have an opportunity and the public is with us.

The public will not tolerate going back to a two-tier health system. Its tolerance for that was ended by Covid-19. The opportunity to make a change arose in the three or four months in which we had a single-tier health system for acute care. That was a missed opportunity which the Minister will regret. The overall bed capacity in our country needs to increase dramatically. We all know the studies. In the coming months and years I will pursue the Minister quite intensely on public bed capacity and his plans to deliver it. I want to know how he will do it. I do not have faith in this Government's initial moves to deliver that.

I despise the cycle of reliance on the National Treatment Purchase Fund, NTPF. Every year it encourages a dumbing down of the public health system. If we keep going to the private health system to bail us out, we will never sort out the public health system. Fianna Fáil Deputies are the biggest proponents of this approach. They always have been. The party's leader, An Taoiseach, has always supported it. That is not acceptable to me. Running to the NTPF every year is completely and utterly unacceptable. This matter needs to be dealt with.

I have several other questions for the Minister. I would like to know what he is going to do about the provision of drugs. We went around the houses quite a bit in discussing how this is dealt with. Our method of procuring various drugs is incoherent. Will the Minister honour what he said in opposition about changing that system? Change is very much needed. A lot of people out there are hopeful and want the Minister to honour what he said in opposition. We need a lot of structural changes and changes to the HSE. We need to ensure that more services are offered in the community and we need to reorganise community structures.

There is one pledge which the Minister will have to honour. At what point during this year will he end two-tier pay for new entrant consultants? I will say it straight: the Minister is out on a limb in respect of this matter. He has hitched his wagon to this promise very publicly, more so than anyone else. When will he deliver on it? He has said that solving this problem would unlock a range of other issues. I agree with the Minister to an extent, but I do not feel as strongly as he does. He has to deliver that this year. I do not think he has any choice. If he does not, he will certainly have failed to honour a pledge. The Minister has said that a lot of the issues with the health service emerged from that problem.

We are very dependent on bringing in doctors and nurses from outside of Ireland. I do not blame the Minister for that, but we need a plan. How are we going to plan to address this issue? I will work with the Minister on this issue.

I want to highlight several issues not related to Covid-19. The mortality rates relating to non-Covid-19 conditions are now higher than that relating to Covid-19. The resumption of service provision has left a lot to be desired. I refer to mental health services, community services, services delivered in the home and home help hours.

The issue relating to disability services is a real bugbear of mine. I will speak a little bit about that issue. People with disabilities are forgotten. I have spoken about adults with intellectual disabilities on two or three occasions in this House. The Minister of State, Deputy Rabbitte, replied to me earlier. She indicated that the Minister would bring a memo to the Cabinet next week. The Minister has the budget, by the way, because the Minister of State does not have delegated powers. These people are being left to rot. I have spoken to many of them throughout the country. I spent a couple of evenings talking to their families. Before half past seven this morning, I spoke to a family whose 29 year old son had been up most of the night because he has no routine. He no longer has the will to keep one.

Resources have been transferred from day services to residential services. As such, those who need day services are effectively being discriminated against. This cannot continue. They need some form of service, even if it is only available two or three days a week. Those people will be outside this House next Wednesday so the Minister can talk to them. This situation is intolerable, upsetting, wrong and immoral. It has to stop. Bringing a memo to the Government which states that there will be some form of service provision throughout Ireland in September will not wash. These people are at the end of their tether. I am pleading with the Minister to ensure the return of services. Just two days a week would be massive.

They have been locked inside their homes only going out for small occasions and they have no routine, no facilities, no stimulation and very little to look forward to. Every day is Groundhog Day. I have met with them and they are destroyed by what is happening. I keep raising this issue because I got so upset talking to them. This is way beyond politics and I am asking the Minister please to help them.

John Wall is an amazing human being whom I have got to know quite well over the past number of years. John is terminally ill and is fighting for medical cards for those who have been diagnosed terminally ill. I do not think there is a single person in this House who would oppose the entitlement of those people to a medical card. John's project, as I call it, has been brought to a certain stage and now we are waiting on the sign-off of the Comptroller and Auditor General. John is well at the moment, but as he says in his letter to the Minister of 21 July - I presume the Minister has received and read it; if not, I will text it to him now - he is begging him to push this issue forward and get it implemented. The Minister has dealt with John before. Some of the people John has been campaigning for are no longer with us and the amount of money involved is small. The previous Minister, Deputy Harris, brought the matter to a certain level and I am now asking the Minister to execute it. Again, this is not a political issue and the sums involved are very small. I ask the Minister to engage with John on the matter and to honour the undertaking of the previous Minister in this regard.

I attended Ruth Morrissey's funeral yesterday. Ruth was a national hero who was not only let down by the State but let down in a way that, for me, was unforgivable. She fought the State not once but twice. I know, because I had communications with Ruth and her family, what she wanted her legacy to be. It was not about getting an apology, because it was too late for that. She wanted the Civil Liability Act to be amended so that no more families would have to go through what she and others went through. Together with my colleagues, I am going to bring forward a Bill dealing with this matter in September. I will work with the Minister on it and I want to see it implemented. Ruth also wanted screening to be brought home. In addition, she wanted to ensure that women would never go through anything like she had gone through. We now have a situation where the tribunal is not sitting and two of the judges have gone off to other jobs. It is an adversarial tribunal. The Minister sat beside me in this House for years and he knows what these women went through. He saw the testimony of so many of them. A piece of work needs to be done to deal with this matter and it needs to be done very quickly.

Last week, I visited St. Gabriel's respite centre in Mungret in Limerick. It is a state-of-the art facility and the best one in Ireland for children with very severe disabilities. It cost €2.9 million to build and is supposed to provide a service for 100 families but it has been sitting idle for two years. It is an absolute scandal. I have never in my career seen a better, more purpose-built building. I am absolutely committed to raising this issue with the Minister. From a funding point of view, the money required is not huge and there are some economies to be made from funding it. A little over €1 million will fund it for 100 families every year. I implore the Minister to look at this issue because the St. Gabriel's facility is the example of what we should be providing for all such families throughout Ireland.

I believe we have a real issue in our acute system when it comes to transport provision. We have a fantastic ambulance service but it is not being ramped up. In the mid-west, which is my area, we have four hospitals all based off University Hospital Limerick and three other hospitals all at the same level, although in different tiers. Transport provision is always delaying how patients are being released from hospital for aftercare or to be taken out of a serious acute setting and into a step-down facility in the other hospitals. It is a ridiculous situation and it is one of a number of reasons that University Hospital Limerick has been left the way it is, because it cannot get people out to St. John's, Ennis and Nenagh hospitals. There is no way of doing it. We need intermediate vehicles and more ambulances. Sorting out that whole system should be a priority because it will unlock certain aspects of the issues with acute services.

Finally, I really implore the Minister to honour what he said he would do in regard to home help. The provision of home help hours is massively important. It keeps people in their homes, prevents them from ending up in nursing homes and, with a tiered-up provision, prevents them from ending up in acute settings. It actually makes economic sense as much as it makes health sense. The requirement here is considerable, not in money but in hours. However, the savings and the health benefits from keeping people in their homes are huge. I have 18 pages of notes I took of things the Minister has said on the record and he has said some serious things about this issue. Taking action on it is a quick win and it makes sense. We have always agreed on this issue and I ask the Minister to implement the necessary action now. I wish him well.

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