Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I commend Deputy Cullinane on a very good, detailed and timely motion tonight, providing an opportunity to take stock of the state of our health service. We have had many accounts this evening of the shortcomings in our health service. Various people read out letters outlining the incredible difficulties people are having in accessing healthcare. It is important to take a bit of time to listen to another letter which was delivered to every home in England in 1948 about the new National Health Service. It reads as follows:

Your new National Health Service begins on 5th July. What is it? How do you get it?

It will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as tax payers, and it will relieve your money worries in time of illness.

Is that not a wonderful letter? Imagine everyone in England getting that through their door. Imagine the value system and the ethos that underpins the political thinking behind that. Here was a country emerging from the war. It was broke, but the Labour Party government at the time and the Labour Party Minister for Health, Aneurin Bevan, had that vision for a civilised society, part of what has to be a modern, caring and inclusive society. He created the NHS and he spelled out to people why he was doing that and what it was.

The most impressive part of that letter was in telling people that it was not a charity but that they were paying for it. Is that not a million miles away from our health service where successive governments have regarded the public health service as some kind of charity? Indeed, for many decades it was provided as a charitable service, mainly from religious organisations. To a large extent, there is still that element and the ethos behind our public health service that somehow this is a charity.

This goes to the core of why we do not have a modern public health service that is universally available and that everybody is happy to use. There has been a mindset within successive governments, including this one, that the public health service is merely for people who cannot afford to go private. Fundamentally that is what the thinking is. I grant that is not to the same extent in Fianna Fáil, but it is a very prevalent view within Fine Gael. That view is not only in respect of the health service. It is also about childcare and housing. There is an attitude that there must be something wrong with someone who cannot afford to pay their own way. That absolutely goes against the thinking in any kind of modern inclusive social democratic society where there is a social contract, where people pay a fair share of tax and in return they get access to good quality public services in a timely way.

I have quoted the origins of the NHS. I am not saying the NHS is perfect by any means. Successive Tory governments have starved the NHS of funding.

It is probably the least good model of universal healthcare across Europe. We are an outlier in not having free access to primary care and other levels of care. What happens in this country is unheard of in other countries. Looking at the NHS and its current shortcomings, almost 90% of people in the UK are happy to use it. The level of private health insurance in Britain is only somewhere around 12% to 15% even after all of the cuts but the vast majority of people there are more than happy to use the NHS and they are proud of it. We know that and there have been many demonstrations of that.

It is part and parcel of the social contract to know there is a service available and the vast majority of people are more than happy to use it whereas almost half of the population here feel they have no choice but to scrimp and save, as many have to, to pay for private health insurance in order to access timely care. It is a massive indictment of successive Governments in this country that people feel they have to fork out thousands of euro every year. It is effectively a health tax and people feel they have to do that in order to be able to access care. People who cannot afford to do that, which is nearly half of the population, are told that they can wait, which is what they do. Some of those people are left waiting for too long and they lose their lives as a result. Other people suffer massive impacts on their quality of life because of health conditions that they cannot access services for. Many thousands of people cannot go to work because they are waiting for hip operations or some kind of procedure. These people are effectively disabled and dependent because they cannot access healthcare.

Many thousands of children are robbed of critical years of their childhood because they cannot access services. We have early intervention teams for children under five years of age. The theory behind them was to pick up on difficulties or conditions that children had at the earliest possible stage. The tragic irony is that some children age out of that because they have been waiting for so long by the time they reach five years of age and the early intervention team is not available to them any longer. Hundreds of thousands of children are waiting for speech and language therapy and assessments of need. Many elderly people have a seriously diminished quality of life because they cannot get access to the kind of physiotherapy and other therapies that they need. We know there are 900,000 people waiting for hospital appointments or procedures of one kind or another. There are the hidden waiting lists, including the many hundreds of thousands of people waiting for community services and then there are the other thousands of people waiting for mental health services, including children and adults. It is a scandal and it is a massive indictment of this Government and successive Governments that they have not been able to tackle that.

I listened carefully to the Minister's speech earlier and he barely referenced Sláintecare. The Minister and his predecessor had the unprecedented opportunity of being handed an all-party plan to take us from the current unfair, dysfunctional, uneconomic and two-tier health service to a point where we could be equal to every other European country in having a universal public health service. The Minister did not have to devise a plan or come up with policy. He was handed a plan and he was told that everybody in this House would support him in implementing it. It is disappointing that the Minister is squandering that opportunity.

The Minister talked about more of this, that and the other. That is fine and extra money and capacity are being provided, which are fine and important but unless the Minister implements reform and, in particular, accountability, that will only amount to throwing money at a dysfunctional health service. The Minister has to do much more than that and follow the reform plan which is set out and which is about establishing accountability. Central to that is the aspect of the regional health authorities because that incorporates a legally-based accountability system for the provision of services and the spending of budgets. Unless the Minister does that, this will be another flash in the pan with more money being provided but without any substantial long-term difference being made. Please follow the plan.

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