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

I commend Deputy Cullinane on the motion he has brought before the House. It is certainly comprehensive. It puts in context the scale of the problems that we are dealing with in our health service. It describes those problems well. The Minister described the problems well also. The difference, of course, is that the Minister is in a position to do something about them. Much of the time we hear commentary from the Minister on the problems in the health service. What are all looking for is action. We are looking for action on the basis of a sustainable approach to tackling the nature of the problem.

The Minister’s recent announcement of €350 million for a waiting list initiative brought to my mind something that happened more than ten years ago. The then Minister introduced a waiting list initiative. Consultants were brought in from outside. Health system consultants were advising on it. I gather that some of those people have been brought in again to advise on some of this. What it boils down to is that the Minister is getting a big pot of money and throwing that money at the health service. Yes, we will get results from that. Additional operations will be carried out. For those people who benefit from that, it will be great. However, it will not do anything at all to reform the system. Not only that, this kind of initiative is about buying services, putting them into the National Treatment Purchase Fund, putting a lot of the money into private sector healthcare and putting some of it into what is referred to as overtime for consultants who are already working long hours. That does not seem to make a lot of sense. That approach of throwing money at the problem actually delays the kind of reform that is required in order to make our health service function properly. As a result, what is proposed is very much a stopgap. While we will get immediate results, once the money stops, the additional operations will stop as well. The Minister might look back to ten or 12 years and see what the experience was like then, because it was not good. I see this as a repeat of that.

A statement was made to the effect that the aim is to ensure that nobody is waiting for an outpatient appointment for more than 18 months. That is pretty shocking. For somebody with a serious health condition to be told “We guarantee that you will not have to wait more than 18 months” is just not acceptable. That is light years away from the kind of waiting time limits that are set out in Sláintecare. The Minister has a clear plan. The solution to this is to implement the reforms that are contained in that plan. While he talks about those a lot, he actually is not doing a huge amount about implementing them. I have to refer to the mistake that was made last year. It was a very serious mistake and I think we will pay a big price for it. That was the circumstances that led to the resignations of people who were leading this Sláintecare reform programme. The original plan was that the Sláintecare implementation office would be entirely stand-alone. It would have its own separate budget. That was what happened initially. Of course, the recommendation was that that stand-alone office would be located within the Department of the Taoiseach. This was so that it would have the clout of the Taoiseach and his Department to ensure that roadblocks were cleared. That is what happened with the cancer strategy, which was very successful. Unfortunately, it was not located in the Taoiseach’s office, but in the Department of Health. However, we still had confidence that this could deliver. It was delivering. It was making substantial progress until things stalled in respect of some key elements of Sláintecare. That, as the Minister knows, resulted in the highly regarded Tom Keane and the equally highly regarded Laura Magahy moving on.

The Minister chose to replace that independent, separate, single-focus office with a board led by the Secretary General of the Department and the chief executive of the HSE. In my view, that was a serious mistake. These are two people who have high-profile, high-pressure jobs. They operate on the basis that they deal with the emergencies that arise on a daily basis. They have little time to devote to a reform programme. A reform programme has to be independently, separately driven. I think we are going to lose out badly as a result of that. Those two individuals recently appeared before the Joint Committee on Health. The committee was seeking an update on the reform programme. Unfortunately, we were disappointed to the extent that the Secretary General, Mr. Watt, indicated that he did not understand one of the central recommendations of Sláintecare, namely, the regional plan. He talked about the community services coming under the remit of the hospital groups. That was just last September. The Minister just spoke about standing down hospital groups. That indicates that there is not a great understanding of what is involved.

It is not just me who is saying this. It is important that we look at the Department’s Sláintecare strategic action plan progress report. That is across the two key programmes in Sláintecare. It is worth going down through the progress report from the Department. It rates various measures as improving, disimproving or trending same. The project on enhanced community care and hospital productivity are both disimproving. This information is based on the last six months of 2021. A large part of that period was when the Sláintecare office ceased to exist and the two leaders to whom I referred earlier left.

The project to streamline care pathways. from prevention to discharge is listed disimproving. The project to develop elective centres in Dublin, Cork and Galway is an essential part of Sláintecare because, as Deputy Howlin just said, we have a lot to learn from the private sector in terms of efficiency and specialisation. Some of the clinics, such as the Sports Surgery Clinic in Santry and others throughout the country, specialise in particular aspects of healthcare and do not have emergency departments. It is a kind of conveyor-belt system. It is highly efficient. That is why a key element of Sláintecare was to recommend three elective-only hospitals. We learned from the experience in Scotland where it has been very successful. They took over a private hospital and are building a second one. That is what we recommended. The position in that regard is actually disimproving. Progress should have been made. We were told that the locations for the three proposed hospitals had been identified and that they were to be announced a number of months ago. We are still waiting to hear about those locations. The position has disimproved.

The project to implement a multi-annual waiting lists reduction plan has disimproved. The project to implement the eHealth programme has also disimproved. What I am referring to are the Department's grades in respect of these different measures. The project to remove private care from public hospitals and implement the Sláintecare consultant contract is disimproving. In addition, the project to develop policy proposal and options for achieving universal eligibility across hospitals and community settings is disimproving. Several other areas have remained the same. Progress was not being made at all in the latter half of 2021.

The Minister needs to take responsibility for all of this. It would seem that Sláintecare has stalled. In spite of the claims he made earlier, the Department is bearing out what I am saying in its progress report. The overriding issue that the Minister has to now deal with is the recruitment issue, particularly of consultants. None of the plans that the Minister has set out in the waiting list initiative will work unless he recruits consultants. He needs to implement the Sláintecare consultant contract. Last October, he said he wanted that done within a matter of weeks. We are still waiting for it to happen. The Minister needs to appoint a new chair for those talks because the previous chair moved on to other duties last month.

We still have not appointed someone to replace that chairperson.

The Minister talked about the need to find out why we cannot recruit consultants. I refer him to the hospital doctor retention and motivation project funded by the Health Research Board, HRB, which is almost complete. Will he please read that research? I will send him the reference. The project sets out clearly the reasons we cannot attract Irish-trained consultants back home. Unless we crack that nut, we will not make any progress.

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