David Cullinane (Waterford, Sinn Fein) | Oireachtas source

Budget 2024 demonstrates, from my perspective, how the Government has thrown in the towel on health. This budget lacks ambition and vision. More than that, it lacks the funding that is necessary to properly fund our health services.

The Minister may be aware that over the past 24 hours there has been a perception that he has been thrown under the bus by the Government because of the cost overrun in the Department of Health. In reality, the people who have been thrown under the bus are the patients, those on the front line in healthcare, all of those groups that advocate for better healthcare and those who were hoping to see more new funding for healthcare next year. It simply is not there. Whatever about the internal positioning within the Government, there is a responsibility on the part of the three party leaders, the Tánaiste, Deputy Micheál Martin, the Taoiseach, Deputy Varadkar, and the Minister for Transport, Deputy Ryan, to ensure that the health service is properly funded. We have all known for some time about what the health service needs for next year. I have spoken to the Minister for Health about that being done over a number of years. Yet, what I have seen in this budget really worries me in the context of where the health services is now and how it is being funded.

Three times this year, the Minister spoke about 1,500 inpatient beds for hospitals. These were not just to be 1,500 additional beds; they were to be rapid-build beds. We were told that these would be delivered at speed. There would possibly be 700 of them in 2024 and 700 or 800 the following year. I do not see a single additional cent for those beds in the budget. The matter was certainly not referenced in any of the contributions by the Ministers opposite, that is for sure. The only way the Minister can fund those beds next year is by raising the existing national development funding for healthcare and the capital allocation for health. If the Minister were to do that, it would mean that whole projects in the area of healthcare would not be funded, would be put on hold and shafted, in order to deliver those beds. If any of us are to propose additional beds in healthcare, there has to be additional capital funding and I do not see that. There is a question for the Minister to answer in relation to those 1,500 rapid-build beds, the need for which he spoke about in robust terms, and rightly so. What is the position with them?

There has been no additional money for new medicines. We know what the consequences of that will be for the people who will now have no access to some of those. While they will still have access to the existing budget, because there is no new money or additional funding means that there will potentially be some high-tech innovative drugs and patients may now not be able to access them. One has to continue to increase funding in this area while achieving efficiencies in the overall spend, which I accept.

There has been no additional money of substance for CAMHS. I know the Minister has said there is some funding, but what I see in the budget is a €7 million allocation for lots of different things. CAMHS is mentioned as part of that. I would like to hear what the breakdown is. How much additional funding is being given to CAMHS? Whatever it is, it is nowhere near what is needed when one considers the scale of the crisis. There has been no additional funding for national strategies, which live or die on the funding they get. Therefore, if we do not provide the funding year on year for those strategies, they will stand still or go backwards. We are talking about the areas of cancer, cardiovascular health and the maternity strategy. When people who deliver those services look at this budget and see that there is no funding and when people who advocate in these areas look at the budget and see the same thing, I can tell the Minister that they become very worried.

There is no additional money to cut the cost of healthcare. All of us here are committed to Sláintecare. I have commended the Minister in the past on some of the measures taken, such as abolishing charges in hospitals and additional GP cards, which we also called for last year and which are, thankfully, now in place. However, we have to continue with that every single year if we are serious about delivering a universal healthcare system. That is why we proposed the package of measures that I will speak about in a moment. There has not been one cent of additional funding of substance to cut the cost of healthcare in this budget when compared with previous years. We speak about incrementally moving towards delivering on that core commitment of Sláintecare and universal healthcare. We have now stopped that, and that also concerns me.

There is very little money for primary and community care. While I see some funding for GPs, advanced nurse practitioners and some areas, it is quite small. It is certainly nowhere near the scale of what is necessary. Again, I have commended the Minister, and rightly so, for the enhanced community care model and the foundation that has been put in place in recent years. However, I am sure the Minister will agree that we have to continue to invest year on year if we want to ensure that people get the right care, in the right place and at the right time. There has been no additional funding of substance for digital transformation. For me, that is one of the big issues for driving reforms in healthcare as we look to regional health areas. Those are the enablers in dealing with the healthcare system.

In our alternative budget, we provided for 1,800 additional beds over three years. We were honest and upfront in saying that it would take that length of time to deliver them, because we need to be clear. We proposed €20 million for new medicines, €75 million in additional funding for mental health, €145 million for national strategies, €240 million to cut the cost of healthcare and €100 million for primary and community care.

If I were sitting in the Minister’s spot today and Deputy Doherty was Minister for Finance, we would have been announcing 400,000 additional medical cards. The qualifying income thresholds have not been touched in years. While I accept that this year was not the time to increase the number of medical cards again and that we must allow some breathing space, there was an opportunity to expand the income thresholds, which we would have increased by €10,000. This would have delivered the 400,000 additional cards. We would have cut the cost of medicines by reducing the drug payment scheme threshold from €80 to €50. We would have abolished prescription charges, phased out car parking charges over a number of years and reduced the minor injury unit charge from €70 to €50. We would not abolish the minor injury unit charge because we do not want the unintended consequence of people going straight to minor injury units instead of to GPs first. We would have provided additional money to expand access to contraceptives and IVF. Given what has happened, I am concerned that there will be delayed access to new drugs and therapies next year.

There have been a number of reports by the Mental Health Commission, which has set out reforms that it wants to see. Some of those would require funding. The Minister will accept that mental health services needed more money than they got this year. We needed more money for our hospitals to deal with capacity issues in emergency departments. Learning from best practice in other hospitals, there are steps that we could take regardless – this is something that I have raised previously – but we all know that, year on year, we have to increase capacity, be that in beds, surgical theatres, diagnostics or staffing.

This is not even a standing still budget. I spoke with officials from the Department of Health a number of times in the lead up to the budget. There is no breaking confidentiality in my saying this, as they echoed in private what they had told me at a meeting of the Joint Committee on Health a number of weeks ago. They said that this year’s deficit would be somewhere between €1.1 billion and €1.4 billion. There will have to be a Revised Estimate to deal with that. Most of it is down to recurring costs and needs to be included in the base costs at some point, but the Minister got very little in the budget to deal with that. In fact, what he got to address this issue was only temporary. There is a resilience fund of €480 million, but to say that it is papering over the cracks is an understatement. Separately, the officials told us that maintaining existing levels of service would require at least €1 billion, yet the Minister only got €707 million. This means that we will be underfunding the health service massively. There is a big black hole in the health service’s finances this year with a potential deficit of €1.4 billion. I wonder who will be right when I make the claim that the potential deficit will be even larger next year. That is my concern. This is not the way to fund a health service or to have a true and accurate reflection of what the health budget should be.

My main concern is for patients and those on the front line. I do not doubt the Minister’s sincerity in wanting to deal with the waiting lists and emergency departments, to expand services in primary and community care and the health service to work better, and I have commended much of what has been done in recent years, but I am concerned about what I have seen in this budget. It would be remiss of me not to be robust in saying that I am concerned about the impact it will have on the health service in future. Regardless of who is in government after the next election, that large deficit will have to be dealt with at some point. We cannot continue to park it, fudge it and brush it under the carpet or allow it to become an issue of interparty rivalry at budget time. We must view this matter more seriously, but that did not happen this year. While the Minister has to bear some responsibility for that, the leaders of the three Government parties have even more responsibility to bear.

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