David Cullinane (Waterford, Sinn Fein) | Oireachtas source

We were all hoping that we would hear more from the three Ministers today. Today, from my perspective, it is more about the Government trying to control the narrative, change the story and shift the blame but not fix the problem it created with the chronic and very deliberate underfunding of our health service. In reality, we are now being told that we should stand logic on its head, that previous statements from the HSE, from the Department and from the Minister for Health should be set aside, and that black is white. That is what we are being told here today and I will explain why.

In her contribution, the Minister of State, Deputy Naughton, said funding to maintain existing services has been provided to meet inflation and rising patient demand for next year. That is simply not true. Some funding has been made available but not all of what is necessary. That is what the head of the HSE said on RTÉ this week. It is what the head of the Department said at the Oireachtas Joint Committee on Health a number of weeks ago. They spelled out what was needed to maintain existing levels of services just to stand still. That does not even deal with whatever recurring expenditure from this year's deficit will carry over to next year; it is just to stand still. Ministers have stated we have provided the funding for the health service to stand still for next year, but we have not. That is why the head of the HSE has clearly and publicly said that the health services are not properly and adequately funded.

The Minister for Health said we simply do not know at this point what level of demand will be seen and what level of health inflation we will have to cope with next year. He is correct in saying that, but in recent months we have been told by him, by departmental officials and by the HSE that there are three drivers for the deficit for 2023, which we know will be €1.5 billion. They are health inflation running at between 17% and 20%; an increase in demand because of an ageing demographic, population changes and illness circulating in the community - Covid and all those things have obviously increased demand; and an inability to deal with cost controls. However, two thirds of it are essentially outside the control of the head of the HSE.

When those individuals appeared before the Oireachtas Joint Committee on Health, they told us that the vast majority of the deficit for this year will transfer into next year. The Minister has provided no additional funding for that. He has provided some one-off funding but has not provided for any of that. Health inflation will certainly will not be zero and we will certainly not see a collapse in demand for health services. I do not have to tell the Minister; he knows in his heart that the health service has not been properly funded.

The best of all is commissioning an in-depth report into the future cost of healthcare. I welcome that because it is necessary for all the reasons the Minister has set out. However, in the context of what we are dealing with today, it is a fudge. It is an attempt to shift the responsibility and change the narrative to something that is not the case.

In the days since the budget, I have listened to many Government representatives talk about the issue of health spending. They are trying to blame all this on wasteful spending in the HSE. They claim that if we could rein in the wasteful spending and if the HSE did better, we would not have this big black hole in HSE finances.

It plays well to a narrative - let us be honest - but it simply is not the case. As the Minister has conceded, the majority of the deficit is outside the control of the HSE. Even if we were to achieve savings in the areas where we can achieve them, it would not come within in ass's roar of dealing with the deficit for last year and next year.

I have argued for years with the Government and the Minister, as has my predecessor, Deputy Louise O'Reilly, and her predecessor, Caoimhghín Ó Caoláin, about way too much money being spent on outsourcing in healthcare, on agency and on management consultancy, and the lack of digital transformation, electronic patient records and a single integrated financial management system in the health service. We have long called for a single integrated waiting list management system. If all that were in place, and if corrective measures had been taken a long time ago, we would be in a better position. We therefore do not have to be told by any Government backbencher or Minister about reforms in healthcare. We have spelled out chapter and verse what can be done to fix the problems in healthcare, make the health service work better and deliver greater efficiencies.

All of that, however, has now been used as an excuse by a Government that made an intentional decision not to properly fund our health services, and there is a responsibility on me and others in opposition to spell out the consequences of that. We know we have a recruitment embargo now in place. That has now reached into the front line to non-training junior doctors, some healthcare assistants, some home help workers and many other areas. Clerical grades are also needed to provide a lot of the healthcare infrastructure which will be needed. We know that 7,000 posts which were approved but not funded are now gone. I still do not know about these 1,500 beds the Minister announced a number of times or when we will see an announcement on them. Certainly, there was no additional capital funding or a mention of them in the budget. All of that will concern people. There is concern about all the clinical programmes and national strategies and access to new medicines. All those will be really important. I am concerned about the impact all this will have on patient care.

I will give the Minister a local example. We can all talk about the abstract and big figures running into billions. The quantum of money can bamboozle all of us. The stark reality is that this budget will have an impact on patient care next year. I have absolutely no doubt about it. I contacted the manager of University Hospital Waterford. The Minister has rightly praised management, as I have and as the Minister of State, Deputy Butler, has done, for the work it has done to ensure we got to zero patients on trolleys in that hospital. One of the reasons the hospital achieved that is it was allowed to open a medical ward. It is medical ward 6, which has 35 beds. Almost all the staff who keep that ward open are from unfunded posts or agency staff, so the manager told me that, in reality, he should really be closing that ward. He certainly will not have the staff to keep it open. The consequence of that is 35 fewer beds, and in a hospital that achieved zero people on trolleys, it could now be back to people on trolleys again. However, the manager does not want to do that so he has been forced into an impossible position of having to take staff from elsewhere. One of the areas from which he can take staff is cardiac care and the operation of the two cath labs, including the second one that we worked so hard for, and there will be fewer planned procedures.

The Minister was in University Hospital Waterford some months ago opening the palliative care centre and he announced that the emergency cardiac services, which now run from 8 a.m. until 8 p.m., Monday to Friday, will become a seven-day-a-week service. I am sure he will know, because he would have been briefed, that that means we need more junior doctors, more doctors generally, support staff, administration staff, porters, nurses - a whole range of posts. Again, managers in the hospital have told me that some of the grades necessary to deliver that are now on the recruitment embargo list, so that can be forgot about until that is lifted. I have no doubt that if one goes through every single hospital in this State, there will be similar stories.

National strategies cannot be starved of funding. Cardiac, cancer care, diabetes and all those really important strategies need year-on-year, continuous funding. If we do not provide the additional funding, they simply stand still. I am on record as accepting the additional investment that has been put into healthcare in recent years. There are lots of things on which I have agreed with the Minister and the Government - public-only consulting contracts, the enhanced community care model and so on - which I know will serve the health services well. However, there has to come a time, when mistakes are made, that we are very clear, honest and forthright in our approach to what this Government has done as regards healthcare. There is no doubt that if it were a Sinn Féin Government sitting opposite and we made the decision this Government made to deliberately underfund the health service, with all the consequences - a recruitment embargo in place, beds which are needed and may now not be funded, no new medicines for new drugs - the current Minister would be making exactly the same speech I am making today because he knows that what I am saying is true.

It was really regrettable that some Government Members - not the Minister for Health - tried to throw the head of the HSE under the bus and made some misleading and inaccurate statements about briefings he has given me, which he has not given me. The only information I ever got from the head of the HSE was when I contacted him to seek clarity. I am sure the Minister will agree that it is important we have factual information and not misinformation. There lots of other things I have read over the past 24 hours which I do not believe are helpful. This person has come into the role, has been six months in the job and has a job to do. What has happened is part of this pushback and this shifting the narrative and trying to blame somebody else, rather than taking responsibility for the decisions that have been made.

Here is the point. There may well be a Revised Estimate - there has to be one before the end of the year - and we know now that the deficit for 2023 is €1.5 billion and that it will have to be paid for. If it is not all paid for in a Revised Estimate, some of it will carry over into next year. However, when the Minister says we do not know, that is not true. We may not know the full extent of it but we certainly know that the vast majority of it will be recurring. It has not been provided for, however. What the Government provided for in the budget was €707 million for existing levels of service, €100 million for new measures and then an expenditure line of non-core, one-off funding of €1.032 billion, which includes Ukraine money, waiting list money, money for Covid and then this resilience fund of €480 million. However, it is not core, does not go into the base and does not deal with the permanent funding the health service needs. If we had a big black hole in the health budget last year, we will have an even bigger black hole in the health budget next year. The Minister has left the head of the HSE, clinical leads across the healthcare system, hospital managers and those who are trying to deliver healthcare to the best of their ability, as well as all the front-line staff, in the lurch.

The final point I will make is this. The last message we needed to give out at this point in time, when we struggle to recruit staff, is the words "recruitment embargo" because that will resonate and will be felt and I think more people will leave. When I was in St. Luke's hospital in Kilkenny this week, hospital management told me it was fighting to hang on to non-training junior doctors. The HSE is trying to poach them. Now they have been given a green light to go to the NHS and elsewhere because they are on the recruitment embargo list. For all those who are in training colleges and whom we want to come and work in the public system - and the Minister talked about increasing training places - the message they have now heard from budget 2024 is "recruitment embargo". I know it is not across the system, but the very notion there is a recruitment embargo at a time of crisis in healthcare, with a million people on waiting lists and all the issues we have as regards emergency departments and so on, just beggars belief. I am very disappointed that no news or new information came from the Minister today. That is regrettable.

See this speech in context