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

Okay. The Taoiseach was asked and he completely ignored this request. If we are to have accountability to the Dáil, which Ministers are provided to provide, then we need to have questions and answers. As I said, I do not know what the purpose of this session is.

The whole issue of the underfunding of health, of course, actually started last year. The allocation made in budget 2023 was not sufficient to maintain the existing level of service and to provide for new services. The whole question of a budget campaign for any Department is a key aspect of the activity of that Department, in terms of the Minister and the Secretary General. Quite clearly, that campaign on the part of the Department of Health was not sufficiently successful last year. This was spelt out very clearly. We know there was a three-month delay in approving the service plan. We also know that a senior member of the HSE board resigned over this because he was not prepared to go along with the pretence that it was possible to deliver that service plan when there was a black hole of €2 billion in the allocation.

I must say this does raise questions about the ability of the Minister's Department, and senior people in it, to make the case sufficiently and to secure sufficient funding for the health service. Additionally, in the early months of last year, we saw the acting head of the HSE at that point being very clear about the shortcomings in what was allocated. An attempt was made by the Minister's Department to silence the person and to get that person to go along with the pretence that the money would be fine. Of course, we know it is not and we are facing a significant deficit this year.

I wish to talk for a few moments about the Department of Public Expenditure, National Development Plan Delivery and Reform. I think that Department is a disgrace. It is by far the most conservative Department in this country. It does not seem to have any appreciation at all of the fact that it has a role in relation to reform. I do not think it gets the reform programme that is under way, or that has been under way, within the Department of Health. When we look at the kind of spinning that the Department of Public Expenditure, National Development Plan Delivery and Reform engaged in this time in respect of other Departments, it was telling them that they could not get their allocation because of what the Department of Health had done. It claimed that we spend more in this country on health than in any other OECD country. Both those things were lies being spread around by the Department of Public Expenditure, National Development Plan Delivery and Reform.

Equally, some of the inherent and fundamental problems, the structural problems, in the HSE are largely down to the failure of the Department of Public Expenditure, National Development Plan Delivery and Reform to understand what providing a decent health service is about. I refer to those things that are critical to ensuring value for money and a properly functioning system. I refer to the individual health identifiers, which is a key element in this context, the digital health strategy and the need to ensure multi-annual funding is provided. The Department of Public Expenditure, National Development Plan Delivery and Reform just does not get that at all.

I am not sure where these people come from. Do any of them actually depend on the public health service? Is it a case that they are okay because they have health insurance with VHI, Laya Healthcare or whatever? Do they get what a public health service is about? The other aspect, of course, is the failure to fund an integrated financial management system. This is why we cannot get to the bottom of the black hole of the funding of the HSE. We do not know where the funding is going and we do not have the data to measure what is going on.

I cannot help but comment on the fact that the Secretary General of the Department of Health came directly from what was then the Department of Public Expenditure and Reform. Is there a mindset there that does not understand about what a public health service is and does not understand that we have an agreed, all-party strategy for health that is about creating a single-tier, universal health service, comparable to what is available in every other country in Europe and most other developed and advanced countries? Do those people not get that? What is wrong with that mindset there that it is so shortsighted and unappreciative of the shortcomings in our health service?

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