John McGuinness (Carlow-Kilkenny, Fianna Fail) | Oireachtas source

I am delighted we are having these statements because it gives us all the opportunity to put on record what we believe should be done in health or our views on the various aspects of the policies of health. I am sure there is nobody else in this House who will appreciate more than the Minister himself that what gets counted gets done. Is that what we are doing? I have been here at various budgets and I have seen the health budget increased year on year with substantial amounts of money. How is that money being managed? In her contribution to this debate, Deputy Shortall is correct that we have to go back to how reform is treated in this country by this Government and by successive Governments. When we examine it we will see there is little or no reform around the management of taxpayers' money in most Departments and particularly in health.

For years we have debated the integrated finance system and the integrated management system for patients and nothing has happened. We have seen very senior people from the commercial world resign from boards of the HSE or from activities within the HSE because they say they met with huge resistance to change. The status quoin the Department of Health and the HSE cannot continue. It cannot continue because regardless of how much money we put in we are not just funding the services in the HSE and the delivery it is responsible for, we are also funding the huge waste that went on the previous year, the year before, the year before that. If we do not correct that we will be in the same difficulties next year and the year after regardless of which Minister is in place.

I welcome the fact the CEO of the HSE is briefing people. It is a great idea. I do not see anything wrong with it. He does not work for the Government and he does not work for a political party. He works for the HSE and he should be telling it as it is just as Ministers should be brave enough to put their names to the statements we are reading in the papers about what they think of the Minister or the allocation. They are showing total irresponsibility. They are irresponsible in their statements. They do not have any regard for the impact of those statements on people who are working within the HSE or those receiving services from the HSE. They certainly do not have respect for the patients, absolutely not. They are showing an awful lot of weakness in their own characters. If we are to have budgets and if we are to have a well-run organisation to deliver on those budgets then we must start telling the truth. Somebody in the HSE or in the Department of Health has to tell the truth about what is happening. Did anyone hold an exit interview with those people who resigned from the organisation? Did anyone take up the recommendations of Dr. Eddie Molloy, for example, who in the AV room many years ago told us we can have as much reform as we like but if we do not have the change managers in place to implement the reforms - I am referring to the bureaucracy of the HSE - then we will never have real reform?

One of the ways we get information from the HSE is through parliamentary questions. A parliamentary question was sent to the HSE in relation to the section 44 report, which is all about money owed to people who are now retired or a cohort of people still working in the HSE. I asked if the €42 million was set aside to meet and cover that expenditure. I was told that the question could not be answered and yet the information was released to some other individual under a freedom of information request, not a Member of the House. There is a need for fundamental change in our attitude towards transparency and accountability within the HSE. We are not getting it. Until we get that then we will continue to preside over all sorts of misspending, inefficiency in spending and poor planning. Change and reform is not only about money and how we spend it: it is about planning for the loss of jobs and people leaving positions; it is about having the correct number of GPs; it is about having the correct number of consultants; and it is about ensuring that Government policy is put in place.

I have heard a lot about Sláintecare. We hear a lot about it and then we do not actually do anything about it and we ignore it. Either the HSE management is wrong or the Department of Health is wrong. It is, however, the responsibility of the Minister and Ministers of State to give leadership in the Department to make sure the reform happens and to make sure the services are delivered. There is a political obligation on all of them to take steps to make sure this happens. The people I represent will judge that reform on the delivery of services. For example, people who are on various medications that come through the medical card system and are collected from their pharmacy cannot now get that medication because of the lack of product on the shelves at the chemist. What do they do? They are paying for it now from their own pockets. The Minister needs to correct that immediately and ensure that they get paid for whatever replacement product is there and that it is covered by the HSE and covered by the medical card.

The Minister of State, Deputy Butler, was very good with regard to the spend for community homes but that money had to be dragged out of the Department if the truth were told. Why should that happen? A policy decision was made and the money was given but we all had to kick up a stink in this place in order to get it paid. Not only should that money be paid there should be a plan in place by a group within the HSE to ensure that whatever money is needed for this year and next year is paid in advance or at least on time. Commercial contractors are owed a considerable amount of money. These are contractors to hospitals doing various tasks and delivering services and they are not being paid on time. The HSE is actually putting at risk commercial entities throughout the country by simply blaggarding them by not paying. That is not good enough.

I want to mention CAMHS. Last weekend, a young child aged nine had an exceptional meltdown, according to her parents. I know the case quite well,. There were no services available for that child - none, zero. I was told to come back on Monday. The parents were not even contacted on Monday but they were told on Tuesday that they would be considered at some meeting this week. How in the name of God can we explain to the parents of that child that these are the services we are standing over? Money needs to go directly to where it is most needed. We need to employ the people there and we need to ensure that the staff are provided. We, therefore, need the planners to do their job. If they do not do it, let them get a job somewhere else. That is what needs to be done here. Drastic action needs to be taken because there are no services and there is no real effort that I can see to fill the vacancies and get people attended to.

I have raised SOS funding in Kilkenny umpteen times. The individuals are referred to now as business cases; they are not. They are individuals who need specialised care. They are families who are in distress. Managers within the system are in distress because they are being ignored, not just this year but going back over the past five years. Respite care is not being delivered. Somebody has to step in and give leadership in all of these areas. The mental health system is not just broken; it is in a shambles all over the country. It is no comparison to the private services being delivered. We should be delivering to that level. Telling a patient who is suicidal and in real difficulty to give us a shout back on Monday and we will try to fix it up is just farcical.

I appeal to the Minister of State, Deputy Butler, because she has visited the facility. Teac Tom is running into serious financial difficulties. We are meeting HSE officials on Friday. If they tell me they are going to do a report or that we will see about funding for the future, and it jeopardised the continued services being given by that voluntary organisation, I will be in this House demanding that the Minister of State meet with Teac Tom and the HSE to secure the funding. Likewise with the cancer services, voluntary organisations are filling the gap where the HSE should be, yet they are not being acknowledged by the HSE or the Department. They are having to fight for every cent to keep their services going. I am aware of them all over the country. We had them here yesterday in the Dáil lobbying. I am aware of the services in Kilkenny such as Cois Nore. I am giving the Minister that example. He should immediately set out a pathway to fund all these services. These services are filling in where the HSE has failed. Yvonne - not her name - went through the services in Waterford University Hospital. Her family fought for the services that were needed. They fought for respite care and asked that she be sent to Thomastown to be looked after. She died. She had not been washed for 16 days. She had the same clothes on her for 16 days. I cannot stand over that health service.

All the Ministers today would give the impression that everything was okay. They are all constituency operators. They are all elected and work in the same way as we do. They know damn well the system is not working. They know the money is not going directly to the different areas that I have just mentioned. There is an awful lot more. The other example is Covid recognition payments. The Ministers know from the letters they are getting that these payments have not been made to people who are on the front line or who left their jobs to go to the front line. They have not been paid. I am asking that the Ministers take not of what is being said in this House. They should not take it as a personal criticism but as constructive criticism. Going back to Deputy Shortall's point, maybe the Minister is not here to answer questions. That was the way it was arranged. There is nothing to stop officials from going back over the contributions that are made, writing back to the Deputies and giving them the answers. That would be a start as far as transparency goes.

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