Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank colleagues for taking the time to contribute to the debate. I listened very carefully to the debate and there are some common themes. In spite of the fact that there are differences of views, there is actually an awful lot on which we are broadly in agreement, if not on all the detail then certainly on the main themes. One of the most important is what our collective ambition is for healthcare in our country. We are united on that. We are agreed that we are looking to provide universal healthcare in our country, a public health service whereby people get the care they need when they need it. It is very important and very useful that we are all united as to where we need to go.

The other theme we are united on, broadly, is how we need to get there. There was broad agreement that we need to continue to invest in community-based care, be it mental health services, disability services, primary care services, general practice or whatever else. There was broad agreement that we need to continue to invest in our hospital sector. Nobody questioned moving to a regional model. Nobody questioned our move to joined-up care for the patient from his or her home to his or her GP, to primary care services and to hospital services.

Critically, then, unlike in many other parts of our country and our society, we are pretty well in agreement on where we are trying to go and, broadly, how we get there. We all know we need to have much better digital services and e-health services. We are agreed that we need more hospital consultants. We are agreed on nursing levels based on safe staffing frameworks. That is a very positive thing, and that is what will bind us together from government to government in getting to this place that we are all fiercely determined to get to on behalf of everybody.

While there might be differences of opinion as to how much progress has been made, I have heard broad acknowledgment that, while there are very significant challenges in various areas that we must address - they might be in individual services, in an individual hospital or in a part of an individual hospital - a lot of progress is being made, not by me, not by the Ministers of State here, not by the Government and not by us in the Oireachtas, but by the doctors, nurses, health and social care professionals, hospital managers, porters, cleaners, care assistants and all our healthcare professionals. They are working so hard, and they really are making a difference for patients.

Let me take our cancer services. Our screening services are far more advanced than they were even ten years ago. We are identifying cancer earlier and earlier. The rapid access clinics are fantastic. They were not in that place ten years ago. We are consolidating services. Tomorrow I will launch a new state-of-the-art radiation oncology service in Galway University Hospital. We have psycho-oncology services. We have access to better treatments, be it radiation oncology, chemo or cancer medicines, than we have ever had before. For those who unfortunately do not make it through, we have palliative care services that we did not have. They did not look anything like they look like today even ten years ago. There is broad agreement that, in spite of the many challenges to come, our healthcare workers, not us, are making things better for patients. Services are getting better. The women's health services that are being rolled out, including see-and-treat gynaecology centres, menopause, endometriosis, perinatal mental health, maternity services, eating disorder teams and so much more, are getting better and better. We can emphasise different amounts but we are broadly agreed that that is the case.

We are also agreed that there are real challenges that we must still overcome in youth mental health services. We have huge opportunities that we need to seize as regards health and well-being. More needs to be done as regards addiction services, treatment and rehab. We know that our clinical services need to go further. We know we need more neurorehabilitation. We know we need to invest in new medicines and I am acutely aware that there is no new development funding for medicines.

I have explicitly told the HSE and the National Centre for Pharmacoeconomics that any savings that can be found next year can be reinvested into new medicines. To give colleagues a sense of that, our medicines budget is at about €3.2 billion. A 0.5% saving would give us €16 million next year for new drugs. The new drugs budget for this year was €18 million. Therefore, a 0.5% saving gets us to broadly what the new drugs budget was for this year. I am having conversations with the National Centre for Pharmacoeconomics about individual high-cost drugs that are coming off patent next year, for which we want to immediately move to generics and biosimilars where that is clinically appropriate, to accelerate savings. We can find that money, although it remains to be seen how much, and we will ring-fence it for new medicines. The biggest challenge is access. The budget funds the waiting list action plan, which is working, and it funds the emergency department plan as well. We will keep driving on with taking people off the waiting lists by getting them the treatment for which they have been waiting for too long, and important progress is being made.

I heard from a lot of Deputies, both in Opposition and Government, that we need to focus on productivity and I agree. Over the last three years we have put a lot of these measures in place and we have put a lot of structural productivity measures in place, including moving patients out of hospitals and into the community. That is better for the patient and it is also much cheaper to treat the patient. We are investing in advanced practice. For example, we have advance practice nurses seeing a lot of patients who would have previously had to wait to see a consultant. The patient is getting much quicker access and we are getting expert care to that patient at a fraction of the cost of them having to see a consultant.

I hear colleagues say that we have a long way to go and we do. We will never have a really productive health service until we have proper ehealth. We just will not have it. I hear colleagues say that we need to accelerate the financial management system and we do. I have put an additional €40 million into the budget this year to accelerate the roll-out of that so that we can get proper line of sight of spending right across the service. It is worth saying that when we talk about the service and a culture of cost control within it, I do not accept the view I have heard expressed in some quarters that there is no respect for money or a culture of cost containment in the HSE. That is not true. When we look at the HSE, community services, mental health services, older persons services and primary care services are on budget. A lot of parts of the HSE are on budget. The one part of the HSE that is spending beyond what it is funded to is our hospitals and that is because they are not going to turn away the patients who are coming in. There is more we can do in productivity and we will do that.

It is clear from listening to the contributions from Dáil Éireann this evening that we need an agreed baseline for how much money it will cost us to get where we all want to go. We all want to get to healthcare for everybody and we all broadly agree with the steps we have to take to get there. What we have not had so far is an agreed and independent assessment of how much that costs, including this existing levels of service, ELS, funding we all refer to, which is just the amount of money needed from year to year to keep the current services going. How much does that cost? This is a world where we have, as Deputy Pringle said, a level of population growth that was not forecast. It is beyond what the statisticians forecast. We have a large number of people coming into the country fleeing war who we must and will always help and provide health services to. We have huge healthcare inflation, driven partly by the war in Ukraine and partly by Covid. We have an unprecedented and unforecast wave of patient need because of Covid, driven partly from unmet need or deferred care during Covid.

I am setting up this study and report to give us that so that we can have an agreed baseline for how much money it will cost, and then we will have a simple conversation before us. We know where we want to go and if we can get an agreed view on how much money it will cost to get there then we can agree that we will fund that, and it is more expensive than is broadly understood by all of us. It is an expensive journey but a worthwhile one. Alternatively, we can decide that we do not have that funding and we can say we will do it more slowly, for example. I think we should move there as quickly as we possibly can. That is one of the things I will take away from the last few weeks and from the Dáil debate this evening, namely, the sense that we need to get that work under way so we can all have an independent assessment of how much it will cost us. If we achieve this, and we will do so together as we are all signed up to universal healthcare and Sláintecare, as a nation we will have achieved one of the cornerstones of a decent society and of our Republic, that is, to make sure that everyone can get access to great healthcare when they need it.

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