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

It is quite infuriating when debates are reduced to the level of personality clashes or something from the past. It is quite annoying. The point I was making, and I thought I had made it quite strongly, was that the Minister is not the only person responsible for the health budget, that the health budget and its adequacy is the responsibility of the entire Government, from the Taoiseach down. We need to bear that in mind and those people need to bear responsibility for what is happening to the health budget next year. I also made the point quite strongly that it is not only an issue at a political level. There is also a mindset in some Departments that is anti public service in terms of ensuring we have properly functioning public health services. There is a kind of begrudgery about that, with some people thinking we could not possibly spend money to have a properly functioning public health service even though every other country in Europe has that. I just wanted to clarify that. I do not engage in personal animosity. I am not interested in that.

I listened to what the Minister said earlier about the achievements over the last couple of years. I do not doubt any of that. In the main, we have all been on the same page. There is an agreed policy there and a very important reform programme. The challenge for us as a country, as a Government and as a political system and all the administration associated with that, is to implement this. After Covid, even though there was glacial progress made for a few years, in the last couple of years progress was beginning to be made and the Minister made that point. The Minister used the term that things were beginning to work. There was a momentum there. There is momentum this year but the big danger now is that unless we actually fund that necessary reform programme, that momentum will be lost. Confidence will be lost as well. For many years, staff in the health service did not have confidence in the ability of the Government of the day to actually reform the service. They chose in many cases to go abroad to systems that work, where they get satisfaction and where they can meet the needs of patients. Gradually, we were starting to convince people that with Sláintecare, there is a reform programme and it is being funded.

I have already given the Minister credit for progress that was made last year in starting to remove cost as a barrier. We need to do a whole lot more next year. Progress was also beginning to be made on shifting activity out of hospitals to the community. We were beginning to make progress on that. The big concern now is that that will come to a standstill and the momentum will be lost because reform costs money and there is not money, it would seem, to continue that kind of reform within the health service.

I listened this morning at the Joint Committee on Health to the Secretary General of the Department of Health talking about the importance of reform and reorienting the health service, getting better value for money, moving to a new model of care and a lower-cost model of care.

All of that sounds grand. If that is what we are aiming to do, why are we not funding it this year and why are we putting the progress of the past year or two at risk? That is the risk involved in this. The progress that has been made will be put at risk and things will be set back by some time.

It is one thing to say we need to move to a lower cost model of care, which is what Sláintecare is, but the funding that is provided for next year will not allow us to do that. If we are trying to get activity out of hospitals and into the community, we cannot stop funding the hospitals. The alternative community facilities and staff must be funded and then the activity can be moved. It is not something that can be done overnight with a click of the fingers. It must be planned and, for a certain period, there will be an element of funding of dual schemes. That is the reality and unless that principle is recognised, we simply will not achieve the delivery of Sláintecare.

The CEO of the HSE absolutely gets this and recognises it fully. He repeated today what he said on radio last Sunday week, which is that unless there is additional funding, there will not be enough money to fund the health service properly next year. He could not be clearer that there is not enough money to do it. There are three main standout areas in which there was unexpected expense. There was health inflation, over which the HSE has no control. As an example, the CEO referred to the energy bill, for which the HSE signed a new contract during the year. The increase in the cost of that contract was 85%. There is nothing he or the HSE could do about this; that is a reality. Food costs are also very high. The other area of increased expense arose from the unexpected demand. The Minister spoke about this earlier, saying that where ten patients are expected to come in the door, 11 are arriving. It is right that the 11 are treated. There were 70,000 additional areas of activity within the health service last year. That is a good thing and people should not be penalised for delivering it. The only way to make progress in working through and reducing waiting lists is by increasing productivity and treating more people. We should not be penalising the HSE for doing that.

It was said clearly by both senior people who attended the committee meeting today that the big problem with overruns is in the acute sector. There are, in essence, 22 privately run hospitals in the form of the section 38 hospitals. I do not know how the system operates but it seems to be a black hole. We do not know how much a hip operation costs in hospital A compared with hospital B. We do not know why some hospitals operate on a 24-7 basis and some of the big hospitals do not, with people downing tools at 4 p.m. in some cases. We also do not know about productivity of consultants and what oversight there is in that regard. This morning, I queried the oversight of the operation of the big hospitals. I was told the reporting is not to the HSE or the Department of Health but to the hospital groups. I know from data I sought not so long ago on clinical directors that the reporting used to be to the HSE before it changed to the hospital groups. What is the governance and oversight of the hospital groups? In time, this process will change, which we hope to see at some point next year, but there are big questions to be asked about accountability in regard to the operation of the voluntary hospitals.

I repeat a point I made last week. There are also big questions to be asked about the reason we have not until recently started to implement an integrated financial management system. Why on earth has the biggest organisation in the country not had such a system? We do not know where money is being spent and where staff are located. This goes back to the historical underfunding of the health service over many years. Why do we not have a fully implemented digital health strategy? A plan for such was refused and knocked back by the Department of Public Expenditure, National Development Plan Delivery and Reform when it was presented to it in 2018. The Department said the plan must wait until the opening of the national children's hospital. Why do we not have multi-annual funding? Responsibility must be taken at Government level and by the Department of Public Expenditure, National Development Plan Delivery and Reform.

I understand there will be a Supplementary Estimate within the next three weeks. That provision absolutely will have to go into the base for next year and be included in a Revised Estimate for the HSE and for health provision generally next year. If that is not done, it will be a huge failure on the part of the Government. There is an opportunity for the Minister to do something of real consequence in totally reforming the health service by correcting the underfunding for next year.

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