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

I thank the Cathaoirleach Gníomhach for allowing me to contribute and I thank Sinn Féin for tabling this important motion. The Social Democrats will support it. It is frankly unforgivable this Government has allowed a situation to occur where a recruitment freeze is even on the table, never mind being implemented. It is not as if Government was not aware of the challenges facing the health service and the need for additional funding. After all, there have been repeated warnings, all of which have been ignored, it would seem. For example, the HSE national service plan was not published until March in 2022 and it was similar this year. This was due to a protected allocation process. That kind of delay would have been unthinkable previously. The statutory periods around the letter of determination, the submission of the service plan and the approval used to be adhered to and it seems they are being ignored completely now. It is now abundantly clear the process for allocating HSE funding has become extremely awkward and difficult due to inadequate funding. Attempts have also been made to conceal gaping holes in the budget, such as the €2 billion shortfall identified by a former HSE board member earlier this year.

This increasingly fraught process is a very disappointing development given Sláintecare was supposed to take the politics out of health by building consensus on the need for major reform. Instead, this Government has allowed it to become a political football all over again. In this context, there has never been a stronger argument for Government to lay out a five-year funding programme for Sláintecare. Only then will I believe it is genuinely committed to reforming our public health service.

What is most galling of all is this recruitment freeze is taking place against the backdrop of stubbornly high waiting lists. At any one time there are at least 1 million people on some sort of healthcare waiting list. Between April and June of this year there were almost 300,000 people on a waiting list for community services such as counselling or occupational therapy. When it comes to hospital care, the situation is, of course, even more stark. At the end of October, there were just over 826,000 people on some form of hospital waiting list. Of those, more than 106,000 were waiting for inpatient treatment, while almost 600,000 were waiting for outpatient treatment. To make matters worse, 70% of those waiting lists exceeded the Sláintecare targets for maximum waiting times six years after the report was first published. How can the Government ever expect to tackle these waiting lists without providing the necessary funding to increase capacity and activity levels?

Reform costs money and our health service is crying out for it but the Government is just not listening. The Government can try to put a positive spin on underfunding our health service but it is fooling no one. The Minister need not take my word for it; the INMO has said that this decision will send the health service into free fall while the IMO has warned of chaos in the system.

One would also have to wonder what this means for previously made commitments, for example, the commitment to implement the safe nurse staffing framework. In May, funding of €25 million was announced for an additional 854 posts to fully implement the framework. What now for those posts? The whole point of this framework was to take an evidence-based approach to determining safe staffing and skill mix in acute settings but it now seems this principle is to be abandoned, at least for this year.

Another concerning aspect of this decision is its impact on the implementation of Sharing the Vision. The strategy's national implementation and monitoring committee recently published two quarterly reports, which revealed continuing difficulty in meeting timelines. Its second quarter analysis noted “with concern that for the first time ... the problem category of cost and budget outweighs recruitment”. The report goes on to highlight the significant recruitment challenge that is resulting in underachievement in key aspects of the implementation of Sharing the Vision. It is clear that momentum is being lost in implementing this key strategy because of funding shortfalls. A recruitment freeze would effectively stall that progress.

With regard to home care, allowing this freeze to go ahead would completely undermine the Government's supposed commitment to implementing all 16 recommendations of the strategic workforce advisory group. What happens now to the four recommendations that relate directly to recruitment and training? Will they be put on ice at a time when almost 6,000 people have been approved for home care but when there are no carers available?

What now for regional health areas? Many of us were starting to believe that the Government was serious about restructuring the HSE, breaking up the centre and devolving powers held there, which is an absolutely critical component of Sláintecare, but this freeze has also cast some doubt over that. What does it mean for recruitment to key positions in these new regions, including the six regional executive officers? I would appreciate it if the Minister would clarify that point in his closing remarks. Is the timeline set out in the RHA implementation plan still going to be adhered to? The implementation of the six RHAs was supposed to begin next February with further reforms and devolved authority to be delivered the following year. It is now increasingly difficult to see how this much-needed reform can be delivered on time in the absence of increased staffing and funding. We already have HSE managers and administrators engaged in industrial action because of the freeze. Their work-to-rule action includes a boycott of all engagement with regional health areas.

The most concerning aspect of this whole debacle is its impact on patient care. In last month's budget, the Government was more than happy to throw money at people who did not need it, all the while failing to provide sufficient funding to meet patient need. Bridging the gap between supply and demand will not be achieved by austerity era measures. Recklessly repeating the mistakes of the past, mistakes we are still paying the price for today, is not the answer, nor is this Government's complete denial about the need to increase healthcare funding. Unless this Government takes its head out of the sand, health service overruns will be an annual feature of the HSE budget process. A recruitment freeze will not change that.

This Government needs to realise that our health service must expand, not stall. Progress was being made. We know that and I give credit for it but why are we not continuing that progress in reforming our health service? In fact, numbers need to increase by an additional 12,000 to 15,000 healthcare workers by 2035, according to ESRI estimates. That is the scale of the challenge. We cannot afford to lose a year. It is incredibly short-sighted, even for this Government, to allow this recruitment freeze to go ahead. Additional funding must be provided. I have given the Minister and all of the Ministers of State credit for starting a reform programme and getting momentum going. Things were really starting to move, particularly for healthcare staff but also increasingly for the patients who depend on our health service and for those of us who desperately want our public health service to be a success and equivalent to the public health services available in most other European countries. We were excited about that. We were starting to have real confidence that the Government was serious about implementing the Sláintecare reform programme. The serious errors that have been made right across this Government, although particularly at Cabinet, in restricting and basically freezing funding, resulting in a recruitment freeze, cast serious doubt over this Government's ability to address the whole issue of reform.

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