Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

I thank Deputy Cullinane and Sinn Féin for tabling this motion. I welcome the children and parents in the Public Gallery who are watching the debate.

Waiting lists remain a national disgrace. That has been the case for a long time. While the Government has made efforts to address them, the fact that they are so long should illustrate how those efforts have failed. Last week, the Taoiseach stated that waiting lists in Irish hospitals are going down. That is not entirely true. The fact is that waiting lists for children have not fallen. Children with scoliosis and spina bifida are waiting longer now than was the case four years ago. In 2017, the then Minister for Health, Deputy Harris, made the commitment that no child would be left to wait longer than four months for surgery. It is deeply concerning that a staggering 78% of children are enduring wait times longer than Sláintecare target times for paediatric orthopaedic inpatient appointments and that 81% awaiting paediatric urology services are similarly affected. The situation is equally dire when it comes to outpatient appointments, with 84% of children waiting beyond target times for paediatric orthopaedic services and 72% beyond target times for paediatric urology. The Government has a responsibility, not just because members of Government made a commitment, but because it is undoubtedly the right thing to do to ensure that children with these complex medical needs are seen and treated on the basis of clinical need in a timely manner through the public system.

It is becoming increasingly frustrating for me and for the parents whose children need these services to hear that when the new children's hospital is finally built, all these issues will be fixed. We cannot even get a nailed-down date for when that hospital will open. Let me remind the Minister that the cost of what is going to be the most expensive healthcare facility on the planet has skyrocketed to €2.2 billion. The pure incompetence on display across every aspect of the construction of this hospital is outrageous. Of course, I used the word "incompetence" to quote the Minister, Deputy Donnelly, who, in 2018, following news that the cost of the children's hospital was set to rise by a then €450 million, said that one could not make up this level of incompetence. I wonder whether the Minister still holds the same view.

The current state of paediatric orthopaedic and urology services is nothing short of a disaster. I already mentioned the unacceptable waiting times for essential procedures, but there is also a chronic shortage of specialised medical professionals. The HSE's recruitment freeze is certainly not helping to alleviate matters. The reality is that without action, the futures of multiple children are being compromised. The children are not only not getting the care they deserve; we are four years past the date on which the children's hospital - which, according to the Government, will address the deficit of care - was due to open. Seemingly, no one is willing to accept responsibility for this failure. Children are being left behind. That is a fact. It is a theme that crops up often with this Government, and it has been the case with Fine Gael in particular for a long time.

Whether they are young doctors or nurses, people are moving abroad for better conditions. Young couples are forced to live with their parents while saving for a home. Young people right across the country are being let down but no one is being let down more than the children with complex orthopaedic and urology needs. It is just not good enough that the Tánaiste acknowledges how poor paediatric care is by stating that the new children's hospital will mean that care will be worlds away from where we are in respect of the treatment of children. What is worlds away is needed right now. Why do we need to wait for the new hospital to improve care at that level and more important, why is care so poor that we are in such desperate need of this children's hospital? It is frankly preposterous that the children's hospital is seen as the only fix for the problems in care that the Government has allowed to accumulate over many years. It is worrying that we are being told to wait, particularly when we do not have a date for when the hospital will open.

Ultimately, these issues all come back to the Government's mismanagement and underfunding of healthcare services. When the Government announced the health budget for 2024, I spoke about the fact it had left many people afraid about what the next year would bring. National strategies are being starved of funding, and the lack of financial supports for the care of children has clearly not been addressed. That means these young people are suffering. I reiterate a point I made at the time. Health is not like any other area of Government responsibility. It is a demand-led service. It is the Government's duty to strive to meet demand, not to cut off or starve healthcare of supports, reallocate funding or rob Peter to pay Paul within the service. That is why we need to see action in paediatric orthopaedic and urology services. Clearly, as the families and children present will tell the Minister, the demand is there. Waiting lists have been growing for too long. With each missed appointment, each cancelled surgery, the health of these children is further compromised and the possibility of providing the kind of care that will help them and bring them back to some form of health moves farther and farther away.

We fully support the establishment of a task force that is independent of CHI management, comprised of parents, patient advocates and clinicians, as we believe it is one of the only ways we can ensure the deficiencies in our paediatric orthopaedic and urology services are addressed. A multidisciplinary approach would ensure that the voices of those directly impacted on by the shortcomings of our healthcare services are heard and considered when solutions are being provided. Parents bring first-hand experience of navigating the complexities of getting care for their children and clinicians can provide expert knowledge and the guidance that is clearly needed on best practice. This type of task force would ultimately lead to more effective and patient centred healthcare delivery for those children.

There is also an urgent need to address how reliant this country has become on private health insurance. Private health insurance cannot become a synonym for good healthcare. With waiting lists as long as they are, there is a perception that people need private health insurance because people feel that without it they might not get any care, especially the care they need. It has certainly become the case for paediatric and orthopaedic and urology services. The waiting lists children and parents are facing in these services have led to them feel that private health insurance is the only way they will get the care they need. The whole goal of our health policy at the moment is the delivery of Sláintecare, a universal single-tier healthcare system accessible to all and services free at the point of use. That is why it is extremely concerning that we do not seem to have any real movement in the delivery of the single-tier system. Progress aside, the fundamentals behind Sláintecare are a real risk. It remains silent on health insurance because the gamble is that once it is delivered, people will be so happy with the system that they will give up their private health insurance. We need a plan to deliver a proper, universal healthcare system and the two-tier system that currently exists is not the future of healthcare.

It is abundantly clear that the Government has failed in its duty to safeguard the health and well-being of children with spina bifida and scoliosis. We cannot allow these failures to persist and that is why I fully support this motion. It is an important step in the right direction. We need to see the establishment of an independent task force, free from the influence of CHI management. We need to ensure equitable access to evidence-based care regardless of socioeconomic status and reduced reliance on private providers.

We need a commitment from Government in the context of ongoing engagement with patient advocacy groups to inform policy and decision-making. The new children's hospital cannot be a shield that the Government rolls out to deflect away from the fact that the levels of care for children in this country are simply not sufficient right now. We also finally need to see accountability with regard to the cost of the national children's hospital and an answer from the Minister about whether he believes, as he did in 2018, that the management of the delivery of the hospital is a display of incompetence.

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