Dáil debates

Wednesday, 15 May 2024

Delivering Universal Healthcare: Statements


2:30 pm

Photo of Peter FitzpatrickPeter Fitzpatrick (Louth, Independent) | Oireachtas source

Ireland remains an anomaly in Europe in not providing universal healthcare. While there has been some progress in implementing the proposals set out in the Sláintecare report, much more is required to move towards universal healthcare in Ireland. We need to get to a point where we truly have healthcare delivered free at the point of delivery. Three principles should underpin all of our approaches to healthcare, namely affordability, accessibility and accountability.

With regard to affordability, all of us have received great care in the public system but we also know about the issues with costs. There is no denying that achieving this goal will take investment. It is evident that waiting lists are only getting longer and the resources invested are not being utilised efficiently. We only have to look at the children's waiting list for spina bifida and scoliosis surgery. I acknowledge that €123 million in funding was allocated for the delivery of the HSE waiting list action plan in 2023. This should have facilitated, improved, and broadened paediatric orthopaedic service delivery and access to specialists in the area of neurodisability, neurosurgery, orthopaedics, urology, occupational therapy, physiotherapy, and neuropsychology but it did not. It is estimated that between 20% and 40% of global health spending is used inefficiently. Therefore, it is critical that future investments are targeted in a way that gives them the best chance of delivering for people and society, working to widen access to timely and affordable care. Without the requisite funding and follow through, what if reform just makes the system worse? What if waiting lists get longer, not shorter? The answer to all these questions, put simply, is that reform only works if we work together. The achievement of universal healthcare must be an absolutely central aim of all those who wish to bring about a decent and truly modern Irish society, fit for the next century, including for those who work within healthcare.

To make the transition work, medical staff currently working in the private healthcare system will be encouraged to switch to the new public model. Contrary to the norm, consultant doctors who have been incentivised for years to practise privately would be offered a public-only contract worth up to €300,000 a year under Sláintecare, but would be restricted from seeing private patients in public hospitals. The response is mixed. New consultants may still be attracted overseas ahead of a public-only contract. Existing consultants may prefer the greater freedom and private income of their current contract, and decline to move to the new one. Yet, for this to work, we need to ensure staffing capacity is there to meet demand and successfully implement our targets.

With regard to accessibility, while the Government is committed to delivering universal healthcare, how are we to achieve the Sláintecare commitments with few or no staff? I am dealing with issues in my constituency clinics every week relating to people who are unable to access health services. In 2023, nearly 500,000 people exceeded the Government’s maximum waiting times for outpatient appointments and endoscopies. Just last week I spoke to the family of a young boy who has been waiting for an orthopaedics appointment for three years. The problem is chronic. While inpatient charges for public hospital services have been abolished, it remains to be seen if measures to reduce user charges for primary care services and to tackle long waits for a variety of services will be implemented and will have an impact on the current barriers to accessing healthcare services in Ireland.

We have historically placed a strong emphasis on the role of private care, and consequently private health insurance, in the Irish system. Over the years, the proportion of citizens using private insurance has grown, as people sought protection from soaring waiting times for elective procedures. In 2022, 47% of the population used private health insurance. There is an urgent need to identify the role of private health insurance in a universal healthcare system in Ireland, where access to services is based on need rather than ability to pay. We all know that early prevention saves lives. By meeting people’s health needs as early as possible, from health promotion to prevention to treatment, and keeping care close to their every-day environment, primary health care can help save millions of lives.

In the budget we committed to increasing access to GP care without charge for more than half of the population. This is an important healthcare measure that removes a prohibitive cost barrier to accessing GP care. However, the extensions of free GP care require a focus on building additional capacity in terms of training places and support for GPs. We know the challenges faced by patients in accessing healthcare at every level, including long GP waiting lists and long waiting times in accident and emergency departments. The demand for GPs is unreal. The amount of people who are telling staff in my constituency office that when they ring up their GP they are being told that it could be two or three weeks before they can get an appointment. This is not acceptable. I will be honest and say that the Louth County Hospital out-of-hours service provided by the doctors there is second to none but such services are not available in every town so people end up going to accident and emergency units.

Research suggests that up to 18% of GP visits relate to minor ailments. According to the Irish Pharmacy Union, IPU, the Irish health service has the potential to revolutionise community care by empowering pharmacists and allowing them to operate to their full scope of practice, thus presenting a significant opportunity to eliminate more than 1 million clinically unnecessary GP visits. The IPU said the expert taskforce on pharmacy, established by the Minister for Health in July 2023, is a key resource to drive this transformation. We also need to offer more choice by delivering more services through digital channels, where it is safe to do so. A new digital health strategy, "Digital Health Strategic Framework 2024-2030 " is currently being finalised by the Department of Health. It will set out a shared vision and guide a clear roadmap for investment in digital health, including delivery of digital patient records. The framework will be supported by rolling delivery plans developed by the HSE to achieve the desired level of accelerated digitalisation of health and social care services in future years.

We will never deliver or realise universal free care unless we increase capacity and have a plan to increase training places. Healthcare workers are no longer attracted to what the HSE has become, so we are short of staff. The recruitment freeze and lack of funding in this year's budget will surely have a negative effect on staffing. However, the HSE is to offer permanent contracts to all nursing, midwifery and health and social care graduates, who account for 25% of the clinical workforce and 14% of the overall health service workforce, which will be central to our drive toward universal healthcare and delivering health services for our growing and ageing population.

Another issue to consider is accountability. Progress on the Sláintecare programme is painfully slow, with complex structural and legal barriers. The fundamental problem with our health service is that it is inequitable because it denies care. Patients are forced to borrow money to get an assessment of needs done. Allowing a situation like that to continue drives behaviour for patients and also for medical staff, who are incentivised to set up in private practice. The number one responsibility is to make healthcare affordable and ensure adequate supply. We need to recruit staff.

People's health is their wealth. Healthcare is one of the leading issues today, driven by medicine shortages, a staffing crisis, an ageing population and a stalled modernisation agenda. Ireland's population is ageing and requires a constant stream of skilled staff. Poor wages and conditions have triggered an exodus of workers from Ireland in search of better working conditions and pay. Ireland trains approximately 750 Irish and European doctors each year. In 2022, 442 of them emigrated to Australia, according to the Royal College of Surgeons in Ireland. To reverse this tide, the new model will need ample funding. A failure to make progress will have real consequences for people's health, our society and our economy.

I got a telephone call today from a constituent in County Louth. She told me I can name her son in the House. She provided me with the following details:

My son is Leo Lynch. He is almost nine months old. He was diagnosed with Hirschsprung at birth and needs surgery for this. He cannot pass his own poo. We as his parents have been doing daily flushes since he was born. Surgery for this is usually at around four to five months. His surgery has been cancelled three times. He is booked in again next Tuesday, 21st May, and we have been told there is a 50% chance it could be cancelled again.

This cannot happen. It is affecting the child's health and well-being. Leo's consultant is Professor Alan Mortell in Crumlin children's hospital. I will forward the details to the Minister, Deputy Stephen Donnelly. I would appreciate any help with the case. This child is going through serious pain. His family is going through serious pain. Leo is only one patient but any help we can get would be really appreciated.


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