Pádraig Rice (Cork South-Central, Social Democrats)

I welcome Second Stage of the Health (Amendment) Bill 2025, which regrettably is the first health legislation to be taken on Second Stage since the general election last November. This is one of only two health Bills listed for priority publication yet it was only published last Friday, just shy of the summer recess. Nevertheless, it is worthwhile and modest legislation.

To pick up on some comments by the previous speaker, we hear two different narratives constantly. There is a narrative from the Government that there is plenty of staffing and an increase in staffing. We hear from nurses, doctors and people working in hospitals that they are short-staffed, posts are not filled and there is no maternity leave coverage under the pay and numbers strategy. Some services are particularly short-staffed. There is a juxtaposition which needs to be teased through to see if certain parts are understaffed and resources are stretched. We constantly hear there is enough staff but that is not what is said on the ground.

One of the main purposes of this Bill is to replace the HSE's annual service plan with an annual performance delivery plan. I have no objection to this in principle but I would appreciate if the Minister outlined in more detail how this new performance delivery plan will be different from the service plan. I assume it is more than just semantics. I note the Minister of the day will have a clearer role in shaping and influencing the final performance delivery plan. Under section 17, the Minister for Health, in consultation with the Minister for disability, will prepare an annual statement of health service priorities to guide its development. While welcome, this is a small change. There have been serious issues in recent years with what have been characterised as HSE overspends. I argue that Government underinvestment is the root of this issue. That is not to excuse the HSE's ballooning spend on outsourcing and agency staff but there must be an acknowledgement that funding has not matched what is required to deliver services and Sláintecare reforms. This has been repeatedly pointed out by the Irish Fiscal Advisory Council.

Health spending has undoubtedly gone up in recent years but there was a lot to catch up on after decades of underinvestment. There have also been population increases and demographic changes, not to mention the money that should be front-loaded into the Sláintecare reforms. At the core of health funding issues appears to be a different view between the Department of Health and the Department of public expenditure. This is despite the fact that the entire Government has a collective responsibility to ensure there is an adequate level of patient care. That is why the greater level of oversight provided for in this Bill, while welcome, will not address the real problem, which is the dysfunctional method of allocating the health budget.

The provisions in the Bill related to corrective actions are a necessary safeguard but we should focus on addressing those problems further upstream. What is more urgently required and should take precedence is the move to multi-annual funding. We raised this during the Estimates process in the health committee. That would provide a more sustainable and coherent model of service planning, especially with respect to staffing and major service developments. Multi-annual funding was first committed to in the 2016 confidence and supply agreement between Fianna Fáil and Fine Gael. Almost a decade later, with the same parties in government, it remains undelivered. A commitment to multi-annual funding appears in the new programme for Government but delivery must be accelerated. Without this important change to the budgetary process, this Bill just tinkers at the edges. The existing annual cycle of service planning is not fit for purpose, especially in the context of implementing Sláintecare reforms. In fairness to the Minister, I have little reason to doubt her commitment to delivering multi-annual funding. My fear is the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation will continue to be a barrier to implementing this crucial reform, which is ironic given that reform is in the title of the Department.

The HSE corporate plan under this Bill would also inform the strategic direction statement. Given that the new HSE corporate plan for 2025 to 2027 was published just last week, I will use this opportunity to discuss some of its contents. While I agree with the sentiments and objectives expressed in the new corporate plan, it is difficult to have faith in them being realised. This is an aspirational three-year plan with aims that are not matched by deadlines or key performance indicators, KPIs. I appreciate it is the job of the service plan to say how, but the corporate plan should at least say when.

Women's health is a priority under the healthy communities section of the corporate plan. My main concern in this regard is there is no commitment to replacing the women's health action plan. The current plan runs out at the end of the year and the corporate plan is for the next three years. Many initiatives in the first two action plans have yet to be delivered, for example, the long-promised mother and baby unit. It was first recommended in the 2017 specialist perinatal mental health service model of care. According to the implementation plan for Sharing the Vision, the new mother and baby unit was to be delivered by quarter 4 of 2024. That unit is nowhere near being established. St. Vincent's, the proposed location, no longer seems able to accommodate the unit or at least not any time soon. Despite being promised in the 2022 and 2023 women's health action plan, this commitment was quietly dropped from the successor plan for 2024 and 2025. These units are commonplace in the UK, France and Australia yet Ireland does not have a single unit. Delivery of this unit must be prioritised. The adverse effects of separating mothers and babies are well documented.

In terms of dental care, the HSE corporate plan also makes a vague commitment to improving access to emergency and routine dental care. When will this happen? Public dental care waiting lists are at breaking point. The medical card scheme is haemorrhaging dentists but one would not think it from reading the corporate plan. Where is the ambition? I cannot understand why we are still waiting on the Department to publish a new dentists Act. The current Act remains largely unchanged since its enactment 40 years ago. It is not fit for purpose. A complete overhaul of the underpinning legislation and the medical card scheme is urgently required. They are relics of the past and must be modernised, not just modified.

I also mention laboratory services, which get a passing reference in the corporate plan. However, there is no mention of the eroded medical scientist workforce, which is jeopardising the ability to deliver safe laboratory services. There is no reference to the botched medical laboratory information system or how the HSE intends to get the project back on track. My understanding is this new IT project was to be delivered to more than 40 public laboratories but to date one has only been rolled out in Beaumont hospital. There are serious questions about the HSE's procurement process for this project and many others, yet procurement is not mentioned once in the corporate plan. This is disappointing considering only last year the Comptroller and Auditor General identified serious levels of non-compliance with procurement rules in the HSE. According to the Comptroller and Auditor General, "The HSE's control systems are failing to highlight the level of non-compliant procurement occurring", yet the corporate plan is silent on this issue. The corporate plan also mentions the long-promised reforms of home care but makes no mention of the statutory right. Is this no longer a priority? It is one of the most important parts of the home care reform programme. The Tánaiste, Deputy Harris, first committed to a statutory right to home care in 2017 during his tenure in the Department of Health. Eight years later, we are still waiting. Not even the regulations needed to underpin the statutory scheme have been legislated for. Never has the case for alternatives to nursing homes been greater. This must be prioritised.

My final point about the corporate plan relates to elective hospitals, one of the most non-committal parts of the whole document. The best the document could do was state, "We will continue the development of the ... elective hospitals in Dublin, Cork and Galway." This document covers a three-year period. The four new elective-only hospitals were to be delivered by 2028. While I accept that target is no longer achievable, one would expect by 2027, the final year of the corporate plan, planning applications would at least be submitted. There is no mention of that, just a vague commitment to continuing development. Overall, the corporate plan is a disappointment. I accept the service plan, soon to be the performance delivery plan, is a more specific document but that does not excuse how flimsy the corporate plan is. I hope this will change in the future but it is regrettable that we must wait another three years to find out.

The Social Democrats will support this limited legislation but I call on the Minister to be more ambitious. Multi-annual funding needs to be delivered as soon as possible. We need the Minister and her colleague, the Minister for public expenditure, Deputy Chambers, to set out a definitive pathway to multi-annual funding and to increases in capital funding. Otherwise, we will keep seeing the same budgetary issues in health year after year.

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