Michael Harty (Clare, Independent)
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45. To ask the Minister for Health to outline his views on the Sláintecare report of the Committee on the Future of Healthcare; and if he will recommend that the report form the basis of health reform to introduce a universal single tier health service delivered on need rather the ability to pay [28073/17]

Michael Harty (Clare, Independent)
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I too wish to congratulate the Minister on his reappointment. Continuity in the Department of Health is important. I look forward to working with the Minister as closely as possible. I also congratulate the Minister of State, Deputy Jim Daly, on taking over responsibility for mental health affairs and care of the elderly, a major portfolio in which I wish him the best of luck.

I am seeking the Minister's views on the Sláintecare report of the Committee on the Future of Healthcare. Will he recommend the report as the basis for reform of the health service and introducing a universal single tier health service based on need, not on ability to pay?

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy for his kind wishes and important question. This is a preview of what I imagine will be a more substantive debate on the Sláintecare report in the House tomorrow.

Supporting the establishment of the cross-party Committee on the Future of Healthcare in June 2016 was one of the first actions I took on becoming Minister for Health. I commend genuinely the great work done by all members of the committee, including Deputies Michael Harty, Billy Kelleher, Róisín Shortall and Pat Buckley, as well as a number of others who worked extraordinarily hard on the committee. Everyone involved across the political divide worked extraordinarily hard. The committee's establishment was agreed to across the House, demonstrating a shared understanding of the scale of the challenges facing the health service, as well as recognition of the need for a fundamental reshaping of our vision and long-term strategy for health care. It should be based on cross-party consensus that does not change every time the Minister, the Government or electoral cycle changes. I have consistently supported this process which I firmly believe can provide a once-in-a-generation opportunity to transform the health service.

The committee has lived up to its mandate and is to be commended for the significant achievement of developing a future vision, based on political consensus, for the health service. The report is the culmination of a year-long process of unprecedented cross-party collaboration, dialogue and engagement. It is testament to the desire across the political spectrum and the broader stakeholder community to work collaboratively to address the challenges in the health service.

I have been clear in my view since the committee commenced its work that, out of respect for its work, I would not advance major structural reforms until it had reported. It is vital that we now allow time to reflect and deliberate on the findings of the committee. I do not envisage it being a substantial period. I look forward to the Dáil debate on the report tomorrow. I will give full consideration to the recommendations made in the report when I have had the opportunity to hear views from across the Dáil.

The Taoiseach was very clear in his speech to the Chamber last week when he said delivering real improvements in the health service was a key priority for the Government. He has tasked me with preparing a detailed response to the report, including proposed measures and timelines, to bring to the Government. It is my intention to do so following the Dáil debate. I hope to bring a detailed analysis and proposals to the Government quickly.

I have no doubt that the report will be an essential document for all Governments and parties in the fundamental reform of the health service in the next decade. I look forward to talking with colleagues in more detail in the coming days about implementation and about how we can show the public that we intend to make quick progress in the areas where it is possible to do so, as well as how we intend to advance in the more challenging areas.

Michael Harty (Clare, Independent)
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It is important that the Minister understand the need for health care reform. The public system is not fit for purpose. It is fragmented, disjointed and incoherent. Some areas work reasonably well, but all areas are under pressure and struggle to deliver quality care services. There are lengthening waiting lists in outpatient departments, as well as lengthening inpatient lists for urgent and planned care. Of course, there are also lengthening trolley queues. In addition, there is an increase in the population, with a corresponding increase in the number of patients with a chronic illness or who have complex needs within the community. We must reform the entire health service rather than only parts of it. This process cannot be delayed any longer. The Minister has a responsibility and a duty to deliver health service reform, starting in this Dáil. Delaying reform will only make it far more difficult and costly. There was a common thread in all of the submissions received - that there should be a shift from secondary to primary care services. The reform programme needs to include the entire health service. There is a need for a universal single tier public health service to cover everyone based on need.

Pat Gallagher (Donegal, Fianna Fail)
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I thank the Deputy.

Michael Harty (Clare, Independent)
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I think the clock is wrong. I think I only had one minute instead of two.

Pat Gallagher (Donegal, Fianna Fail)
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4 o’clock

There was one minute for the first supplementary question.

Michael Harty (Clare, Independent)
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This was my first, a Leas-Cheann Comhairle.

Pat Gallagher (Donegal, Fianna Fail)
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It is one minute. The Deputy has now almost two minutes gone. He inadvertently got two minutes.

Simon Harris (Wicklow, Fine Gael)
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We will have a lengthier time to discuss this issue tomorrow. It deserves and requires more time. The Deputy is correct that I do have a duty to deliver health reform. Clearly I have to discharge that duty in terms of my membership of the Cabinet and the Government. I formally received the report, which I am happy to describe as an excellent piece of work unprecedented in terms of cross-party effort. There are many elements within it that reflect my own thinking, which I articulated when I had an opportunity to address the committee. While I am eager that we put in place health care reform as outlined in respect of Sláintecare, we need to discuss some elements of the report. The Government will have a duty to do its own analysis of the costings, and to put in place implementation structures that can get on with delivering the report. I am committed in that regard.

While a number of elements of the report are in line with long-standing Government policy, such as e-health, integrated workforce planning, and clinical governance, it also puts forward a number of key policy changes, which I welcome. The biggest is the clear indication of a desire to move towards the establishment of a universal single-tier system, where access to care is on the basis on need and not ability to pay. That is going to require the introduction of a universal entitlement to health care services underpinned in legislation, at no or low cost, and the removal of private activity from public hospitals. I am committed to doing this but it is a substantive body of work. That is why it is a ten-year plan.

Michael Harty (Clare, Independent)
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This report needs to be implemented. It contains strong recommendations on implementation. To drive implementation forward, there needs to be political buy-in. The first requirement we ask from Government is that there be strong political buy-in for this reform. If that is not present, the reform programme and Sláintecare report are not going to get off the ground. Part of that is the provision of legislation to provide accountability, governance and responsibility in our health service, which is sadly lacking. No longer can we have a shrug of the shoulders style of management whereby things that go wrong are blamed on system failure. We must have strong governance underpinned by legislation.

We need to restructure the HSE so that it is decentralised and devolved down to regions. We need new contracts, as Deputy Kelleher said, not only for general practice but also for consultants. We need an implementation office developed very quickly to drive this reform programme forward.

Simon Harris (Wicklow, Fine Gael)
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I agree fully on the need for new contracts. It is very important, and not just in the area of general practice. There is political buy-in. Every political party and grouping in this House, bar one, decided to sign off on the report. There is a role for Government as well. As the committee members have pointed out, while the committee has costed the proposals, it was not its role to decide how to fund those costs. There might be very different views in the different political groupings as to how we might go about doing that. The Government has to look at all of the resources available to it, the fiscal space and all these terms of which we are well aware.

As Minister for Health, I am determined to work with the Oireachtas to put in place an implementation structure to get on with progressing Sláintecare. One other point which I will discuss further in tomorrow's debate is the issue of capacity. As a general practitioner, the Deputy, Dr. Harty will know very well that even if we had the funding to provide free entitlement to all general practice services tomorrow, we might not have the capacity within general practice. The sequencing of change is very important if we are to make sure it is a sustainable model. Where there are entitlements, there must also be the capacity of health care professionals to deliver them. That view is shared by many health care professionals around the country.