Brian Ó Domhnaill (Fianna Fail) | Oireachtas source

I congratulate the Minister of State on her appointment to the health promotion brief. It is an important brief, which can play a part in reducing the spend on health, depending on what policy is articulated. We have had a good discussion. The spend on health is approaching €14 billion from the public purse with an additional €5 billion provided by the VHI and other private sources, giving a total of almost €20 billion. The health sector has been debated in both Houses and by commentators over the past ten years, in particular, as people live longer and our demographics change. There is more disease and there is a need for prevention, treatment and cure. As a result, there is a cost to the Exchequer and private health insurance companies, which must be met. The sector faces major challenges but a ten-year vision is the correct way to approach them. I believe we need a 20-year vision in this country and across Europe. We should not stop at ten years but look much further ahead than that, taking on board new treatments and so on.

A number of areas need to be targeted. One is the cost of drugs and the patenting arrangements and how that can be reduced. Elderly care and home help hours, in particular, must be addressed. Demand exceeded supply by 10% at the end of 2015 and that will not improve this year given home help hours have been cut again. The average cost of home help is €75 per week. The alternative is for the elderly to participate in the fair deal scheme and obtain long-term private or public residential care. The public cost averages €1,390 per week while the private cost averages €893 per week. When that is compared to the cost of home help, it does not make sense. The Department's strategy seems to support increased spending on the fair deal scheme. More money has been allocated to the scheme this year and for the home help service. That is only one example of how resources are not being targeted efficiently and effectively.

The Department and the HSE have spoken a great deal about targeting efficiencies across the sector but that is not happening. There are no financial oversight or performance-related auditing and accounting practices to provide value for money and more effective outcomes for the patient. The approach is, therefore, not patient-centred. It is about going into hospitals and cutting costs. Until the system changes from a block grant to hospitals to money following the patient, patient care will not be at the centre. For example, Letterkenny General Hospital should get a block grant based on last year's performance not on this year's. That does not make economic sense. I am examining this from a financial point of view in respect of allocating resources more efficiently and effectively. Reference was made to the OECD report on spending on the health sector in this country. It found that our spend is higher than the average but our outcomes are lower than the average. We must consider our ten-year vision in that context.

That are many other issues but other Members are offering. I would very much like the opportunity to have an open-ended debate on health with contributors speaking for an extended time because every Member has something to offer. Our spokesperson, Senator Swanick, made the case for primary care and I agree wholeheartedly with him.