Lynn Ruane (Independent) | Oireachtas source

I welcome the Minister to the Chamber. I will start with a quotation: “It turns out, however, that the cost [of austerity] could be large – much larger than the benefit." That statement is not from a left-wing politician but from a report by International Monetary Fund, IMF, economists in the last few months. We have seen our health service spiral into what feels like an unprecedented disaster. It is devastating to see and feel the impacts on patients and medical staff as they struggle to navigate this crisis.

I want to focus today on what austerity took from our health service and why we need to let go of an austerity mindset if we ever want to repair it.In 2014, a study in The Lancet examined the effect of austerity on the Irish healthcare system. It found that €3.3 billion had been cut from the health system since austerity began. Budgets were slashed by 22%. It found that there were 12,200 fewer HSE staff and 941 fewer public beds in the system since austerity began. Those figures are from 2014, but the system still has not recovered. The consequences of austerity are all around us today. They have gradually eroded our health system over the last decade, leading us to the breaking point we are experiencing now.

Since I have limited time today, I can only focus on staffing as one example of the impact of austerity on the health service. A direct line can be traced from those staffing cuts that were made a decade ago to the chaos and suffering that we are experiencing. A 2017 study on the impact of austerity on Ireland’s health workforce found that permanent staffing was reduced as a supposed money-saving measure to ultimately make our budgets look more streamlined for the EU, yet the study found that the reduction in directly employed staff was to a great extent matched by a marked increase in agency spending. It did not matter how many doctors’ contracts we cut on paper because we still needed the doctors and, therefore, the shortfall had to be made up through agency staff instead. The agencies charged high fees to supply staff, so the HSE ultimately ended up spending more than they would have done on permanent contracts. The amount spent on agency staff doubled in the austerity decade from €136 million in 2010 to €355 million in 2019. We are now spending well over €1 million per day on agency staff. We are evidently still living with this austerity hangover. These changes in spending were never reversed from austerity. The special, once-off austerity budget measures have just become standard, everyday budget measures. We have watched as our health service has buckled and we are paying for the pleasure. These staffing cuts have had significant knock-on effects. The remaining staff were put under more and more pressure and had to work more unreasonable hours.

I am highlighting this example because it clearly shows how spending cuts that were made decades ago have created these cycles. They have set off these chain reactions where the health service has deteriorated and worsened. These cuts created a runaway process which has now escalated beyond control. We are at the end of a long decade of a downward spiral where the effect of every euro that was cut was amplified. It is no longer enough to simply carry out business as usual. If we want to reverse these catastrophic chain reactions that have seen so many staff leaving the service and put in piecemeal bits of spending here and there, we will not make a difference. We need transformative spending to dig our way out of this. What concerns me is that the Government still seems to be clinging to an austerity mindset, whether actively or not, when it is clear our only solution to reverse more than a decade of cuts is through radical, unprecedented levels of investment into our public service.

This year, the Government left billions of euro on the table in the budget, citing the fact that our surplus may have been a windfall from corporate tax receipts. The Government called this “the rainy day fund”, and a couple of months later nearly 1,000 people were waiting on trolleys in our emergency departments. It is beyond time that we realise that the rainy day has arrived.

Senator Conway mentioned the issue with GPs. I will not shame the surgery in Tallaght on the record, but there is a surgery in Tallaght that is making women, children and older people show up before the surgery opens and queue down the street just to make an appointment. This is not even to see a doctor. No wonder people are showing up in accident and emergency departments when they are waiting for days and weeks to see a doctor. By the time they need help, they show up in the accident and emergency departments, which are bursting at the seams. Receptionists are triaging people. These are receptionists who are answering the phones and who are prioritising people's illnesses as to whether they will see a doctor, even though they have no medical training. We need to address the situation with GP capacity in communities and also ensure that we give adequate investment to the health service to reform.