Leaders' Questions

I was reading again the programme for Government in respect of health, which I have described as one of the great works of political fiction. Let me read the key passage:

This Government will introduce Universal Health Insurance with equal access to care for all. Under this system there will be no discrimination between patients on the grounds of income or insurance status. The two-tier system of unequal access to hospital care will end.

Yesterday, the Taoiseach admitted that his Government had failed in achieving that objective. Leaving aside that objective, I put a question to the Taoiseach yesterday on how he and his Government could have approved the HSE's health service plan for 2016 when the executive itself said it was €100 million short for hospitals. The Taoiseach approved funding for health knowing that the HSE is already, in January, €100 million short of what is required to meet the needs of acute hospitals. When I put the question to him, he refused to answer it and implied that the HSE requests every year more money than it gets. In other words, he is playing poker with people's lives.

I ask the Taoiseach to read again pages 90 and 91 of the health service plan. It outlines that there will be a growing and ageing population and greater demand on hospital services. There are overcrowded emergency departments. Cork and Beaumont hospitals are closed to elective admissions. Operations are not being carried out. St. Vincent's hospital was described by a public representative yesterday as being like a war zone, and it was stated the experience of patients there is unimaginable. That hospital had highest number of patients on trolleys in the country yesterday.

People are afraid to go to emergency departments and hospitals. A community nurse in Galway told me that elderly citizens were begging her not to send them into the emergency department in Galway. That is what is happening and there seems to be no realisation of it. Waiting times are getting longer and the numbers on the waiting lists are increasing because of the consistent neglect of health by the Government.

The Minister for Health, Deputy Leo Varadkar, said he will have to use private hospitals and overtime to try to deal with the problem now in the first weeks of January.

A question, please.

Does the Taoiseach believe the HSE when it says it is €100 million short for hospitals in 2016? Knowing that there can be no Supplementary Estimate next year, what will the Government do if there is any increase at all in the activity in hospitals in 2016?

I dealt with the question the Deputy asked yesterday. The Government has approved €13.6 billion for health services this year, which represents an increase of €800 million on last year. We are dealing with circumstances in which 1,000 beds were taken out of the system. We know the demographics and the fact the population is ageing. I pointed out to the Deputy yesterday the increase in the number of attendees with flu-like symptoms at accident and emergency departments and the fact there are 250,000 unused vaccines at present, of which people in vulnerable positions should avail. I also pointed out to the Deputy the importance of having an economy that is capable of dealing with the resources for investment in medical personnel, facilities and providing primary care centres, which are being built on an ongoing basis, and also in community facilities, increasing home care packages and the development of hospital groups evolving into trusts. This is to deal in a systematic way with providing health services of a much better kind for patients. The Deputy encountered all this himself. I am not going back. We can only go forward here.

The Deputy asked whether the Government had approved a budget that was inadequate in the eyes of the HSE. What the Government approved was the health service plan submitted by the HSE to the Minister. It includes an allocation of €13.6 billion for 2016, which is an increase of more than €800 million on last year's Estimate. We will not be in a position to provide all the services we need now - doctors, nurses, medical personnel, specialist facilities, the expansion of hospitals, including accident and emergency facilities, and all of those things - without having an economy that is capable of providing these resources. We had all of that before when an endless pot of money was thrown at a system that was not capable of dealing with it.

The Government has admitted that we have not been in a position to introduce universal health insurance. What it is committed to is a universal health care policy driven through primary care centres and communities and an expansion of facilities in hospitals. As the Deputy knows, 750 extra nurses and 300 consultants and specialists have been recruited in recent years. However, one must have the capacity and resources to employ these people. This means there are difficulties in many cases with patients and people who have to attend hospital for one reason or another. I understand the difficulties and the stress and pressure they cause, not only for front-line staff but also for patients.

People are afraid to attend accident and emergency departments.

I remind Deputy Martin that the allocation for 2016 is €13.6 billion, which is an increase of €800 million on last year. In the next number of years, I would like a multi-annual budget to be set out for the health system.

The Government cannot set out a budget for one year, not to speak of a multi-annual budget.

Such a budget would be much more structured than an annual budget and would allow the system to plan in a much better way for the treatment of patients in the home or in the community and hospital sectors.

The Government does not do any of that. The budget has not increased by €800 million, because the Supplementary Estimate introduced at the death of last year was €660 million. In other words, the Government left the health service short at the start of last year. The increase works out at less than €200 million if one adds it up. The HSE is stating simply that, in summary, when account is taken of the 2015 cost of services, the expected growth in costs and initial cost savings, there is a preliminary shortfall of €150 million. While it will do some cash management exercise to reduce this figure to €100 million, it is stating that it will be €100 million short and that one of the options will be cuts in health services.

The frightening thing about the report is the statement on page 91 that day case activity will be delivered at 100% of 2015 levels, while emergency inpatient activity will be delivered at 100% of 2015 levels.

The Deputy should ask a question, please.

The population is growing and demands on hospitals are predicted to increase next year, as we must all accept. As a result of an ageing and growing population, the population will increase by 1% and the number of people aged over 65 years will increase by 3.6%. However, the Estimate does not make any provision for additional activity, meaning that children with scoliosis who are already waiting too long for operations will wait longer next year, and other people, including cardiac patients and people with a range of conditions, will wait longer or may not even have operations next year if the Government's policy continues.

A question, please.

We need honesty in the debate about health and services. There is a medical manpower crisis. If one speaks to doctors, nurses and acute health care staff, one finds that they are under enormous pressure. What the Government is doing with the health budget is fraudulent and false.

Sorry, Deputy. Will you put a question, please? We are over time.

The Taoiseach is pretending enough money has been provided when he knows in his heart there is not enough money available. He will use language to camouflage this and get the Government over the next five or six weeks.

What is the Deputy's question?

What will happen in the rest of the year? I asked the Taoiseach a question about the supplementary health budget, which cannot be provided this year under European Union fiscal rules. How will the health service cope in 2016, given the degree to which the Government has under-provided for it? This is not my analysis-----

There will be more cuts after the election.

-----but the analysis of the Health Service Executive, whose plan the Government approved in the knowledge that it was short €100 million for hospitals.

The Deputy set up the Health Service Executive to provide world-class services. As he knows, the HSE has always had a difficulty in spending the money it received, although it may have claimed every year for more and more money. We cannot return to a position in which we continuously throw money at a system that is not reformed or capable of dealing with a situation that has evolved over very many years. It was created when the HSE was set up on top of the old health board system.

The taxpayer is putting up €13.6 billion for health this year, so of course there are requirements for reform and the effective expenditure of this money. The important point here is that one cannot employ the professionals who work on the front line - consultants, doctors, nurses and so on - and provide them with proper facilities unless one has the resources to do so. We have never had that, and we will not have it unless we can develop the economy to a point at which it can continuously do that.

That is my point. The Government is leaving the health service short.

The Deputy failed miserably in this regard and abdicated all responsibility.

He buried himself in reports.

In 2015, an extra €117 million was provided to the HSE to deal with overcrowding in emergency departments, and the waiting time for the fair deal scheme was reduced from 16 to four weeks. Even Deputy Martin will accept that this is reasonable and-----

Under this Government, the waiting time increased to 16 weeks.

The Deputy overlooks the minor matter of the economic crisis.

-----will allow people to be discharged from hospital.

Will Deputies listen, please? We are over time.

The Taoiseach's starting point in dealing with this issue must be that the health service for which he is responsible is in total chaos. Sin é; that is the truth of the matter. Last year was the worst year on record for patients in terms of the indignity and distress of waiting on hospital trolleys. The European health consumer index published recently found that this State had the worst emergency department waiting times among 35 European states. St. Vincent's hospital in Dublin yesterday became the latest hospital to cancel surgeries, following the debacle witnessed at Cork University Hospital last week.

Having promised to fix the health service, the Government has made it worse. Yesterday, there were 517 citizens on trolleys in emergency departments. The Government promised free general practitioner care, an end to prescription charges and the abolition of the Health Service Executive. Broken promise after broken promise and a health service in chaos - that is the Taoiseach's legacy as his Government prepares to leave office.

These difficulties arise because the Government has set its face against developing a universal health service. Fine Gael, the Labour Party and Fianna Fáil are committed to a two-tier system which is dependent on a patient's ability to pay and his or her location. The result is the appalling and chaotic conditions that the Government has refused to address.

If patients were treated as citizens-----

-----they would have a right to health care based on their health needs. If citizens were treated properly in this centenary of 1916, the Government would be obliged to guarantee not only the right to proper health care but also the right to dignity and respect. To do so, it would have to build a public system, but it refuses to do this. That is the nub of the problem. The Government's aim is to privatise health care. It wants to heap even more chaos on a system that is in bits.

Will the Deputy put a question, please?

Mo cheist is as follows.

How are things in America?

After five years in office, will the Taoiseach give a straight answer as to the reason the Government refuses to develop a universal health service for all that is free at the point of delivery and paid for through progressive taxation?

Is that the way it is up North?

That is the question the Taoiseach should answer, and he should ignore the hecklers behind him. Why does the Government not develop a system of universal health care for all, one that is based on equality and health needs and paid for through progressive taxation?

The intention was to introduce a universal health insurance system. The Government has been up front about the fact that that is not possible in its lifetime.

That is a different issue.

We also indicated that it was our clear priority to have a system of universal health care which works on a number of levels, including primary care centres, community care, home care packages and investment in hospital facilities and medical personnel.

The position is that given our ageing population and the existence of inferior facilities in many of the locations throughout the country, we need to have capacity to invest and provide the best facilities for front-line staff in respect of their patients. As I said to Deputy Martin, €13.6 billion is allocated this year for health and services.

I wish to point out to Deputy Adams again that €117 million was made available for the fair deal scheme.

(Interruptions).

Ask Deputy Michael Lowry to sort out his telephone.

Sorry, Taoiseach, a telephone is interfering.

I think it could be here, a Cheann Comhairle.

I think it might be Deputy Michael Lowry ringing the Taoiseach.

Some €117 million extra was allocated for a reduction in the fair deal scheme from 16 weeks to four weeks, which has allowed for the discharge of patients to free up beds.

What if they need 16 weeks?

Obviously, the expansion of community teams to deliver opportunities for people to be at home and having services outside hospitals, in so far as that is possible, are the aims. Deputy Adams will be aware of the decision, and its implementation by the Government, in respect of free general practitioner access for children under six and people over 70. The next stage is to have it provided for the children of all working families. The increase was substantial on the allocation from last year and amounts to €13.6 billion this year.

Clearly, the Government's intention is to set out a multiannual situation for investment in health which will allow for a far more structured and focused allocation of those moneys. The intention is for hospitals to be paid in respect of what they do rather than simply a blanket annual budget being applied with a percentage increase each year, only to find at the end of each period that the money might not have been spent in the first place. Money is not as flush as it used to be, so it is a case of allocating for the best purpose.

Deputy Adams does down the service of those who work on the front line by some of the statements that he makes. These people work under exceptional pressure, admittedly. The recent discussions between the Irish Nurses and Midwives Organisation and management will, I hope, result in the facilities in accident and emergency units being rectified and presented in order that staff can do their job professionally and in the interests of minding patients to the highest level of service.

I am not doing down health service workers. I have had the experience of being in their care since I came to this part of the island.

Let us go back to what the Taoiseach promised. The Taoiseach promised free GP care for all. Where has that promise gone? The Taoiseach promised to abolish the HSE. Where has that promise gone? The Taoiseach promised to abolish prescription charges. Where has that promise gone? The Taoiseach promised to bring in a universal insurance scheme, but, like the five-point plan, that was simply a public relations stunt.

The Minister for Health, Deputy Varadkar, said that was never going to work. Five years in, the Taoiseach's Minister - not me or anyone here on the Opposition benches - said it was never going to work. He also said that the chief executives of hospital groups should be allowed to transfer management of hospitals to private operations. He said that hospital groups should be able to conduct business in the manner of semi-State companies. That highlights the ideological position of the Government, which, as I have said, wants to privatise our health service.

I asked the Taoiseach a question which he refused to answer. Why has the Government refused to develop a universal health service for all, based on health needs, free at the point of delivery and paid for through progressive taxation?

Sorry, we are over time.

I will put my question now. We are on the cusp of an election. Whatever we can say about Margaret Thatcher, she told it as it was. Would the Taoiseach not be better facing into this election by telling people that he wants to privatise our health service? The Taoiseach should tell people that as opposed to all the slíbhín weasel words that he uses to disguise his real intent. That would be the way to deal with the citizens, as opposed to making the promises he has made as he creates more and more instability and chaos in people's lives.

The term "weasel words" comes from a different vocabulary and a different time. Perhaps Deputy Adams is used to using those words. As someone who does not use the health service here, Deputy Adams is an objective commentator from outside.

I do use the health service here.

Let me reject categorically the statement Deputy Adams has made twice this morning to the effect that it is the intention of Government to privatise the health service. Let me reject that categorically.

Is it the Taoiseach's intention to build a universal health service?

The Government is clear that there should be an end to an unfair two-tier system and that there should be a single-tier system whereby people can have access to medical care and attention as close to home as possible and based on their medical needs as distinct from their income or resources. The intention was that we would introduce a universal health insurance system. The Government has been upfront about not being able to do that in the timescale that was set out.

No, it was not.

The Government is very clear about having as an absolute priority the introduction of universal health care based on the principles of primary care, community care, home care packages and having an economy that can provide the resources to invest in facilities in hospitals and other locations, as well as the employment of qualified personnel, consultants, doctors, nurses and all of the other medical specialist personnel that are required.

Use taxes to provide it.

We cannot have that unless we have an economy that is thriving and moving forward, unlike the sort of fantasy populism that Deputy Adams comes out with in this House every week-----

The economy should serve the people.

-----as if everything can be paid for and provided without having to produce the resources.

The Taoiseach wants the people to serve the economy.

Of course, Deputy Adams does not use the system anyway.

I am afraid that I have to put the Taoiseach under pressure on health today as well. The Taoiseach will recall that in April 2013 I raised the grave concerns of people in my constituency to the effect that Waterford Regional Hospital, as it was then called, was in danger of being downgraded under the proposed hospitals network reconfiguration. Prior to raising that issue, the Taoiseach will remember, an estimated 15,000 people took to the streets in Waterford to raise their concerns. A number of concessions were made at the time to allay the fears of the people of Waterford, including that the hospital would be renamed Waterford university teaching hospital and academic teaching posts would be provided for consultants. We were told this would make it easier to recruit suitably-qualified medical staff. Round-the-clock interventional cardiology services were promised as well. When I raised the issue with the Taoiseach during Leaders' Questions in April 2013, he gave me his word. The Taoiseach said that Waterford would not be downgraded as a result of the reconfiguration.

I wish to draw the Taoiseach's attention to the comments of Michael Murphy, head of University College Cork. He is now threatening to issue a public apology to the people of Waterford for misleading them over false promises from the Government to fund academic appointments at University Hospital Waterford as part of the reconfiguration. It seems the Government commitment, made jointly with the HSE, to appoint three professors, two senior lecturers, a clinical tutor and administrative support has been broken. UCC has agreed to take on the permanent costs of the posts but has sought support from the Department for the funding for the first five years until an income stream is established. This has not been forthcoming. This is why Michael Murphy is now threatening to issue an apology to the people of Waterford.

The people of Waterford and the south east took the Taoiseach at his word when he told me that the hospital in Waterford would acquire the status of a specialised teaching hospital. Does the Taoiseach now acknowledge that in promising these teaching appointments and the 24-hour cardiology services at UHW, the Government has not kept its word? People in Waterford believe they have been sold a pup.

Deputy Halligan has raised an important issue. I know that he is raising it in the best interests of facilities for University Hospital Waterford. This matter was the subject of some controversy several years ago. My understanding is that the HSE and the hospital group are working in respect of the appointment of the personnel, including the specialist consultants Deputy Halligan has mentioned, and that the Department has informed University College Cork of that. My understanding is that the process for the appointment and employment of the specialists he has mentioned is under way. I can advise Deputy Halligan later of the exact position in so far as that is concerned.

At a press conference to rename University Hospital Waterford in May 2014, the then Minister for Health, Deputy James Reilly, and the Secretary General of the Department of Health again committed the Government to funding these academic posts.

Professor John Higgins said that recruiting and retaining clinicians of the highest quality would require the teaching, training, research and innovation that would be needed for the full integration of the mission of that hospital.

I do not know if the Taoiseach is aware that Waterford has had great difficulty attracting consultants in the intervening years. Such is the lack of, for example, dermatology consultants that the service has basically shut down. Only emergency cases are being seen and people must travel to Cork. The rapid access clinic for prostate cancer experiences major delays because no consultant urologist is in place. We regularly have the worst accident and emergency overcrowding in the country, yet we cannot fill the consultant post in emergency medicine. The list goes on.

The failure to sanction these academic posts is hampering the hospital in competing for the recruitment of the best clinical talent available. The research opportunities that would present through these academic posts are not forthcoming. Patients are not benefiting from the latest clinical expertise and knowledge they were promised. Dr. Murphy in UCC wrote to the Department of Health about what he perceives to be the broken promises made to the people of Waterford. I have been told that letter upon letter has gone unacknowledged and unanswered.

I do not know the answer to the Deputy's last comment. Waterford is not the only hospital which has had difficulty in recruiting consultants for which advertisements have been placed. I am not sure of the number of advertisements that have been placed for consultants in Waterford, but I am sure the hospital is not alone in this particular difficulty. As I said, my understanding is that once agreement was reached between Waterford and Cork on the processes, facilities and specialties that would be provided in each hospital, the matter would then be followed through on. I understand the appointment of a specialist consultant, something the Deputy mentioned, is under way between the hospital group and the HSE, and that Cork has been notified of that. That is my understanding and I will confirm it to the Deputy when I have the opportunity to do so after leaving here.