Dáil Éireann Debate, Wednesday - 15 November 2017
29. Deputy Richard Boyd Barrett asked the Minister for Health the portion of the additional €658 million allocated to the health service in budget 2018 that will deal with changing demographics; the amount allocated to new or additional services; and if he will make a statement on the matter. [48131/17]
Amharc ar fhreagraEvery year, the Government propaganda machine states that it is spending more this year than has ever been spent before on health. Every year, the number of those on waiting lists increases and the number of those on trolleys increases or stays the same. Given that the Government is doing it again this year and spending €600 million more than we have ever spent before, I want to know whether that sum is actually going to cover the increased demographic demand for those services, produce anything like new services, or deal with the massive crisis we face in respect of waiting lists.
I thank Deputy Boyd Barrett for the question, although I can assure him that it could not have been said every year by every Government. Before my party came into Government, the health budget was cut in the previous three budgets. It has not risen every year. The Deputy is right, however, that it has risen significantly again this year.
The gross current budget for the health sector for 2018 will be €14.798 billion. This is equivalent to a €646 million or 4.6% increase compared to the 2017 allocation of €14.152 billion. The increased level of funding available to the health sector in 2018 seeks to address the challenges facing the health services into the future posed by demographic pressures, including a rise in chronic diseases and an ageing population, technological developments and health inflation. These challenges are being addressed through the implementation of strategic initiatives such as ongoing initiatives to improve access and the continued focus on the shift to primary care, while continuing to address effective management of resources to ensure that services are delivered in line with the national service plan and within budget.
Let us break down that figure of €658 million, which I think is what the Deputy wants me to do. Of the increase in funding, over €200 million was provided for new developments, which will include expansion of existing services - things we are not doing this year and wish to do next year, and things we wish to do more. It includes funding for the National Treatment Purchase Fund, NTPF, to reduce waiting lists, and a primary care fund. It includes expansion of services in the areas of mental health, disability and home care. The balance is available to maintain the existing level of services taking into account demographics, central pay decisions and other increases in cost. The costs of central pay decisions including national pay increases and the nursing agreement is €278 million in 2018.
To summarise, that is €278 million for central pay decisions and just over €200 million for new developments, out of an increase of €646 million. The exact quantum of services to be delivered in 2018 will be set out in detail in the 2018 national service plan currently being prepared by the Health Service Executive, which will be published before the end of the year. It is, however, not just about funding, but also about reform. I will come back to that in a moment.
I was going to say, "Blah, blah, blah" but actually the Minister did give a bit more detail, in fairness, to back up his assertions.
The Minister is on a roll.
There is a credibility problem, however, with what he is saying. In 2015, we had 386,000 people on waiting lists and there was a budget increase in 2016 of about €1 billion. In that year, the highest number of people on trolleys on a single day was 330. The following year, despite the increase, we had 490,000 people on waiting lists and a high point of 470 people waiting on trolleys on a single day. We had another approximately €1 billion spent, yet in 2017, despite supposedly covering demographics, we are up to 685,000 on waiting lists, which is a spectacular increase. Today, as we speak, the figure for people waiting on trolleys happens to be 470, exactly the same as it was in November 2016.
Can we believe what the Minister just said when all the indications are that the allocations he is making for health, although being flagged as big increases, are not even keeping pace with demographics, never mind actually delivering new services?
I was encouraged by the start of the Deputy's supplementary question but it went downhill after that.
Without wishing to damage the Deputy's credibility, I agree with him that if we continue to just pour resources into the health service without looking at the outcomes rather than the outputs, we will find ourselves in a cycle where we continue to increase investment but do not necessarily tackle the core issues. That is why I am disappointed that the Deputy's political grouping is the only one which did not sign up to the Sláintecare report. The report is a genuine effort by Deputies on all sides of the House to agree there is a need for increased resources, but it is how one spends them. If one continues to do everything in the acute hospital setting, it will continue to cost more money. As demographics continue to rise, with more older people and a rise in chronic diseases, the health system will then find it difficult to be sustainable.
I do not agree with the Deputy's waiting list figures because the figures for this year include data never published before. I have published more data as Minister for Health than any of my predecessors. The pre-planned list and the suspended list are both published, as a result of the RTÉ documentary on waiting lists. The Deputy is not comparing like with like in that regard. The waiting list trends for the past three months show some improvements.
Last week, I was contacted by a man who has been two years on a waiting list for spinal surgery and is in intense pain. He recently received a letter from St. Vincent's hospital, stating it was no longer in a position to offer appointments in the orthopaedic department for spinal review and, therefore, his referral would be returned to his referring doctor with a view to that doctor securing a spinal appointment for the man in another hospital. This is the reality of the so-called increased allocations, as against the actuality of waiting lists getting longer and being told to go back to the start while suffering chronic pain. The evidence on the ground, despite the game of statistics and so on, is that the situation gets worse because the allocations are not sufficient to meet increased demands. We get overruns, which next year's new allocation will just about cover, never mind dealing with backlogs or the need for increased services in several areas.
I will reiterate the point I already made. That is why it must be about reforming the system. It has to be about looking at what we are doing in the acute hospital setting that we could do in the primary care setting. For example, recently, we had the primary care eye review. Ophthalmologists working in the community pointed out they can do much of what their counterparts do in hospitals. This would free up hospitals to do more complex and expensive procedures. High-volume and often relatively low-level complexity cases can be dealt with in primary care. That is why we need to do more of that. We need to shift more and I will show that when we publish the 2018 service plan.
We are making progress with waiting lists. If the Deputy wants to believe my statistics or not, it is up to him, but they are the National Treatment Purchase Fund, NTPF, statistics. The number of persons on the active waiting list for a hospital operation or procedure has fallen for the past three months and is now at its lowest in 12 months. The number of people waiting for an outpatient appointment has fallen for the past two months. The overall number on those lists has fallen over the past two months.
We have a hell of a lot more to do, however. It must be remembered we are coming from a lost decade of investment in public services. I am not going to make the mistakes made in the Celtic tiger by reducing the debate to purely one about funding. Even if one gave an extra €1 billion on top of the budget without reforming the system, it will not be sustainable in the future.
