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Cabinet Committee Meetings (Continued)

Wednesday, 3 July 2019

Dáil Éireann Debate
Vol. 984 No. 6

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(Speaker Continuing)

[Deputy Joan Burton: Information on Joan Burton Zoom on Joan Burton] Will the Taoiseach make a commitment to the Dáil to publish the report so that we can have a discussion? We do not want doctors in Ireland to be in a version of the gig economy, developing a career in Ireland, either because they are from Ireland or they have come here to work, only to find they are caught in a completely dysfunctional system.

Deputy Richard Boyd Barrett: Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett I asked the Taoiseach this morning about the really shameful inequity in the cancer treatment available to people with malignant melanoma. Some people who have the right private health insurance can get access to pembro and other potentially life saving drugs, while others who do not have private health insurance or have the wrong policy cannot. It is shameful that money should dictate access to cancer care which could be potentially life saving. The Taoiseach said it is a complicated situation because the private health insurance company has taken the unprecedented step of moving ahead of the Government in providing cover for this drug. Telling us it is complicated does not answer the question. The national cancer strategy says we should have equitable access to cancer care. Morally, it is just obvious, is it not? What does the Taoiseach have to say to the person who wrote to me whose wife needs this drug and cannot get it? Should she just suck it up that she cannot get access to this potentially life saving treatment? That is just not acceptable. I want to know what to say to this man and his wife and to the many others who have signed a petition on this issue saying they need access to these life saving drugs. They deserve the same chance to live as anybody else, regardless of what private health insurance they do or do not have. What is the Taoiseach going to say to those who need this treatment now?

Deputy Brendan Howlin: Information on Brendan Howlin Zoom on Brendan Howlin The vital and often hidden role of healthcare assistants has come to light in recent weeks. A report published on Monday which reviews their role and function is really important and worth noting. It recognises the crucial work of healthcare assistants in delivering high quality care across the health service and calls for a formalisation of the job title of healthcare assistant. It recommends the immediate establishment of a permanent forum which would deal with issues including education, recognition and registration. Has this important report been discussed yet at the Cabinet subcommittee? Will it be discussed? Has the Taoiseach had a chance to have a look at it himself?

  On a separate matter, in The Irish Times today, David McConnell and Orla Hardiman raise serious issues about genomic medicine in Ireland, the influence of a Chinese-controlled company, Genomics Medicine Ireland, and the handing over of genetic data gathered in Ireland to this private company. These are matters about which general citizens are concerned. I ask the Taoiseach to examine the matter and to ensure that Irish genomics remain in the public domain and do not become part of a privately owned database for a private company.

Deputy Martin Kenny: Information on Martin Kenny Zoom on Martin Kenny There has been great mention of the absence of staffing and staffing levels in various areas of the health service. One of the key things for getting staff into place is having the proper infrastructure in place. That brings me to Sligo hospital, where a cardiac catheterisation laboratory, cath lab, has not been place but has been promised for almost 20 years at this stage. This is getting to be serious because the senior consultant is about to retire. There is great concern that it will be impossible to recruit a senior consultant without having a cath lab. It is a serious problem and needs to be resolved as quickly as possible. I know the HSE capital plan is soon due to come out and we are very much hoping that a permanent cath lab for Sligo will be in that plan. We are not looking for a second one: we are looking for the first one. That is different from other areas which I know are also under serious pressure. Two new wards have also been promised for a long time for Sligo hospital, which is under considerable pressure in regard to numbers and space. This is vital and needs to be in the HSE capital plan and to happen as quickly as possible.

Also part of the same issue of pressure on beds and hospitals are home care packages for the elderly. We have a serious problem with home care packages for the elderly in CHO 1. While it may not be officially stated that funding is frozen, it is effectively frozen. People cannot get access to new home care packages because there is no money to provide them. That is the answer we are getting when we look for them. Every constituency office in the country is meeting the same problem but it is particularly acute in the north west. A new emphasis needs to be brought to the areas that are going to provide the most relief for people. One of them is the home help packages which will have an immediate effect. Another is the infrastructure for University Hospital Sligo.

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar I thank the Deputies for their questions. On the possibility of the need for a supplementary estimate for the health service, I have not seen the precise comments of the Ministers, Deputies Harris and Donohoe, so I am not au fait with exactly what the difference is. It will not surprise anyone in this House that it is often the case that a supplementary estimate is required for health. That was the case long before 2012. It is not a recent development. It often arises because extra costs arise during the course of the year. One of the extra costs that has very evidently arisen during the course of the year is the cost of resolving the nurses' dispute. We are not going to fund that from cutting services so there are areas where we may need to provide supplementaries later in the year. In the meantime, the Department of Health, the HSE and the Department of Public Expenditure and Reform are working very hard to ensure that the HSE comes in on budget while still accepting that there may be additional costs that arise during the course of the year which will have to be funded.

  As to what coming in on budget means, it is important to get this message across if I can. Coming in on budget in the health service this year means spending no more than €1 billion extra compared to last year. It means keeping the increase in spending to about 6%. A €1 billion or 6% increase more than provides for demographics. Perhaps they were not provided for adequately in the past but they are more than provided for this year and last year. The population is growing by less than 1% per year. The population is ageing but not to the extent that it should require an increase of greater than 6% in any one year. The increase for this year is €1 billion. It is what people protesting on the streets are demanding. It was done. We need now to try to come in on budget while allowing a degree of flexibility to provide a supplementary for additional costs that may arise during the year that we are not going to fund by cutting back services elsewhere.

  Deputy Martin mentioned that up to 2012, there were never supplementaries in health. That is not true. Indeed, when the Deputy was a Minister himself one year there was a supplementary for €250 million. That was when the budget was a fraction of what it is now.

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin I was referring to the HSE.

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar In percentage terms, it was not dissimilar to the kind of overruns we have now. The record for the biggest health supplementary ever was under a Fianna Fáil led Government. About €1 billion had to be provided in a supplementary because of illegal nursing home charges, of which the Deputy will also be aware.

On the recruitment of doctors, all the questions asked by Deputy Burton were asked by Deputy Shortall earlier but I am happy to do her the courtesy of giving the answers again. The Deputy is correct that we have one of the lowest numbers of doctors per head of population in the OECD. Ireland has a relatively low ratio of doctors to patients. In contrast, we have one of the highest ratios when it comes to the nursing profession. We are in the top three, four or five in terms of the number of nurses we have per head of population. I agree that we do not have enough doctors working in our public health service but we do have more than ever before. This often does not come across but there are more doctors now working in our public health service than ever before and more doctors are registered with the Irish Medical Council than ever before. Sometimes the impression is given that there are more doctors leaving the public health service than are joining it but that is not correct.

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