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Estimates for Public Services 2016 (Resumed) (Continued)

Thursday, 16 June 2016

Dáil Éireann Debate
Vol. 913 No. 3

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(Speaker Continuing)

[Deputy Stephen S. Donnelly: Information on Stephen Donnelly Zoom on Stephen Donnelly]  Since the Minister, Deputy Harris, had to leave the Chamber, I ask the Ministers of State who are present, Deputies Helen McEntee and Finian McGrath, to raise as a matter of urgency the fact that, owing to Government cuts, Cappagh National Orthopaedic Hospital has not got the money for the implants needed for patients who have been waiting for two and a half years for orthopaedic surgery. However, the problem is even worse because, as I found out, the target of being admitted to an operating theatre within 15 months of meeting a consultant is a HSE target. Cappagh National Orthopaedic Hospital will now miss the targets. The HSE will, therefore, fine it and it will have less money for implants. The waiting lists will get longer and the HSE will fine the hospital again. That is happening right now in our national orthopaedic hospital. If we are to have a conversation about a budget of €13.7 billion and additional expenditure this year of €500 million, the Minister should, as a matter of urgency, engage with Cappagh hospital. It needs approximately €5 million or €6 million for the rest of the year.

Cappagh National Orthopaedic Hospital also needs multi-annual funding. I cannot understand why this is not made available. Imagine a hospital not knowing in the first three months of the year how much funding it will have for the year. Other organisations just do not operate like that. The hospital needs funding for this year, and it needs multi-annual funding. It needs more ambitious targets. It is unacceptable that the HSE target for orthopaedics is 15 months. This period needs to be reduced.

There is no load balancing across the hospitals. Thus, the waiting lists in Limerick are much smaller than in Dublin. There is no national patient database. There is no co-ordinating function whereby one would be asked whether, on the basis that one must wait 15 months in Dublin, one would be willing to wait six months on a list in Limerick. There is no load balancing in this regard at all. I will send the Minister the notes on this. Will he please consider providing a low number of millions of euro to Cappagh National Orthopaedic Hospital? I will be more than happy to send him all the details.

What is happening in Cappagh, including the mismanagement by the health care system of the funding for the hospital and the results for patients and the medical staff, is symptomatic of a Health Service Executive that clearly does not know how to run budgets. The Government is asking the Dáil to sanction an additional €500 million. To put that in perspective, that is more than half the total fiscal space we will be debating in October for the entire budget for next year. An extra €0.5 billion — over half the entire budgetary space for next year — is being sought by the Government. I apologise if the analysis is unavailable. I have tried to obtain it. We have contacted the Minister’s office and looked at the website of the Department of Health but I cannot find any breakdown of the €500 million. I have read through the Minister’s speech and have found explanations for allocations of €40 million here, €50 million there and €15 million in other places.

I have to hand the revised book of Estimates. It gives the revised budget for this year, €13.69 billion, but nowhere is it explained where the extra €500 million has come from. There are references to some allocations in the Minister's speech but I cannot find a table indicating how the €500 million breaks down. There is €200 million for additional services and €300 million for overruns. It ought to be stated that the €200 million for additional services is going to listed places based on certain cost–benefit analyses.

The Dáil voting through an extra €0.5 billion is a massive undertaking but we are not being provided with the kind of analysis one would expect to see if asked to sign a cheque for €0.5 billion unexpectedly. I apologise if we were provided with it. This debate is about whether the Dáil is willing to sign a cheque for the HSE of an additional €500 million. Now that the committees are being formed, surely the Minister should offer an explanation of the allocation and the overruns to the health committee, finance committee or the new budgetary committee.

The Minister mentioned in his speech the new accountability framework that the HSE is putting together. It is very welcome to see an accountability framework coming together. If in my pre-politics world people said they had overspent by €0.5 billion, there would have been serious accountability. I am not talking about the Minister as he is new in the job; I am talking about the HSE. Has anyone been fired? Has anyone been demoted? Someone, somewhere, has overspent by hundreds of millions of euro. Will the accountability framework actually hold anyone to account for over-expenditure of hundreds of millions of euro?

Deputy Eamon Ryan: Information on Eamon Ryan Zoom on Eamon Ryan This is a useful debate. Our most significant budgetary categories are social welfare, health and education. They reflect the three big Departments where the money goes. Our history over the past 15 or 20 years, including in the lead-up to the crash, shows that most of the money went into these categories. Expenditure on health increased dramatically in the period. Obviously, we have experienced a particularly harsh and difficult time in the past seven or eight years as the budgets came down again. They are starting to expand, which is welcome, because our economy is starting to grow but we should be careful to avoid the trap into which we fell in the early 2000s when we were just putting money into a system without getting value for it. We must be razor sharp and clinical in assessing the benefits of our health expenditure.

I am conscious that the Minister has a task ahead of him in conjunction with the rest of us in the Parliament as we are running our health system, or changing the entire system. I am very glad a joint Oireachtas committee is now examining how we can, in mid-flight, change some of the engines of our system to move towards a single-tier system. I do not see any of that set out in Estimates. This relates to one of the questions I was asking during Leaders' Questions earlier today. There is a need for detailed work in the committees whereby the Minister would outline, through his budgetary provisions for 2017 rather than through what we are discussing today, how he wants to make the desired shifts.

There are a number of other shifts I do not see in the spending priorities and on which I want to reflect and comment. Various Members have raised concerns about using specific examples to outline the problems at large. I am concerned that we are not allocating enough money for ICT. We are spending approximately 1%. When we invest in ICT systems — be it PPARS, electronic voting machines or Eircode — and the investment does not work out as originally planned, it becomes a big story. I fear that this freezes the public service such that it is afraid to take a risk or change the way it does business. Officials do not want to risk their career by suggesting some innovative ICT approach. We are not spending enough on ICT. The Green Party’s assessment of health policy is that we radically need to increase ICT expenditure because it may result in productivity in all the other areas where we are spending the money.

I agree with the comments of Deputy Stephen Donnelly on where the money is going. Parsing the figures as best I can, I believe the money is being spent on wages and staff primarily. Are staff being used to best effect? By investing in ICT, we can ensure our health and emergency systems and some of the processing in that regard are carried out in a more careful, creative and humane way. We could direct patients to where resources are under-used.

ICT investment would allow us to treat patients at home. It would allow us to change fundamentally the structure of the health system and the means of providing services, including through remote sensory systems, remote diagnostic tools and remote delivery of medicines. This is all available. We have most of the leading companies in this country that are interested in this space and which are good at what they do in this area. We should be using their expertise. We are not budgeting sufficiently in this space. I flag that for the Minister.

I wish to give a personal example. We have all used personal examples. One of my strongest memories concerning the health system is that I was once invited to an event by the great Risteárd Mulcahy, the professor of medicine in UCD and cardiologist in St. Vincent’s. I was once very proud to be involved with him on a cycling campaign. This is a very important example of preventive activity in the area of health in which we need to invest. Creating a healthy environment will actually cut the budget more than anything else. Professor Mulcahy brought me to the preventive centre in St. Vincent's. It may have changed since my visit was a number of years ago. I will always remember walking through long corridors with massive machines and considerable resources only to finally arrive at the centre of preventive health in the hospital. It was a broom cupboard. That is the only way to describe it. We now have the opportunity not only to put funding back into the health service but to reform it.


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