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 Header Item Death of Former Member: Expressions of Sympathy (Continued)
 Header Item Ceisteanna (Atógáil) - Questions (Resumed)
 Header Item Cabinet Committee Meetings

Wednesday, 3 July 2019

Dáil Éireann Debate
Vol. 984 No. 6

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(Speaker Continuing)

[Deputy Seán Canney: Information on Seán Canney Zoom on Seán Canney] Everybody talks about his political agility, his political wit and so on, but what I remember most about Mark Killilea was that he was a neighbour and a friend. When we were up in Bob Scales's land every summer, he was there and he never offered us anything other than advice. When I was in Fianna Fáil, he was always a good friend and when I left Fianna Fáil, he still gave me advice, which was good. He never had animosity towards anybody. He was a good friend to everybody.

From the point of view of Belclare, we have lost someone great in that we have lost Mark Killilea. Corofin has lost someone great.

What lives on is his memory and all the stories that go with that. Last week, we talked about the late Jackie Healy-Rae. Who originally referred to the common person who ate their dinner in the middle of the day is a dispute that will carry on but I think Mark would win the battle there. I am delighted I got back in time to say a few words. It is great to see everyone from Belclare and Tuam.

An Leas-Cheann Comhairle: Information on Pat the Cope Gallagher Zoom on Pat the Cope Gallagher Ar dheis láimh Dé go raibh a anam.

  Members rose.

Ceisteanna (Atógáil) - Questions (Resumed)

Cabinet Committee Meetings

 1. Deputy Michael Moynihan Information on Michael Moynihan Zoom on Michael Moynihan asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar the number of times Cabinet committee E, health, has met in 2019; and when it last met. [25595/19]

 2. Deputy Joan Burton Information on Joan Burton Zoom on Joan Burton asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee E, health, last met; and when it will next meet. [26568/19]

 3. Deputy Richard Boyd Barrett Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee E, health, last met. [26623/19]

 4. Deputy Brendan Howlin Information on Brendan Howlin Zoom on Brendan Howlin asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee E, health, last met; and when it is next scheduled to meet. [26685/19]

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar I propose to take Questions Nos. 1 to 4, inclusive, together.

Cabinet committee E last met on 22 November 2018. A date for the next meeting is being scheduled for later this month. In addition to the meetings of the full Cabinet and of Cabinet committees, I often meet Ministers on an individual basis to focus on particular issues. In this regard, I meet regularly the Minister, Deputy Harris, and his officials and advisers to discuss issues relating to the health service, and health is discussed by the full Cabinet almost every week.

This year will see the highest ever level of health funding in the history of the State in order to transform the health service to one that can meet the changing needs of the population and be resilient to challenges presented by changing demographics.

We have also committed close to €11 billion in capital investment over the next ten years in the national development plan, Project Ireland 2040, to provide the infrastructure required for expanded community and acute care.

While there is a need for increased investment in the health service, reform and productivity gains must happen as well. These gains are not always easily realised and require a long-term strategic approach.

The Government is advancing a significant programme of reform to ensure meaningful and sustained improvement in the health service in the future.

The publication of the Sláintecare action plan for 2019, the first of what will be annual plans, sets out in a detailed and quantifiable way how the ambitious ten-year reform programme will be advanced this year. The first quarter progress report for this year is completed and all 28 deliverables are on track.

The guiding principle of Sláintecare is to provide the right care, in the right place, at the right time. Recent advancements include the following measures. Reduced prescription charges, reduced drug payment scheme thresholds and increased GP visit card income thresholds all came into effect in April. This is a step forward in benefitting hundreds of thousands of people by reducing the cost of healthcare for them. On 11 June, Government approved the general scheme of a Bill to change how productive assets are treated under the nursing home support scheme or fair deal. This will positively affect families who have family farms and businesses but now require nursing home care. An agreement has been reached with the Irish Medical Organisation on a major package of GP contractual reforms which will provide a 40% in resources for general practice, benefitting patients and make general practice a more attractive career option for doctors. Last Friday, the new HSE board had its first formal meeting following the Minister for Health signing the commencement order for the HSE (Governance) Act 2019. The board had been meeting prior to this on an interim or administrative basis. The board will strengthen the management, governance and accountability of the HSE.

Deputy Micheál Martin: Information on Micheál Martin Zoom on Micheál Martin The Taoiseach will be aware that the Minister for Finance has explicitly ruled out the possibility of any Supplementary Estimate for the Department of Health later this year but, in contrast, when pressed by Deputy Donnelly on this matter, the Minister for Health refused to rule out seeking a Supplementary Estimate. The Taoiseach might be able to explain the contradiction between the two Ministers in that regard. The Taoiseach might be able to indicate what he believes the full year outcome will be in relation to the health Estimate. Does the Taoiseach also believe that there will be no question of a Supplementary Estimate being required? He might clarify that for me.

I note that up to 2012 the HSE demonstrated a strong ability to deliver within budget but that changed due to a new political approach to service plans introduced by the Cabinet. The Irish Fiscal Advisory Council has said that ministerial and governmental decisions in demanding services but not providing the funding at the start of the year have directly added to the end of year Supplementary Estimates - in other words, at the beginning of the budget year every year the Government knew full well that what was provided for in the service plan could not have been met by the Estimate that was provided and that there would inevitably be a Supplementary Estimate. That has been an issue for quite a number of years. Does the Taoiseach accept this, or is that another recommendation of the Irish Fiscal Advisory Council which the Taoiseach will ignore?

I put it to the Taoiseach that whereas he talked about Sláintecare and some of the issues around thresholds, etc., that are doable, at the essence of the health service at the operational level are fundamental difficulties with access to the health service as manifested in overcrowding in accident and emergency departments and excessive deaths as a result. Much of that is contributed to by the deficiencies in step-down facilities, nursing home beds, rehabilitation beds and facilities, and facilitating efficient discharge from acute hospitals. In my view, the demographic realities of health have not been provided for in recent times. As a people, we are living longer. That is a good development but the numbers of people who attend the services, particularly emergency departments, for example, those over 65 years of age, is quite significant. The issue around care of the elderly, be it home care packages or, as I said, the various facilities required once discharge takes place, have not been provided for in budgetary terms by the Government and have been fudged year after year. Does the Taoiseach accept that basic proposition that the Government has not met the challenges arising out of demographic changes in terms of the health service?

Deputy Joan Burton: Information on Joan Burton Zoom on Joan Burton One of the many problems of the health service in Ireland - I do not know whether the Cabinet committee or the Cabinet has had an opportunity to discuss this - is the dysfunctional recruitment of doctors within it. We now have one of the lowest numbers of doctors per head of population in the EU. At the same time, we are increasingly relying on the recruitment of doctors trained outside of Ireland and coming to this country. Within a few short years, the service has become dependent on a category of junior doctors, most of them foreign trained and on the lower rungs of their medical careers. Ever more healthcare is delivered not by consultants or trainees who are in secure career structures, but by an ever-growing army of non-training scheme doctors. This is unfair to those in the medical profession who want to work as doctors and who have a completely uncertain career path, so much so that many of the foreign doctors ultimately end up going to the UK or other countries where, having gained experience in Ireland, they can get a career path in those countries.

My understanding is that there is a draft Health Service Executive report on this problem of recruitment which ties in with all the other problems the health service is experiencing but has a significant impact on patients and their families in terms of their access to care, waiting times, appointments, etc., in hospitals and service facilities around the country. Has the Taoiseach discussed this draft report?


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