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Dáil
‹ Leaders' Questions

Sláintecare and health roadmap

Summary

Jan O'Sullivan welcomed some budget measures but criticised property-tax changes and the lack of progress on Sláintecare and public housing. The Taoiseach said the Government supported Sláintecare in principle but needed proper costing, legal advice, and a roadmap before implementation.

We do not oppose everything announced in yesterday's budget. We argued for some measures, including reduced class size, the increase in the national training fund levy, increased welfare payments and additional gardaí. The Government will have the Labour Party's support for these measures.

However, some of the choices the Government made yesterday were deeply flawed. Using property revenues to reduce income tax seems to be a return to Charlie McCreevy economics and a dangerous direction to head down. As was stated earlier, no public home construction has been provided for in addition to what was announced earlier this year. The new measures to which the Taoiseach referred all relate to the private sector and no affordable housing scheme has been provided for to ensure homes will be affordable for low and middle-income earners. There is no vacant homes tax and, therefore, the housing emergency will worsen.

The issue just raised by Deputy Martin, which is the allocation of €5 million for the Taoiseach's new strategic communications unit, seems likely to only fund more of the Facebook and Twitter-type advertisements with political messaging that we witnessed from his Department yesterday along with some odd videos of the Minister for Finance arriving at each of his appointments.

Arguably, however, the abandonment of Sláintecare is the worst decision the Government made. Only five months ago, there was cross-party support for the Sláintecare report, including from the Taoiseach's party. Yesterday, it abandoned that cross-party agreement, the only substantial decision that has been made by this do-nothing Dáil. The Government utterly disregarded the funding plans for Sláintecare, which were provided by the all-party committee. At Fianna Fáil's urging, the Government prioritised investment in the National Treatment Purchase Fund, NTPF. The fund can provide short-term results for individuals but focusing investment on the private sector in this manner deprives us of the ability to begin genuinely building our publicly-funded health service. The amount allocated to expand primary care is risible. Sláintecare envisaged free GP care being rolled out to all by 2022 with an additional 500,000 people getting this support each year, including in 2018. It envisaged a substantial increase in primary care diagnostics, counselling and psychology in primary care, as well as universal access to a range of other primary care services. The mere €25 million the Government allocated will do nothing for this. Will the Taoiseach confirm whether the Government has decided to ignore the Sláintecare recommendations?

Comment on this
Leo Varadkar The Taoiseach Fine Gael

I reassure Deputy O'Sullivan that we are certainly not ignoring Sláintecare. We very much support as a Government the principles behind it but it requires a bit of work. It requires proper costings for a start. We do not accept the costings in the report and they need to be done. The Labour Party seems to have accepted an obvious one in its alternative budget, which is the cost of abolishing all hospital charges at only €25 million. No one in this House believes that all hospital charges could be abolished for €25 million. The Labour Party in its document has accepted that costing hook, line and sinker. We think we need to do some proper costings first before we make decisions. However, the Deputy will see some real measures in this budget that show form and that show our commitment to begin to implement the principles of Sláintecare in the years ahead. For example, there is the reduction in the drug payment scheme threshold by €10, thereby reducing the cost of medication for families that do not have a medical card from €144 to €134 a month. There is also a reduction in the prescription charge. Having reduced it for the over-70s last year, we will reduce it for the under-70s in the year ahead. There will also be additional investment in primary care. As indicated by the Minister for Health, funding is being put in place to establish a health reform programme office to draw up the road map and plan to implement Sláintecare. It is a good report and I support its basic principles, as does the Government. It will be discussed in more detail at our special Cabinet meeting in Cork on Friday but it is, at best, a plan for a plan. It needs a great deal more work before it can be turned into a roadmap for health reform. That is the kind of work the Minister, Deputy Harris, is now undertaking.

Comment on this

That is a disappointing response considering that the Taoiseach's party signed up to Sláintecare and that included signing up to the costings. The principle is not much good to those who are waiting for access to health care. In our alternative budget, we costed the various elements that were supposed to be introduced in 2018. The Government's allocation of €25 million for primary care and just setting up an office will do nothing to implement Sláintecare. The Taoiseach outlined figures earlier in the context of additional money for health. When they are broken down, €125 million relates to announcements in the previous budget, €60 million relates to the public sector pay deal, while the speculated overspend for this year is €300 million, which the Taoiseach has indicated will be a charge on the Department. When they are taken into account, the additional money available to health for new measures is only €165 million. This does not indicate meaningful progress with regard to Sláintecare and it must be particularly disappointing for all those who sat on the committee and signed up to the report. Is it the Government's policy to ignore that ten-year vision, given the first year of that ten-year vision is next year? The Taoiseach said there will be a special Cabinet meeting. When does the Government intend to seriously get about implementing the Sláintecare report?

Comment on this
Leo Varadkar The Taoiseach Fine Gael

It is absolutely not our policy to ignore it; our policy is to develop a road map to implement it. The Minister for Health has been tasked with doing that and we will discuss it in more detail at the special Cabinet meeting on Friday. I have asked him to develop a roadmap to do exactly that before the end of the year. However, it requires development, which needs to be built on. I had the privilege of meeting the academics and others from Trinity College who were involved in drawing this up and at the meeting, they admitted to me that were one to implement the first year in full as they proposed, the cost would be an additional €1.3 billion. I said to them and I meant it - and everyone in the House knows this full well - that €1.3 billion in the first year would not be affordable. It would not be possible to implement the plan as they proposed it because we would not be able to find that level of money in year one. Pages 34 and 36 of the Labour Party's alternative budget outline the details for implementing Sláintecare. The total the party provides is €626.9 million.

Comment on this

It is much more than what the Government has provided.

Comment on this
Leo Varadkar The Taoiseach Fine Gael

It is approximately one third of the cost proposed in the Sláintecare report. I could just as easily accuse the party of abandoning two thirds of the report but I will not do that. It is a good report. The Government accepts the principles behind it but it is not, on its own, a roadmap to reform our health service and to provide the universal health care that we want to be provided for this country in the next ten years. It needs proper costings and it needs to be "legalled" as well. There are issues in the report in respect of breaching of people's contracts that require legal advice. It can be built on into a deliverable roadmap and that is what we want to do.

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