http://www.youtube.com/watch?v=J3jBRC12Dc4

THIS IS THE SPEECH given by Róisín Shortall TD, the Minister of State for Primary Care, in the Dáil last night. She was speaking during a debate on a motion of no confidence in the Minister for Health – her boss – James Reilly.

During her four-minute speech, Shortall did not reference Reilly once, nor affirm her support for him. She nonetheless voted in Reilly’s favour in both of the votes taken on the motion.

The government faces a huge challenge to manage and reform the health service when the health budget is being reduced.

As part of that process, a key question arises for us all: Who will bear the burden of the cuts? Do we increase prescription charges for medical card patients, for example, or instead reduce the drugs bill? Do we cut public health nurses, or instead collect money owed by insurance companies? Do we cut home help services, or instead impose a cap on consultants pay?

Our priority must be to protect frontline services. We cannot cut our way out of problems. We must reform, and that reform must happen quickly. Unless there is substantial reform, there will be cuts and the poor will be the hardest hit.

Reform means reducing costs and changing the model of care, to switch the focus from acute hospitals to community and primary care. This will ensure early diagnosis and much better value for money. That is why the Programme for Government prioritises primary care in the term of this government.

To deliver on the programme we need fully-staffed primary care teams, working from modern primary care centres. That is why we must recruit the 300 frontline primary care staff to areas of greatest need. Staff such as public health nurses, speech and language therapists, and occupation therapists. Staff for whom funding was provided this year.

Thousands of people – children and adults – are on waiting lists for these services. It’s time we started the recruitment. Decisions on where staff are allocated, and where primary care centres are located, must be transparent and objective based on health need and no other consideration. Primary care centres, just like schools, are essential public infrastructure and should be provided on the same basis.

The programme for government commits to extending free GP care to all in this government’s term. We know that fees stop people attending their GPs, so they eventually need more expensive hospital care. Private fees for GPs are just 2% of national health spending, but their removal unlocks the potential for major reforms.

The lack of priority afforded to producing the Free GP legislation has been very disappointing. Allocated funding must be restored to start this key initiative this year. We must also have a clear roadmap that charts the road forward and ends the uncertainty about the future.

These are just some of the questions that need to be resolved. Are we going to reform and strengthen our public health services, or privatise large parts of it? How do we assure equity and access in the health service? What model of universal health insurance best suits the situation here in Ireland? Should it be a commercial insurance model or a social insurance model? What will replace the HSE? And how best can we control costs?

Reform of healthcare, I think as we all know, is never straightforward. Decisions taken by the government over the next few months will determine the shape of the future healthcare system. That will determine the shape of the system for years to come. We have to get it right. Reform must be made in the best interests of patients.

Read: Reilly wins confidence vote as Taoiseach and Tánaiste state their support