Andrew Doyle (Wicklow, Fine Gael)

This is a pertinent and relevant issue to discuss. If it was as simple as more money, the health service in this country would be one of the best in the world. In the good old, bad old days when there was growth and inflation of 5% or 6%, inflation in the health service was running at 10%, extra funding was going into it and the problem still persisted. The Minister and myself sat on the old Eastern Health Board followed by the Eastern Regional Health Authority, which split into three boards, and then we all were booted off in the infamous centralisation of the health service with the establishment of the HSE. We have seen more money thrown at it in the first four or five years of the HSE, and it is still no better. It is not quite simply a matter of funding.

Other countries that have adopted a fair care model of universal health insurance are spending far less per head of population than we are. There are reasons for it other than management. There are certainly many reasons for it with the way we do our business as a health service provider.

The principles of building a proper primary care structure, of having the money follow the patient - in other words one gets paid for the service one provides and if one does not provide it one does not get the money - and of having a system of universal health insurance are ones to which we should aspire. I note the motion states the plan is in chaos but it does not state that it is a bad idea.

We should remember that right throughout the years of significant extra funding going into the health service, accident and emergency services, in particular, did not get any better. Many other areas of health care improved and others have not improved, but accident and emergency, in particular, did not get any better.

In the case of the hospital closest to me to which Deputy Harris referred, St. Columcille's, the clinicians are the ones who are recommending a change of configuration, but it will only be effective if the proposals are implemented along the lines Deputy Harris outlined. One must put in the extra infrastructure. One must manage the flow of patients between both hospitals, and who goes in to each hospital. By doing that one can improve services in both places but one cannot do one without the other. The one commitment - we met members of the HSE management last night - that none of it will be completed until such time as the clinicians approve of it is key. There are different cases across the country in other areas where there was a split between those who were involved, the health clinicians themselves, and the HSE as it was. They all are individual and every case is different. However, in this case it is the clinicians who are recommending it. In the first instance, it is not a cost saving measure; it is a cost efficiency measure and what is best for the patients. We should bear that in mind.

It is easy to make a political football out of everything, but I plead with people to take the advice of those who know best, which is not the politicians nor the bureaucrats. If it is those who are involved in the delivery of the health service, please listen to them.

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