Catherine Murphy (Kildare North, Independent) | Oireachtas source

If one is to get good outcomes, it is important to have a good process, but we have skipped one of the fundamental processes here, that is, the Green Paper. The Green Paper should have asked what we want and how we will pay for and deliver it. There was a widespread expectation that when this Government took office, there would be very significant changes to the vehicle that delivers most of our health care, the HSE. From now on, people will measure what will be done on the basis of what has happened with the HSE. In essence, the HSE is underpinned by a 19th century health board system with a layer on top. This Government put another layer on top of that instead of radically reforming it. I accept that the current Minister inherited the system but it is in need of radical reform and the Minister said so before taking office. It has not been radically reformed and there is no sign of that happening.

People are asking what vehicle will deliver the health service. I do not believe we have had an NHS moment but we need one. We must look at this in a very broad way, from primary care right up to the most technically advanced units in our hospitals. I want to see a system where medicine is free at the point of delivery and where people are seen on the basis of being a patient rather than a consumer. I believe that we do have to pay for health care but we are already paying quite a sizeable amount of taxation. People are asking me what PRSI is actually for. There used to be a health levy alongside PRSI but they were amalgamated. We are still paying PRSI which now includes a health levy. Then the question is, what is the universal social charge for? What do we get for that? Now we will have universal health insurance too. There is also the new term, "basket" but no one knows what it is in it, which is part of the flaw in this model.

In essence, for many people, this is just another way of extracting taxation and they are not quite sure what they will get for it. Some Ministers have suggested sums of €1,000 or €1,600 which may well be way wide of the mark, but we do not know for sure. It is interesting that this Government is always hugely concerned about uncertainty in the context of the financial markets, for example, but in the context of individual household incomes, people also need certainty. Such certainty is essential, especially given the recently published survey by the Irish League of Credit Unions on levels of disposable income in Irish households. We need to know what will be in the basket. We also need to know whether it will be a tapered or cut-off model, as with the third level grant system. We need to know what services will be provided.

What is going to happen in the meantime? As colleagues have said today and as I have said to the Minister during Topical Issues debates, we are seeing sick people at the moment struggling to get medical cards while also seeing the roll out of medical cards for children under six, which may or may not work. Ideally, I would like to see children under six being able to go to their GP for free. However, I spoke to the Minister previously about a man who is on dialysis who does not have a medical card, although he is making an argument for one. I know of a child who is just over six and who is being peg fed. Crumlin Hospital would not discharge her until she had a medical card because she would not get services from the public health nurse without one. Recently, I spoke to a man who had his leg amputated. A public health nurse and occupational therapist arrived at his house and the very first question they asked was whether he had a medical card. Once they discovered he did not have a card, a line was drawn under his case and they said "cheerio", because they could not deal with him. That is the reality for people at the moment.

I am not sure what is going to be delivered from this and I have no confidence in the HSE. I put that on my election leaflet in 2007 which was not appreciated at the time as I was not re-elected. However, I still do not have confidence that the HSE is the vehicle to deliver this. The HSE needs radical reform if we are going to have a vehicle to deliver a decent health care system. That system must be underpinned by a decent primary care system in order that we can keep people well and out of the more expensive hospital system. Unless we get that right and have the right vehicle for delivery, people will resent paying for it. They will feel there is waste in the system and that they are paying for that waste. They had an expectation that the waste would be addressed before they were asked to pay more. I do not believe there is a person in this country who does not want to have confidence in our health system but what is being talked about at the moment is seen by many people as an additional tax rather than something that will pay for a predetermined system that they buy into. I do not believe people will have confidence in this. There are so many mixed messages coming out of this that I do not see how the Minister will build confidence and bring people with him on it. People do not know exactly what they are going to get.

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