Jim Daly (Cork South West, Fine Gael) | Oireachtas source

Fáiltím roimh an deis labhartha ar an ábhar seo agus cur isteach ar an díospóireacht.

I welcome the opportunity to speak during these statements on the White Paper on universal health insurance. The previous speaker made a good point about having confidence in our ability to reform the health services. We will achieve nothing if we do not have that confidence. If we do not believe it can be done, to quote the Minister for Finance, we may all pack up our tents and go home.

We must have confidence and there is good reason for having it. I have sat in this Chamber for three years and have heard people decry the health system and predict its collapse. Over recent years, €3 billion has been taken out of the health service which now has 10,000 fewer staff. Many Deputies said the system would not work, but in fact there has been an 8% increase in the number of procedures carried out in hospitals in the past 12 months. People can therefore have confidence in the health system. Collectively, we have a responsibility to share that confidence. People should make the distinction between management and policy because this is a policy shift.

If someone falls down in Bantry General Hospital this evening, it is not the Minister's responsibility, nor is it his job to manage that hospital. His job is to bring about a policy to reform health care. The Minister has a responsibility, and rightly so, to taxpayers who are funding the health service to the tune of almost €14 billion. We must examine what we do and how we do it. Throwing more money at a problem is the political solution to everything, but who will pay for it? Will it be taken from the education or justice budget? We must have radical reform, so I commend the Minister on this initiative and I look forward to seeing it working. I also look forward to being part of that solution, rather than highlighting the problem.

I think everyone in the House accepts that the current system is not working as it should. We inherited a dysfunctional health system, but the question is what we will do about it. It is easy for people to complain about micro issues and say the system is not working. They all know about a lady on a trolley or an ambulance that arrived late. However, we must become part of the solution by supporting the Minister, the Department of Health and the HSE in bringing about the type of changes that are envisaged in the universal health insurance plan.

When there is a change of Government, people wonder if there really will be change or will it just be the same old same old. One of the most striking aspects of health policy since this Government came into office is how it views small hospitals. The day after I was elected, there was a big protest in Clonakilty to keep the local hospital open. At the time there was major unease in many communities about the future of local hospitals. The public rightly have an attachment to small hospitals. The Government sees such hospitals as a solution rather than a problem. It has decided that the only way to take people out of the chronic queues in major centres is by moving patients out to smaller hospitals, with money following the patient. The viability of local hospitals is not built on sentiment or community pride but on practical, procedure-based work. The future of the health care system is to move as many patients as possible from large centres to smaller ones. Hospital trusts have been established to do that. Consultants are no longer appointed to a single big hospital, be it in Galway or Cork. In my own constituency, hospitals in Bantry and Mallow are part of the hospital trusts. A consultant will spend one or two days per week in smaller hospitals to carry out procedures. This significant development is clearly paying dividends and showing great promise for the future.

As it currently exists, private health insurance is a major issue which is spiralling out of control, and the costs cannot be contained. Fewer people are availing of it, it is top heavy with those who are likely to use it, while those unlikely to use it are not paying into it. No Government policy can secure the future of private health insurance. The fundamental basis of any insurance policy is that one has a large broad base of subscribers, which is no less the case to ensure the survival of private health insurance. That cannot be done in the current climate, however, because it is optional. Fewer people are opting into it, so it just does not work. It is going to collapse on its knees, which is what has brought about the idea of making universal health insurance compulsory.

One of the keys to the success of, and building confidence in, UHI is the elimination of waiting lists. The only benefit for people with private health insurance, if they can afford to pay for it, is that they can gain access to health care more quickly. I commend the Department, the HSE and the Minister on the successes to date in eliminating waiting lists. There have been some substantial reductions involving people waiting on trolleys and waiting lists generally. There is a long way to go to get to where we want to be, but I am confident it will happen as a result of the measures being taken, which include co-sharing theatres and discharging 24-7.

In many hospitals, if a patient comes in for a private procedure and is ready to leave on a Thursday, the next person is due in the following Monday. However, there is every chance that bed will be gone with an accident and emergency case over the weekend, so the consultant will not have a bed for his or her private patient. The Minister has eliminated a lot of those issues by tackling them head on. That is showing significant results, with a 95% reduction in the numbers waiting over eight months for procedures.

Universal health insurance is about fairness, equity and ensuring everyone has access to the health service irrespective of their means. Everyone will contribute also. It is nonsense to say that people who do not have health cover will not have to pay anything, because they are paying anyway through the taxation system. They will also have free general practitioner care as part of the wider health reform plan. People who are paying GP fees at the moment will not have to do so.

The objective and overriding goal of UHI is to reduce the overall cost of the health care system by 15%. That will be a significant reduction in what is a massive bill. The current contribution of €1.5 billion from private health insurance will be spread over the population on a fair and equitable basis.

No one in this House or commentators outside has a monopoly on the right thing to do for the future. There is an onus on us, however, to engage rather than just criticising and objecting. It is nauseating to see some of the people who presided over the health system for the past 14 years, and who walked off the stage leaving a crumbling health service for us, now criticising a genuine plan to fix it. I would back anyone who criticised us for not having a plan, but not vice versa. Of course, any plan can he held up to scrutiny and debate, but opposition for the sake of it does not do any favours for the future of our health system. I appeal to Members of the Opposition to engage in this UHI plan and support health service staff. Morale is important for the practitioners in our health care system.

Everyone agrees that health service practitioners, including hospital staff, are superb, as is the treatment they provide. They deserve our support, encouragement and confidence concerning this significant reform. We have already touched on the issue of ambulances. My own constituency has seen real reform of the ambulance service through the reconfiguration process. Ambulances have now moved from being on call, whereby one could wait up to 20 minutes to have an ambulance mobilised, to being on duty sooner.

We must address the issue of ambulances being delayed outside accident and emergency departments. This is especially so in a large county like Cork where two or three ambulances serving the west Cork area could be outside an accident and emergency unit at any one time. Irrespective of the nature of the call, ambulances must collect patients and take them to an accident and emergency unit. These issues are being addressed and will form part of the overall solution to providing better health care.

There are many good examples of health care. Unfortunately, I have had first-hand experience of the health care system in Spain due to a serious traffic accident some years ago. It was superb and there were some notable differences in the Spanish system. One difference that has always stood out in my mind was that in Spain, they had very few nurses on the ward. They were more top heavy with doctors. In addition, family members were expected to come in to help the patient wash and eat in the morning. In the case of elderly patients, it was a particular requirement that the family would be there to contribute. We are, therefore, examining many such health care models.

I look forward to the introduction of universal health insurance, which is one of the most inspiring, innovative and imaginative reforms that I have seen. I am proud to be part of a Government party that is driving that reform. I wish the Minister, his Department and the HSE every success with this proposal.

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