Liam Twomey (Wexford, Fine Gael) | Oireachtas source

I am told that this information is being collected by someone. Therefore, it should be in the public domain. A patient who would like to go to see a certain doctor should be able to look up his details on a website and find out that the waiting time is six months, for example. If we cannot provide such information to patients, we should not expect patients to trust us to do the right thing.

This issue of trust is equally relevant in the context of how we are reorganising the service into hospital groups. It is imperative that these groups are patient-focused. I have sent patient referral letters to hospitals within the so-called hospital group in which Wexford is included only to receive a reply indicating that my patient is outside that particular group's catchment area. I have sent referral letters to a hospital that is not in my hospital group and received the same reply, that the patient is outside its catchment area. What is really confusing, however, is that I have a letter from the Minister for Health himself saying there is no such thing as catchment areas. Who has come up with this notion of a catchment area, which I am told does not exist? This is a system problem. I should be able to refer patients to whichever hospital I like and whichever consultant I choose on the basis that he or she will provide the best and safest service. That decision should be made by me, not by somebody else unilaterally dictating who my patients can and cannot see.

An issue of concern in respect of many hospitals is that the collation and measurement of data is very poor. Notwithstanding the substantial investment in information technology in recent years, the quality of the data we are receiving remains very poor. We need to take steps to address that problem before we can hope to get anywhere.

There is a need for the system itself to change in order for any programme of reform to work. Moreover, the drive for that change must come from within the system itself. We must have real and effective co-operation between hospitals. If the hospital groups are to work, consultants must be able to move between hospitals. It was always the policy in the past that consultants would serve outlying hospitals. In practice, however, that practice has been very piecemeal and is not working well.

We cannot have a properly functioning system of universal health insurance until the principle of money following the patient is fully embedded and operational. We must be able to measure the level of activity within the system such that we know exactly where every euro is being spent, what it is being spent on and how it is working within the system. The money follows the patient concept must be working absolutely right before we even consider which system of universal health insurance we will operate. I have a proposal in this regard which the Minister might comment on. My suggestion is that universal health insurance be implemented in the first instance only for children aged 16 and under. Paediatric services in this country have a very low input from the private sector, with many of the services in the Dublin area being delivered by stand-alone hospitals. If we begin in this area, we can show people what universal health insurance is all about and instil confidence that it can work. The debate in this House and elsewhere in recent days has highlighted how it is possible to manipulate and twist certain proposals in such a way as to present the conclusion that nothing can lie ahead other than disaster. Once people understand how the system works, however, they are more likely to get on board. They will see that what works across most OECD countries also can work here. Indeed, most of the countries which are considered to have a superior health service operate some type of universal health insurance model. It can and will work for this country.

An absolutely vital component in the success of any universal health insurance model is that we have a properly functioning patient safety authority. Patients must have confidence that they are protected within the system. The Minister is focusing on administrative reform at this time. I accept that this is only his opening gambit and that he supports a fully functioning and powerful patient safety authority. We cannot move down the road to universal health insurance until that particular element is in place. Again, it is a question of ensuring patients have confidence in what we are doing. There will be confidence and increased trust if people know there is a completely independent organisation protecting them. There have been too many crises in the health service in the past decade. Patients, including infants, have lost their lives because of delayed investigations and so on. There have been poor standards of hygiene in hospitals for a long time. All of these problems were happening at a time when the State was doubling the amount of money spent on health. All of the crises we have seen, including Leas Cross, illegal nursing home charges and so on, only became apparent years later. We need a properly functioning patient safety authority to keep such issues in check and ensure patients have confidence in what we are doing.

An important component of a successful delivery of universal health insurance and the delivery of health services in general is the issue of a new GP contract. A great deal has been said in this regard but it is important to note that, for the past decade, it is doctors themselves who have been seeking a new contract. The current impasse must be resolved and we must put the additional resources that are required into primary care. Investment in information technology is required, for instance, before we can even measure - let alone address - such things as the number of children who are obese or have diabetes. It is easy to do all these things with the right system and with a little effort and investment.

That investment must include the provision of resources such as practice nurses, who are the mainstay of the service. In fact, they have prevented the collapse of general practice services in recent years. We are no longer attracting young doctors towards general practice, as can be seen in the number of unfilled places on GP training schemes this year. We are already 40 to 50 places behind in terms of replacing the huge number of GPs who are due to retire in the next four or five years. The reason the system has not collapsed is the increased diversity in how the work is being carried out, with group practices being formed and practice nurses, secretaries and practice managers taking up some of the duties carried out formerly by doctors themselves. That has alleviated the pressure up to this point. However, the latest round of FEMPI cuts has put general practice under unbearable pressure because it has impacted on such issues as the rural practice allowance, provision of practice nurses and so on. We must take a proactive approach to ensure the crisis does not get any worse.

The ongoing review of medical card provision is the number one issue being raised in my constituency office. There is a serious concern about how patients are being treated, an issue I have raised in writing with the Minister. Elderly people in their 70s and 80s are being asked to provide all types of additional information. For most of the elderly people I know, their lives have not changed dramatically in the past two years and are highly unlikely to do so unless they win the national lottery or have a very good day at the races. The idea that we must put medical card recipients through the wringer is wrong and has to change. Again, it is a question of enhancing patient trust and building confidence that we know what we are about.

I am genuinely of the view that universal health insurance will work very well for patients. However, it requires the types of reform I have outlined to be implemented. It requires the special delivery unit to operate in an open and transparent way. Patients must be able to follow through on their outpatient appointments, obtain a reference number and know exactly where they are on the list. The hospital groups must work effectively. Doctors seeking to refer patients must not be given the run-around, which is patently wrong. I have no problem with a hospital indicating that a patient will be waiting four years for a referral, but it should not be able to decide that particular patients cannot be referred at all.

The money follows the patient concept must be the number one priority for the Department and the Health Service Executive, with every single euro accounted for and recorded. That was the downfall of the former Minister for Health and Children, Mary Harney, in that she could not account for so many of the millions of euro that were spent under her watch. That legacy is coming home to roost in terms of what we are seeing at the Committee of Public Accounts. That committee should not devolve into a witch hunt, concerned only with chasing one or two well known personalities.

There is a need to change our approach. I hope we will get matters right in that regard. I look forward to even more public debate on this issue during the coming period.

See this speech in context