Maureen O'Sullivan (Dublin Central, Independent) | Oireachtas source

The third negative aspect we identified is that which relates to community health care, particularly as it relates to those who have just given birth. The type of care provided in this regard could be a great deal better. Another negative aspect we discussed was that which relates to accident and emergency services. Originally, the latter were meant to be for trauma patients. The clue is in the title "accident and emergency services". However, accident and emergency departments are increasingly treating people with minor ailments. As a result of the increase in substance misuse and abuse, these facilities are also being frequented by those with addiction problems. There is a need to re-evaluate the entire accident and emergency system in order that a better service might be provided.

Let us take on board all of what I have said and view it in the context of what is planned in the context of universal health insurance, UHI. The Government has stated that it is determined that total spending by the State on health care in Ireland under the proposed single-tier UHI system, will not exceed total spending under the two-tier system it is replacing. We are aware that anything from €12 billion up to €15 billion is currently spent on health. One would think that with this amount of funding available, the quality of care and service available to everyone would be excellent and that it would be based on need rather than an ability to pay. However, that is not the case. It is certainly not clear that which is proposed will help us achieve that to which I refer.

The White Paper states that everyone will purchase a universal health policy with a standard basket of health coverage. This will cover hospital and primary care, while social and long-term care will continue to be funded by the State. There will be a multi-payer model, with competing private health insurers and the State-owned VHI. I find it very difficult to understand how this will work and be cost-effective within the current budget. That budget is not working effectively and we all know the gaps which exist and which will not be addressed by what is proposed. The Government's approach to this matter is similar to that taken in respect of water. In that instance, a new body was established and the entitlements and pensions of its employees were decided upon first. Irish Water is nothing other than a new layer of bureaucracy and it seems the new national insurance fund will be something similar.

We have been informed that a number of key elements are yet to be clarified. I presume the issues raised in this debate will be taken on board and clarified. We have also been informed that a commission has been appointed to prepare the detailed options for consideration by Government in respect of the scope and composition of the health basket. It has been further stated, however, that the consultation process in this regard will not delay progress in respect of the introduction of UHI. I do not know how it is possible to reconcile the two. We continually refer to what is needed while the Minister states that the new system will proceed.

There are some extras which are included in health insurance policies at present and which can be purchased. The fear is that the costs in this regard will increase.

When I read the White Paper, I tried to find mention of the word "prevention". I may have missed it but I did not identify any commitment to provide significant funding in respect of preventative measures. As we all know, such measures save lives in the long term. If keeping people healthy is a core principle, why is there not a better commitment to prevention? The relevant reports, studies, statistics and anecdotal evidence all confirm that prevention is better than cure. We know that we can prevent the development of certain cancers, certain forms of heart disease and strokes. Promoting healthy eating and exercise will do a great deal to reduce the impact of the illnesses - diabetes, asthma, etc. - associated with obesity in children and adults. Substance abuse currently costs the State €3 billion in the context of health care provision and dealing with crime. However, there are no significant prevention programmes to deal with substance abuse. I would have liked the Minister to have come forward with a White Paper or a Green Paper - I do not care about the colour of its cover - which really focused on the preventative measures that are necessary within the health system.

The purpose of the Government's approach to UHI is to promote the key role of primary care. I want to focus on the latter in the context of mental health. The National Coalition on Mental Health Reform is concerned that the proposed standard basket does not include talking therapies that are accessible through GPs. This is a serious drawback. Failure to cover the provision of counselling in primary care settings under UHI will mean that the majority of people seeking help in respect of mental health issues will not have the same access to such counselling as they will to medication. There are enough instances of there being a pill for every ill in this country. We must move away from that philosophy. Recent initiatives relating to primary care counselling gave rise to more than 5,000 referrals. The latter provide a very positive example of how early intervention can lead to the prevention of more serious mental health issues. That to which I refer is cost effective. There is a need to promote positive mental health initiatives because, again, these are cost effective.

There is a vagueness about the White Paper, particularly in the context of the costs involved and what will be included in the basket of care. What is proposed is based on the Dutch model and I do not think the Government has taken account of the fact that the market in the Netherlands is very different from that which obtains here.

I addressed the CityWide conference on substance last week. We are aware that substance abuse - regardless of whether it relates to alcohol or licit or illicit drugs - is a serious problem. This issue does not relate just to Dublin's inner city, its impact is felt right across the country. Cumulative cuts of 38% have been made to the funding available for substance misuse projects. They will not be able to continue their work if their funding is cut further. There does not appear to be any sense of urgency on the part of the Department to deal with this matter.

We are all in agreement in respect of the need for equal care, timely access, quality health care and cost-effective delivery. There is, however, a glaring lack of detail in the White Paper with regard to how these are to be achieved. There is no guarantee that UHI will provide the answer.

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