John O'Mahony (Mayo, Fine Gael) | Oireachtas source

I am glad to contribute on this debate. For many years, there has been a saying in Ireland - if something is not broken, there is no need to fix it. It does not apply in the case of our health service. The irony is that the service was broken during the country's wealthiest time, albeit one based on a false economy generated by the 2000-08 construction bubble, when the Fianna Fáil-led Government of the day decided to reform the health service. Fianna Fáil Members are conspicuous in their absence this afternoon. The then Government abolished the regional health authorities and created the HSE, which was meant to be the solution to all of the health service's ills. In reality, the HSE introduced layers of bureaucracy, became a monster and soaked up the funding thrown at the health service, which became more dysfunctional as time passed. There was no problem with overruns or missed targets because there was plenty of money to throw at problems, but the service's dysfunctional nature and real problems were not addressed. This is the background of the task given to the current Government. A major problem must be fixed at a time of financial constraints.

During the Celtic tiger, we developed to the ultimate degree our two-tier health service. If one had private health insurance, one was able to jump the queue. If not, one needed to grin and bear being at the back of the queue. The challenge facing the Minister and the Ministers of State, Deputies White and Kathleen Lynch, is to fix that broken system using available resources, which has led to this White Paper.

In the past three years, approximately 500,000 extra medical cards have been issued. I agree with Deputy Twomey that the increase has presented its own problems. The reviews being undertaken in respect of elderly people and so on must be handled in a more sensitive way than is currently the case.

Progress has been made in the reduction in the number of people on trolleys and waiting lists. This has been achieved when €3 billion less is being spent on the health service, highlighting the wanton waste and inefficiencies of the past.

I welcome the White Paper's publication and agree on the need for a radical overhaul of a health service that is two-tiered, inequitable and top heavy and in which there is insufficient emphasis on front-line services. Having read the White Paper, I note that it contains a vision of an end result with which few would disagree. It will result in a fairer, more efficient and more accessible single-tier system for everyone. However, many building blocks must be put in place between now and then. Clarity in the information supplied to the public and stakeholders is necessary at the earliest stage if everyone is to buy into what will be a better system. I welcome that consultation will take place with the stakeholders.

I also note that primary health care is to be a central component of UHI, with an expanded role for primary care centres, GPs and the services they provide. I attended a meeting of GPs in my constituency of Mayo a couple of weeks ago. It was hostile and I have supplied details to the Minister. We were told in no uncertain terms that, despite primary care being a policy priority, funding had been reduced. It was pointed out that, although 98% of patients' initial contacts were with GPs, only 2% of the health budget was spent on primary care. It was outlined clearly that GP services in rural areas were being affected by the removal of the rural allowance and distance coding. GPs claimed that this would result in more referrals to accident and emergency departments, costing the health service even more. They highlighted some procedures for which they were paid €4, but that cost €400 in accident and emergency departments. There is much food for thought in this. I hope that the relevant heads are knocked together on this. GPs will play an important part in UHI. There is no point in their being kept waiting outside the discussions.

I look forward to the implementation of UHI and its building blocks. On the way to the winning line, it is important that we not trip up by failing to consult. I am glad to see that consultation is a part of the process. The other building blocks should be structured in such a way that allows people to buy into and feel a part of them and achieves the creation of a single-tier health service by 2019 for everyone's benefit.

See this speech in context