Peter Mathews (Dublin South, Independent) | Oireachtas source

These things are important.

I would be wary of the insurance industry having that purchasing power over the medical services. They are vocational medical services. Insurers are not the people who should do that. It is difficult to arrange but, generally, people are prepared to pay directly for the people who provide their health services. If the Government wishes to introduce the concept of universality, we already have universal taxation. People understand that. The rules are the same for everybody, or at least they should be. However, we now discover that corporations appear to have a preferential universe - to remove the "al" from the word universal - whereby they can hover over nations like hovercraft and not be connected for the purpose of contributing fiscally to the countries over which they hover.

That is not right either.

The idea should be to get to a system whereby we have looked at the thing and understood it in its physical, concrete realities. The best people are always those in the front line. It is like sports. If we want to build an Olympic pool, we should not ask engineers, quantity surveyors, accountants and so on who will number crunch. They have not swum competitively. We should ask somebody who has travelled around the world to compete at international events, be they European or world championships or the Olympics. They will tell us what is needed in order to provide the stage for what we intend to do, and then we can refer back to the people who can cost it. That is what should be done here.

The concepts are framed in a way that there is a lurch to go there, rather than asking where we are at the moment, what are the demographics, what are the age cohorts and other profiles. Ireland has its own profiling. We have more red-headed people per capita than anywhere else in the world. That is a reality. We have a disposition to multiple sclerosis that is higher than other parts of the world. We have a disposition towards lots of things. The Government should get a feel for those by people who are in the front line and then it can work out physically that so many hours of attendance will be needed to be devoted to that over the years. Only then can it be given to the accountants and the guys with the ritzy headed notepaper. They will be able to send the fee notes, as we found out from the guys who set up NAMA. The professional firms invoiced at will once they got in there. Some of the advices and the measurements they gave us were absolutely pathetic, such as the estimates for loan losses in the portfolios that travelled to NAMA. Just because there is a ring about the name and the notepaper is five star vellum does not make it intelligent. We can get silly people giving orders to inexperienced people to crunch numbers, and they produce a glossy spiral bound and everybody thinks it is great, but it is not. People with back of the envelope calculations were able to say that the NAMA loan loss estimates were absolutely nuts. People with experience in the front line of doing restructuring and recoveries of loan portfolios were able to get it right to within 5% on a figure of €100 billion.

This is very important. No face is lost ever in doing the right thing. When the correct concrete measurement and physical analysis is done, the Minister may feel that this is not the way to go. Deputy Higgins pointed out that Allyson Pollock, who has a lot of experience, has examined the UK situation, where they are trying to unravel and pick at the National Health Service, which was being divided into hospital trusts and insurance-led stuff and so on. It begins to loosen the nuts and bolts at the joints and that is not a good idea. We will need trained vocational, dedicated, motivated men and women as doctors, nurses and auxiliaries. At the moment we have not got it as they are getting out of here. I have nieces and nephews who are qualified in medicine and some of them are at consultancy level, and it is a bad place atmospherically in many hospitals. We must be aware of that reality as well at the GP surgeries. We cannot have a GP, who is already under pressure on an income front and on a time basis, having a whole heap of family coming in. If elderly people have medical cards, they do not bring a bundle of others. They are on their own and they get one consultation. It may be awkward and it may be a geriatric complication, but if a young mother comes in with a child under six she may have three other children in tow, and we must remember that she may need more than general practice consultation and a lead in to gynaecological consultation.

I am just saying that we need to pull in the reins, do a check and make sure that there are not just egos at large here, saying that we said we would do universal health insurance, but that is not what it is. It is the delivery of a health service that has been properly assessed, properly forecast for the next five, ten and 15 years in terms of headcounts and realities, the equipment needed to do that and the spaces to deliver it. Then we should do the costing. If the physics are right, the financials follow. Money follows the patient.

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