Jerry Buttimer (Cork South Central, Fine Gael) | Oireachtas source

I welcome the opportunity to speak on this very important White Paper. If we were to ask at the beginning of this debate or even at the publication of the White Paper what universal health insurance means to the citizen outside, we would be hard pressed to get consistency of answer. That is why it is important that we hold a national conversation on the future of our health service, what it should be about, the basket of services, values and so on.

The Taoiseach referred to everyone winning. Deputy Shortall in her remarks spoke about the poorest running the risk of losing everything. Of course they do not. As Deputy Durkan said, it suits a particular slant to come in and criticise. However, if we are to reflect on where we stand, our private health insurance costs are spiralling upwards all the time, the demand in health is increasing and we are spending €13.2 billion in our health system. We are living longer, we are getting obese more quickly, and associated illnesses are having a profound impact on the people who require to use the services.

I listened to Deputy Twomey speak about the private health system requiring stability and equilibrium, and he is right. The public conversation must be about that. Perhaps the Minister of State, Deputy White, and the Minister, Deputy Reilly, could consider extending the public consultation beyond 28 May. I do not believe that has resonated with people in terms of their ability to play a role in that consultation, so I just ask whether that could be considered.

The basket of services and the costs involved are important, and that is what will focus the minds of people at the end of the day. However, if we are to really look at what we are trying to achieve, then let us look at the building blocks we have put in place, the reform in terms of the abolition of the HSE, the creation of hospital groups, the creation of the special delivery unit and money following the patient. Some of the Members who came in yesterday and today to criticise did not take account of the fact of the 34% reduction in the number of people on trolleys that has occurred under this Government, the 99% reduction in the number of people who wait longer than eight months for an inpatient procedure and the 95% reduction in the number of people waiting longer than a year for outpatient appointments.

These have never been done before. This has happened at a time when, as the Minister keeps telling us, there has been a 20% reduction in funding, 10% fewer staff and an 8% increase in the population.

Everything we do must be about the patients, who must be at the core. This is why I very much welcome the creation of a patient safety authority where we can protect the patient. If we look at what has happened in certain instances in our health system, we can see that the patient has been the secondary part of the process, which should not be the case. The commitment to public consultation, public awareness and the role of the Oireachtas Committee on Health and Children is an important component.

At our committee meeting this morning I am happy to say the committee took the decision to participate, as per the request by the Department of Health and the Government for the committee to play a role in the conversation surrounding universal health insurance. The words "basket" and "values" are now in our lexicon but it is important that the committee plays a role in that. I applaud the Ceann Comhairle because in his role as Chair of this House he has made the relevancy of committees central to what we do as a Parliament. An Oireachtas health committee has the fundamental task of participating and playing a role in determining the value in the basket in terms of universal health insurance. I very much welcome the fact that the committee made that decision this morning. We accept that the introduction of universal health insurance is the most fundamental and radical reform of our health system that has ever taken place. It would, therefore, be remiss of the committee if it did not play a participative role in that. I understand the difficulties that certain members of the committee had in this morning's meeting and I know that members in Fianna Fáil and Sinn Féin are opposed to this. However, if the committee did not play a role, it would have been the wrong decision. The Minister and Government have asked the committee to look at the development of a values framework. If one looks at the development of such a framework, one can see that it is about holding hearings on the shared values of Irish society to facilitate a national conversation. I hope that in doing that, we will assist the Government in guiding the development of a model that has at its core equality of treatment.

In setting a fee, it is important that we do not go beyond where we are at the moment where the individual fee is €920 per person in private health insurance. In doing that, it is important we allow the debate to be about what is affordable and what is in the basket and that we be as inclusive as we can. In respect of the decision to allocate money based on a money follows the patient basis, I would have a small concern that if we are setting this model, we do not necessarily drive hospitals to compete against each other but make it about seeing and treating patients. We are all in favour of that. In the renewal of the health system, we have an obligation to be completely honest. We must look at the recruitment moratorium and ask ourselves about how we allow new graduates, be they nurses, physiotherapists, doctors, occupational therapists or radiographers, to take part in our health system.

During the week, I met a young married woman and health professional who told me about her frustration at being unable to get job sharing or flexitime allowing her to have a career and to be at home with her children as well. In the new health system we are trying to develop, we must be conscious of professional development, get the mix right and create a health system that empowers those working in it as well as those who need to use it. If we cannot bring staff with us, we have lost some of the battle. I am concerned that the moratorium in the health system is one-size-fits-all. We have had the nurse graduate programme and changes to parts of it to allow for this in the area of mental health but there is a fundamental need to look at the recruitment moratorium and to be able to renew the staff and staff levels.

Deputies Durkan and Twomey spoke about primary care. It is important that we acknowledge that since it came to power, this Government has developed at least one primary care centre per month. The number is up to 35 with plans to complete a further 20 by 2015. This is important.

The McCraith report on non-consultant hospital doctors has been published today. I welcome the report. I have not read it in full as I had to come in here to speak. We need to look again at the appointment of non-consultant hospital doctors who are a fundamental bulwark in our health system. Mr. McCraith is right in saying that the appointment of a consultant should be considered as a key step in a medical career rather than an end point. Equally, he is right in saying that we need to look at the onerous out-of-hours commitment and rotas of smaller hospitals. We need to ensure that our health system has doctors who are qualified and who are not under pressure. In a meeting of the Oireachtas Committee on Health and Children, the Minister heard from non-consultant hospital doctors. I pay tribute to Dr. Mark Murphy from the Irish Medical Organisation, IMO, for the campaign he led and the Minister for acknowledging that there as an issue. We should not allow young men and women to work around the clock - in some cases for 36 or 48 hours without a break - to go home exhausted and to almost have catastrophic injuries on the way home.

My next point concerns free GP care for those under the age of six. I welcome the fact that the Minister has engaged with the IMO and the fact that the IMO acknowledged today that it is considering attending talks with him. It is important that there is dialogue and that this dialogue is meaningful because any of us who attended public or private meetings in our constituencies will recognise that doctors across the country have fundamental concerns. The best way to address them is by meeting the Minister. It is important that this invitation is taken up. I will not delay the House by going through the definitions that have been placed in the public domain because the Minister is well aware of them but it is important that this dialogue is meaningful and real and that it takes on board some of their concerns.

My final point concerns medical cards. As of 1 March 2014, there are 1.8 million medical cards in our system and 124,000 GP visit cards. This provides around 43% of the population with access to free GP care. This is commendable but there is an issue in terms of probity that is causing concern and about which many of us have spoken in the past. It is causing particular concern among people who are ill, have disabilities, are over the age of 70 or have cancer or a serious long-term illness. These people have had their medical cards taken away or have been given the letter when their circumstances have not changed and their applications have been subject to inordinate delays. The Minister was involved in rewriting the relevant letter and form but let us make sure we do not allow people to fall through the cracks. We need to be considerate in how we approach the issue of probity and I hope that the Minister would reflect upon this along with the staff in the primary care reimbursement service. People who are sick and undergoing treatment, be they patients with a multiplicity of illnesses or those with transplants, who require lifetime medical treatment should not have to face the pressure and stress of worrying about their medical cards. I understand and acknowledge that the movement towards a universal primary care application system away from the regions has presented difficulties.

It is important to ensure that while we are investing in primary care we do not allow a situation to develop whereby people cannot avail of treatment in the context of medical card probity.

We have started on a journey towards universal health insurance. Questions need to be answered and a national conversation is possible. I hope that the Oireachtas Committee on Health and Children will play a role in that. The creation of the expert commission which will report back on the standard basket of care and the costs involved will be pivotal. Having said all of that, theory and practice are not the same thing. We must make this as easy as to follow as possible. We must be as informative with people as we can be and we must involve a multiplicity of people in this task.

We have put in place a lot of building blocks, both in terms of legislation and organisation, to enable us to put universal health insurance in place by 2019. People have spoken about the Dutch and German models but we must look at what we spend on health in that 70% of our taxation goes on health, which is way more than in many other countries. This is a new departure and it is a welcome one. It is one that we must embrace because what we have at the moment is a two-tier system which is based upon inequality. I look forward to a single-tier system based on medical need rather than ability to pay. We have a long journey ahead and must carry people with us. I look forward to that journey and to the Oireachtas Committee on Health and Children, which I chair, playing a role in that.

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