James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank the members for their questions. Deputy Kelleher made a number of comments. The publication of the White Paper is a key and important step along the road to UHI. It allows for a public conversation to take place and I hope that everybody will engage in that because it is our health service and we all need to be involved in the shaping of its future and the implementation of what I believe to be a more equitable, fair and affordable system than the one that has evolved over decades in a rather chaotic fashion. I refer to building blocks, money following the patients, the directorate, the hospital groups, new GP contracts and access to free primary care, which the Minister of State, Deputy White, will address in a more detailed way but I acknowledge that people are focused now on cost. I reiterate that it is impossible to say what the cost will be in 2019 when we have not even determined what will be in the basket of services. It is important that we have a public conversation around that because it underscores the very values of our society. I believe in a republic that all people should be cherished equally and that everybody should have access to medical care based on their medical need, not what they can afford to pay and I believe most right minded people support that.

People are fixated on the issue of cost. I cannot predict what will happen in 2019 with certainty but I can say what it would have looked like in 2013. I refer in particular to a newspaper article today which states families face huge bills for universal health cover. An individual - he is not here to defend himself and, therefore, I will not mention his name - states that there will be no subsidy for the 40% of people who are currently covered by a medical card - but they will be fully subsidised by the Government - and the top 30%. Clearly the gentleman did not hear me and some of those who wrote the article and who attended the press conference yesterday did not hear me. I made it clear there, here and elsewhere that there will be a considerable subsidy for families in that group and they will be the big winners in this because not alone will they have affordable health insurance, they will have access to free GP care at the point of delivery and a range of services that will be developed through our primary care initiatives locally.

Last year the average premium was €920. If the proposed UHI efficiencies were in place last year that average premium would have been lower in any event. However, the State would have paid for all those people on medical cards and it would have subsidised considerably those on lower incomes - the very group this paper suggests will not get any subsidy at all. So it would be a fraction of €920 and it will not cost families thousands of euro or anything like it.

That debate will continue. I have clearly said we need to have this conversation. We need to continue to make the progress we have made. I again thank the front-line service and all involved for making this progress in the context of a 20% reduction in budget, 10% reduction in staff and 8% growth in population. Deputy Ó Caoláin made the point that with an ageing population things will just get worse. He is right that with an ageing population things will just get worse if we leave it as it is, which is why we must change it from a hospital-centred service to a primary care-centred service where 90% to 95% of patients' needs can be met. The focus must move from episodic illness cover to prevention and secondary prevention - the care of chronic illness such as diabetes, asthma and other conditions.

I look forward to that debate and having a wide discussion. With the commission having reported hopefully by January of next year we will be in a position to bring it to Government to make a decision on what should be in the basket and at that point in time the average costs will be considerably clearer. However, we need to continue to drive down costs. We have done that in the public sector; it has yet to be done at all to my satisfaction in the private health insurance market, but it will be done. Pat McLoughlin's group is working on that with the insurers.

The VHI, as the biggest payer out for insurance with 80% of the market, is considering how it can address this issue through clinical audit of what we are paying and benchmarking what we are paying for the procedures we pay for. It is also looking at how many of them are being done that should be done and how many of them are being done that should not be done. Members have heard me speak previously about an individual who took €1 million from one insurance company here a few years ago.

All those issues need to be addressed. In addition reform of the Department of Health is taking place. All these things form part of the roadway to get to universal health insurance and give better outcomes for all our people and all those who need our health service.

Deputies Kelleher and Ó Caoláin raised the issue of the ambulance service. Yesterday I did not call Deputy Ó Caoláin names but did I accuse him or shroud waving, as he has done in the past. Again today he is talking about only a third of people with very serious illness getting the ambulance on time. I will let Mr. O'Brien respond to that because it is factually not correct. I am very sorry to hear that the Deputy was ill earlier this year. I am glad to see he is in good stead and that he had the medical care available to him in his doctor's surgery. I want to come to that key point.

There has been too much focus on how quickly the ambulance gets there, although that is important. I do not deny that nor do I deny that we need to do much more to improve our ambulance service. That is critical, as everyone here would accept - I certainly accept it. However, what is really important is that the patient gets the care as quickly as possible, which is why the responders, the first responders, the paramedics, the advance paramedics, the response cars and motorbikes are so important in this respect.

I can accept that Deputy Ó Caoláin has had experiences personally and among his in his family which I am very sorry to hear about. As a Minister, overseeing a service, I must bring that service up to speed - and we are doing that. Mr. O'Brien has outlined the number of new vehicles on the road and that we now have new vehicles for inter-hospital transfer thus freeing up our emergency ambulances to do the emergency work. The volume of calls has increased and an amount of money has been invested in recent years and will continue to be invested.

We have targets for response times. While I do not want to be over-political about it, when Deputy Kelleher raises the issue of response times, I remind him that his party had 14 years in government and did not even have a target. I do not even know if HIQA had reported at that point of time-----