Mick Barry (Cork North Central, Anti-Austerity Alliance) | Oireachtas source

It is useful at the start of the work programme of any committee to start with the terms of reference. When we are talking strategy, the terms of reference are particularly important. Our terms of reference include a reorientation from a hospital-based health service to a primary and community care service. Our terms of reference include moving towards a one-tier universal health care system based on need and not on ability to pay. I think we must follow through on the terms of reference in a forensic and laser-like way. Whatever system is the one most likely to deliver on those goals, which have never been delivered in the history of the State, universal health care, a one-tier system based on need and not on ability to pay is what we must do.

Let us remind ourselves of the terms of reference at the very outset. If we do that, there will be no fear of members being at cross-purposes with the health committee. We have very different terms of reference. We are looking at models for the best model of health care in order to deliver on our terms of reference. We need to have a broad vision and, as other speakers have said, an evidence-based approach to our task. The US model is primarily health care for profit. The mainstream European model is primarily based on versions of social insurance. The UK model is a national health service style health provision. The question for this committee is what is the best model for this country. The curse of the Irish health service through the 20th century into the 21st century has been a short-sighted pragmatism, which at the end of the day is not pragmatic.

Working from week to week or month to month without an overall view and strategy is a type of short-sighted pragmatism, which at the end of the day is not pragmatic. The result of this is a health service which is a hybrid. It is actually neither fish nor fowl. We started in the early 20th century with elements of a welfare state, with the reforms implemented by the liberal Government. With the foundation of the State came the role of the voluntary sector and the church in terms of health services, followed in the last decades by a move in the direction of US models. Thus, we have ended up with a bit of everything, which does not deliver particularly well. We need to stand back from the immediate and develop a strategy around the best model for Ireland.

I am not sure about the idea of breaking up into working groups, at least not initially. I think what we need first is an overview of the situation, following which we can get into the detail, rather than the other way around. There are a few other points I could make but I will leave it at that for now.