Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I apologise for being late and hope I do not repeat questions that have already been asked of the witness. Deputy Harty made reference to a suite of services but I would prefer to call it a menu. Who does Dr. Turner believe is best placed to draw up the basic menu or suite of services to which people will be entitled? How will that be worked through?

Deputy Barry spoke about moving things from one system to another. Does Deputy Barry's analogy assume that demand is static and that nothing new emerges as a treatment? Let us say we are moving services from the private into the public health system. Our population is increasing and ageing and at the same time, the costs of modern medicine, with drugs being a prime example, are escalating. In that scenario, we will be fighting a losing battle. Demand for services, whether essential or non-essential, will be constantly increasing. I ask Dr. Turner to outline his views on that.

Dr. Turner's opening statement refers to out-of-pocket payments and suggests that the roll-out of universal access to GP care should involve increasing the income threshold on the GP visit card. The logic behind giving universal access to children under six was to get them into the system early. I know that many questioned why people with sufficient means should be able to bring their children to the doctor for free. Speaking as a community pharmacist, I know that during the recession I was often faced with the difficult decision of whether to refer someone with three children to a doctor because it could cost €150. Even people with a good income might not have €150 to spare. I believe that free GP care for children under six is a good thing. That said, I have three children under six and I am probably more likely to bring them to the doctor now.

Does Mr. Turner believe it would be better to improve access for people with co-morbidities, like diabetes, obesity, heart conditions and maybe cancer? Should we not try to deal with people with complex medical needs before giving universal access to, for example, 12 year olds who have no major medical needs? How can one justify providing access to one group over another, even on an economic basis?

In terms of barriers to GP access, Dr. Turner suggested that we could consider giving everyone five free visits per year and then charging for any additional visits. I ask him to elaborate on where that idea comes from and to outline whether there is research to back up the suggestion that five visits per year would be enough. Would someone who is asthmatic, for example, also be entitled to half-an-hour with a specialist nurse per year?

On the question of disentangling the public and private systems, how would we go about doing that? Does Dr. Turner believe that doing it on a specialty by specialty basis would be the way forward? Before Christmas we discussed maternity services and the fact they are universally accessible, although many people opt to pay for private maternity care. Would that be a good place to start? Those who opt for private care pay approximately €3,000 on top of their private health insurance in order to have a consultant leading their care. They do so because they believe it is the safer option. If we roll out the national maternity strategy and implement it in full, resulting in more confidence in the public system, then that might be a good place to start in terms of disentangling one from the other.

Dr. Turner referred to the need for more money. This seems to be a constant issue. At almost every meeting, the Chairman refers to the fact our health spending, per capita, is one of the highest in the OECD.

I am conscious of a demand-led system and this unsustainable draw on revenue, especially when in another section Dr. Brian Turner said the system is not maximised and doctors are not used to their optimum because there are no theatre or scanning staff, for example. I am concerned an economist would say we should give more money without creating efficiencies or making the system better.

What I took from Dr. Brian Turner’s point about consultant pay is that it is not a pure matter but must be related to the average industrial wage or relative to living expenses. Does he have data on why Ireland is unique and unusual in that we are required to spend almost the highest in the OECD on consultant pay? Obviously, we are spending the highest in the OECD per capitabut that is because of houses, school fees, wages, etc, impacting on that.

Dr. Brian Turner referred to the reduction of bed numbers in the 1990s due to the financial situation then. I assume that was never rolled back on or compensated for when times became good. Was that reduction ever addressed when Exchequer funding was available? Will he elaborate on his statement that waiting lists are one way to ration services? Is that hoping that people will get worn out waiting or might die?