Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I thank Mr. Quinn and the team for the presentation. Commissioning formed a substantial part of the submission. I have an issue with that. I do not see that the creation of internal markets is anything other than the last thing one does before one goes to full privatisation. I note all of the publicity, not only recently but over many years, on the lack of control we have when public money goes to a private or quasi-private organisation for the specific delivery of public services. We seem to lose all control. In a model of commissioning where the HSE or its offshoot, whichever is the commissioning body, is the purchaser of those services, once the service is purchased, how does HIQA envisage us controlling and maintaining standards? To be frank, we have not exactly covered ourselves in glory in that area up until now. I doubt the capacity exists to do that.

Mr. Quinn mentioned the need to statutorily protect health and human rights. Does he have a view as to whether there should be a statutory entitlement to the basket of goods and services he outlined? He mentioned England and the North, but I would also favour looking at Scotland where they have managed to hang on to a great deal more of the NHS than England has. The Minister there is the person who has ultimate responsibility and that is laid down in law. Does Mr. Quinn see us needing that in a model that focuses on commissioning?

Something that did not come up in the course of the presentation but which has come up when we have been discussing the perpetual emergency department crisis is the inappropriate, in some instances, transfer of elderly people to accident and emergency departments. It has been said to me anecdotally that there is a fear that when an elderly person dies in a nursing home, an inspection by HIQA will commence and a certain amount of reporting must take place. That burden is alleviated for the nursing home if the person breathes his or her last in an emergency department. I make no comment as to whether it is true. I have never seen that and I do not know if it is true, but it has been said to me on a number of occasions. While that was not part of Mr. Quinn's submission, demographic pressures were mentioned and the fact that we are all getting older, which is good, and living longer, which is also good. However, I ask to what extent Mr. Quinn believes that is happening and if he could comment on it. It has come up in other areas.