Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

That brings us to the end of the engagement. I just want to make a couple of quick comments. I do not necessarily want responses, but I would like the comments to be absorbed into the system. Perhaps we can get a response at a later stage. What was it the former US Secretary of Defense used to say? There are known unknowns and unknown unknowns. He followed that around to infinity. In relation to health budgeting, it is necessary that we, the members of the committee, the Minister and the general public have some idea as to how close we are to identifying the extent of the known unknowns. It comes as a shock both to those working within the health service and to those who analyse it from the outside. We can take it that politicians will always exaggerate on one side or the other to suit the occasion, and that administrators will accentuate some aspects from time to time to draw particular conclusions on a subject, but it is time that we identified the known unknowns. I was told twice last week in the House that we have a demand-driven service and that it cannot be accurately quantified. We cannot accurately quantify it, but we can very nearly quantify it.

It is necessary to identify the extent to which we are on a moving target or the extent to which we are stopped and the target is moving. In other words, we would like to see a situation at budget or Estimates time whereby some decision is made in relation to the overhang from the previous year. That is part and parcel of what has to be dealt with. We also need to know to what extent different issues that have come up in the course of a year, whether on a monthly, bi-monthly or quarterly basis, have affected the overall outcome by the end of the year. Otherwise, we are going to be into a situation where there is no end to the continuous call for more and more funding. The HSE is not an employment agency; we cannot solve everything that way. However, we need to ensure that sufficient provision is made to keep the service going in a way that is expected and given the costs already undertaken.

There are two things that follow there. The Department is known as the Department of Public Expenditure, National Development Plan Delivery and Reform. Reform can achieve amazing results in some cases. The way we do things needs to be borne in mind. The comparison I make there is that in some recent visits to both public and private health services, I saw a difference in the way situations were managed. Small things make large differences at the end of the day. For example, the distance between one specialty and another, the distance between the reception area and a particular consultant's rooms, or whatever the case may be, makes a huge difference in the overall time cost. There could be ten or 20 of them in the course of the day, and they add to the cost and the merry-go-round. What I saw was that in the private health system, there is a direct approach right from the front door. It is off in the distance, there is no waiting, and people are on the move all the time. I mentioned carparking at a previous meeting. In the public hospital system, you can expect to be told not to park in certain areas. Where can we park? There has to be a set-down place for patients who are not ambulant. Otherwise, patients will have to be carried. There is a rigid line that we do not seem to be able to cross. The probability is that that leads to overruns and extra expenditure.

The other issue I want to mention is identification of the precise causes of the costs, including, for instance, higher prices for individual medicines and higher prices for everything and anything.

In the current inflationary situation, there is a tendency for everybody to say, “Everything has gone up, let us add on our bit and we are in line with general trends everywhere else." That should not happen. It does not work because it has the effect of increasing costs and reducing the degree of certainty. Costs are being increased but at the same time it is reducing the scope of the services that could be provided.

Today's discussion is timely. I have asked this question for many years and every year for the last ten years without exception the Minister for Health replied that adequate funding has been made available to deliver health services. There have been one or two close shaves but every year, without exception, there has been an overrun. Everything in the health services is now identified with an overrun. That is not a good place to be because the taxpayers see themselves as funding this thing that is going nowhere. That should not happen. We need to be competitive and active in pursuing the extent to which public health services can give the same degree and value of services as the private sector. As I said before, we need competition in this area. People may laugh at my saying that but I can tell them about it chapter and verse, and a committee member, who was a former Minister of State, knows all about it as well. We need to be alert because if we are not, then somebody will wake us up. That situation cannot and should not happen because we have a great deal of expertise at our disposal from which we must draw and inquire, at the right time, as to where we are going and as to whether we are going in the right direction, are covering all options and ports and are moving forward in a satisfactory way.

The last point I want to mention is home care and home help.