Billy Timmins (Wicklow, Fine Gael)

Everybody wants health reform. No one is happy with the present situation and people have different experiences of the health service. Many good people work in it, but we always hear the bad stories. Certainly, there has been a dramatic increase in funding but without a corresponding increase in services. I will quote from a Second Stage speech on the Health (Eastern Regional Health Authority) Act 1999:

This is important and far-reaching legislation, which puts in place an organisational structure to deliver a more integrated, efficient and patient-focused health service for the people of Dublin, Kildare and Wicklow. The need for radical structural reform in the health services in the eastern region has been recognised for some time . . . Several expert reports over the years have highlighted the need for radical organisational reform of the structures in the eastern region so that the services can respond effectively to the challenges they face.

At the conclusion it says:

The proposals in this Bill amount to the most significant reform of health service structures in this country since the establishment of the health boards under the Health Act, 1970.

That was the speech of the then Minister for Health and Children, Deputy Cowen, on 11 February 1999, on the establishment of the Eastern Regional Health Authority, which all of us in this House supported, if my memory is correct. Time has shown that this initiative has turned out to be an unmitigated disaster.

When I came into politics first in 1997 and was dealing with the health board, matters were difficult enough. By 2001 or 2002, I could not find my way around the various services because of the re-establishment of the Eastern Regional Health Authority. Only last Thursday, together with a number of politicians from all parties, I attended a meeting in a place called Crab Lane in south Wicklow. The only impact it had on this community was that people from the area who could have attended the old district hospital in Baltinglass, west Wicklow, could no longer do so. They must now go to Rathdrum in east Wicklow, 34 miles away, as opposed to the previous journey of 12 miles. That type of intransigence and negative impact ultimately came to focus people's minds in the locality. It was an indication that the system did not work. That is why we all want reform. There is little public confidence, however, that reform is possible. While I appreciate that the Minister, Deputy Harney, the Minister of State, Deputy Brian Lenihan and others are committed to reform, the confidence does not exist.

Deputy Richard Bruton produced a fine document in recent days. He said that health spending had led the field in public spending from 1998 to 2003, when it increased by €5 billion, or 94% in real terms. The numbers employed by the health sector grew by 28,000.

However, the question patients and taxpayers ask is what was achieved with this massive expansion in spending. The hospital programme dominated the health budget. Spending on hospitals more than doubled, increasing from just under €2 billion to €4.2 billion. Adjusting for inflation, this was an increase of 73% in the five-year period. However, the outcomes from this investment were much less impressive. Despite this massive expansion in spending the crisis in the accident and emergency departments of our hospitals worsened. This deterioration occurred not in the face of a massive increase in numbers attending the accident and emergency departments. In fact, numbers declined by 33,000 over the period.

The Government made the elimination of hospital waiting lists one of its key objectives for the hospitals sector. In this period of massive increases in expenditure, waiting lists has declined only by 6,000 and the Government's promise to end waiting lists in two years has proved to be one of the hollowest ever made. One can understand, therefore, the scepticism in respect of this legislation delivering a better health service.

There was a dramatic rise in the unit cost of treatment. The average cost per patient attending the hospital increased by 53% after adjusting for inflation. The average cost of an inpatient procedure in 2002 was €3,500, an increase of 42%. It was only in the case of day surgery that costs were contained where the average increase was just 6%.

Another statistic relates to the general medical services scheme. Most of the expanded budget has gone on medicines. The frequency of prescriptions to medical card holders has increased by 31% and the average prescription cost has increased by a staggering 151% after allowing for inflation. The average cost is €620 per card holder per year. While it is not Fine Gael Party policy, I have encountered enormous waste in medical supplies. For example, a person who receives a prescription under the GMS uses some it and puts the remainder in a closet. I have been in houses where people who passed away had inordinate amounts of drugs which cost a substantial amount of money. I do not know if the Department has ever carried out any research on this.

I do not want to see what I have to say next misquoted, as often happens with the Fianna Fáil press office. If there were a nominal fee on prescriptions, be it €1 or whatever, it might make people more aware of the cost and they might treat matters with a little more respect. When we, and I include myself in that, get something for nothing, we are inclined to abuse it. This system may have been tried out in other countries and it may or may not have worked.

See this speech in context