James Reilly (Dublin North, Fine Gael)

Unfortunately, I regret that one of the individuals concerned has passed on. It is too late for him. I take this opportunity to extend my sympathies to the family, whom I have no intention of naming but to whom I have spoken. Undoubtedly, there are other people who will find themselves in that situation. I know of at least one and I will consult with the Minister on it privately to preserve the privacy of the people concerned.

There has been much debate about the health service budget and how it has increased fourfold over recent years. However, it only reached the OECD average in the last two years. One cannot catch up on 15 to 20 years of neglect in terms of very low investment in health services by spending the average in two years. More will be required. However, I would not put another bob into health until waste in the sector, and particularly the HSE, is sorted out.

The Minister mentioned new consultants both here and at the committee meeting. She said there would be 189 new consultants, that 59 had been interviewed and 39 had been appointed. I do not know how many have taken up appointments or if the Minister has that information available, but can she clarify if these are new posts or replacement posts for consultants who have retired? With regard to the terminally ill, I am glad to hear the Minister's view. However, it would be better to have a policy whereby that issue would not require the Minister's direct involvement each time a hard case arose involving somebody who is terminally ill.

The Health Information and Quality Authority has shown itself to be independent and capable of doing its job. It conducted a good investigation into the situation in Limerick. I have met with representatives of the authority on a number of occasions and have no complaints about the body. However, as I have asked the Minister previously, and I regularly raise the question on the Order of Business, when will the authority be given the teeth to censure people? At present the authority can inspect a hospital and tell its management the standards are not up to what was agreed but it has no powers of censure. The hospital can say: "Thank you very much. Off you go and come back in another year." The same will happen again the next year. There is talk about licensing but that must cover public and private hospitals and nursing homes. HIQA is involved in the areas of standards and information on quality in health care. Quality information on patients is particularly relevant in assessing whether a person should receive a discretionary medical card.

I do not accept the Minister's supposition that those who hold a budget should carry out assessments because it has been proven in other jurisdictions that this approach results in peculiar anomalies. For example, in the United Kingdom the incidence of autism varies widely as between health authorities. The reason the incidence is lowest in areas where autism services are not available is that under UK law, health authorities are obliged to provide a service and pay for it from another jurisdiction. It is more than a coincidence that areas without a service record a low incidence of autism, in some cases lower than it was prior to the introduction of the relevant legislation. I do not want a similar problem to arise here.

If HIQA is not the appropriate body to carry out an assessment, and there is no reason this should be the case, why should another body not perform this function? Patients are entitled to the comfort of at least knowing they will receive an independent and fair assessment and not one predicated on the level of funds in the kitty at any given moment. In the latter case, those diagnosed with a terminal illness in January, February, March or April will receive a discretionary medical card but woe betide those who are diagnosed in September, October or November because the budget will have been expended and a discretionary card will not be granted. That is the reality. I am not arguing that this arises across the board but it appears to be the case.

I ask the Minister to reconsider her decision on the issue of assessments. I would be satisfied if she chose a body other than HIQA to perform this function, provided it is not the HSE and the approach is seen to be fair. A similar question arises with regard to the fair deal for nursing home care where it must also be decided who will assess whether patients are high or low dependency and what will be the role of those selected for this purpose in terms of their commitment to the HSE, Department of Health and Children or other body. Independent assessment is required because people must be assured they will be assessed without regard to the financial position at a given time in the year.

I agree that moving people from one job to another is not a simple task, as has been evident in the past. However, people are becoming increasingly realistic in the current climate and there is a greater willingness to try to fix what everybody regards as an appalling system in our health service.

I agree with the Minister that people could still top up if they had universal health insurance. Let them do so but let it be for five star accommodation and cordon bleu cooking rather than being allowed to jump the queue and have a colonoscopy carried out ahead of someone else. That is the issue.

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