Mary Harney (Dublin Mid West, Progressive Democrats)

We do not yet have a licensing regime. As the Deputy will be aware, the Commission on Patient Safety chaired by Dr. Madden recommended a licensing regime. We must introduce such a regime as quickly as possible. However, in advance of doing this we must know what it is we are licensing and what standards are appropriate for the acute and non-acute hospital system. As I have stated previously, health care providers generally should be licensed. We all require a licence for many things and it is not acceptable that anybody can build and open a hospital without any authorisation. I fully accept that those who work in a hospital must be registered and I am genuinely committed to and in favour of a licensing regime, which I hope to have in place as quickly as possible.

Notwithstanding the economic circumstances of recent years, as many as 70,000 people have a discretionary medical card. In November this year 196,000 people had a full medical card and approximately 85,000 people had a doctor-only card. While I accept that this figure does not constitute the largest proportion of the population to have held a medical card at any one time — I want to use the data honestly — it is the largest number of people who have held a medical card, notwithstanding the economic circumstances we have experienced.

Next year, the challenge will be to provide medical cards for more and more people who will become unemployed. We all know unemployment is rising. Since September this year, there has been a substantial increase in the number of applications for medical cards due to the economic circumstances in which we find ourselves. For all these reasons and to have the resources necessary to provide these medical cards as well as the attendant payments to doctors and drugs payments, we had to introduce legislation such as this Bill.

Ireland spends 9% of gross national income on health. GNI is the more appropriate measure because gross domestic product, which includes the multinational sector, inflates Ireland's state of well-being. Expenditure levels when measured against GDP are not as accurate as when measured against GNP. The figure of 9% of national income or GNP is ahead of the OECD average, notwithstanding the fact that Ireland has one of the youngest populations in Europe. Some 11% of the population is aged over 65 years compared to 18% in the UK, 22% in Germany and more than 20% in many other European countries. In general, countries with younger populations should be able to do better with the same level of health expenditure. However, for many reasons, we do not get the benefits of our young population. I hope some of the things we are doing such as implementing the screening programmes and placing greater emphasis on primary and community care will help to achieve better outcomes from the expenditure we are incurring. As we know, for older people, in particular, investment in measures to deal with cardiovascular disease and stroke patients are delivering significant improvements and greatly increasing life expectancy.

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