Brian Cowen (Laois-Offaly, Fianna Fail)

I do not agree with the continual portrayal of the health service, for all its problems, as not providing any successes or improvements. That is clearly not the case. If one examines successive HSE yearly service plans, one will see that many of the targets set in the plans have been met and in some cases exceeded. Measures taken in areas like cancer care and the reorganisation of hospital services have been the subject of a great deal of local political controversy. Deputies on all sides of the House have to withstand the pressures and concerns that arise from such developments.

It is only fair for me to indicate to Deputy Kenny that if he makes any proposal to change the health system, as it is currently funded, he needs to have it costed. If we have a costing on it, we can discuss it. In the meantime, the Minister and her Government colleagues are interested in providing for the necessary flexibility and redeployment to facilitate best practice arrangements for better delivery of services. Triage nurses have been provided in parts of our health system. The need to try to provide for best practice across the system has been the big bugbear. We have to get people to identify what is done well. If the community care programme in the north west is working, that needs to be done with greater application throughout the country. We should aim to replicate the success of the accident and emergency services in hospitals in Kilkenny, Waterford and elsewhere. It is usually down to people's ability to organise themselves and work in teams. Staff have to be prepared to make certain adjustments so that the service provided to clients and patients is better than is presently the case. That is how we are seeking to go forward. In the case of cancer care services, for example, we have had to rationalise from a position where we had surgical units in 42 of our hospitals, none of which had the throughput necessary to meet the relevant requirements and standards on a consistent basis or to avoid many of the unfortunate incidents that have been well discussed in this House and elsewhere over recent years.

An acceptance of the need to embrace change in the health service, for the precise purposes mentioned by Deputy Kenny, should be more evident in this House. I am open to listening to a constructive debate in this House on possible improvements in our health service, on the basis that we set out the costs of the alternatives and the issues that are at stake. It is open to the Deputy to seek such a debate. I understand that the Department of Finance has not been asked to undertake a costing of the Fine Gael proposal, but if it is asked it will do it. It will be provided confidentially to that party in the first instance.

If we are to come into this House and have a constructive debate on the matter, we should set out what the costs of the various proposals might be. The possibility that it can all be done at no extra cost is not immediately obvious to us. If it is all made compulsory, the State may have to fund the premiums of everyone in the country, including people who do not have universal health insurance at present. Certain costs would be associated with that. Important issues, such as the relationship between health service providers and hospitals and the manner in which we organise our services, have to be discussed and debated. With respect to the Deputy, who seems to have had a very good trip to The Hague yesterday, we need more substance than a simple policy of replicating the Dutch system in Ireland.

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