Brian Cowen (Laois-Offaly, Fianna Fail)

There is a dynamic in health policy to try to move the hospital based system, the traditional way in which we have provided care in the past apart from the general practitioner system, into the community to a much greater extent. That is fundamentally what we are trying to do. One also has a much greater degree of day case surgery than was the case ten, 15 or 20 years ago because current procedures make it possible to have people come to hospital, have a procedure done and return home. Day cases are an increasing part of the caseload in the system. This is welcome because it reflects advances in surgical procedures and helps, from the perspective of cost-effectiveness and the sustainability of budgets, to ensure people secure access to health care within the budgets available to us.

Over many years, we have built a mixed system of public and private health care in which there are designated beds for private patients in public hospitals. The idea of the mixed system was to ensure we had a good consultant staff. We now have new contracts with public only consultants following reforms introduced in this area.

The basic point of the co-location scheme was that one of the best ways to deal with the situation would be through developing private beds co-located with the public hospitals. One would then re-designate private beds in public hospitals as public beds. That would be the quickest approach and we saw what role this type of approach played in providing sufficient nursing home places. If we had not introduced the measures we did on nursing home provision, where private nursing homes play a role in the provision of care for public patients, it is clear from the procedures we have that we would not have provided sufficient places through the traditional public procurement route when one considers the number of public beds we have for nursing home care, which we mentioned in terms of the elderly, as against what the private sector was able to produce and ramp up very quickly. Issues arose in this regard but as a means of dealing with the issue, there is no question that there can be a role for private sector investment in the provision of public care and public facilities generally. We have seen this in respect of other infrastructure, whether physical, educational or in the health area, and I do not see a reason for anyone to have an ideological objection to it.

Financing issues have arisen because of the changed economic circumstances in which we find ourselves. The basic point, however, is that as in the case of care for the elderly, an effort is being made to keep people as close to home for as long as possible, consistent with their health needs, and to bring people from various disciplines into the community rather than taking the traditional approach to providing care in which an elderly person, beyond GP requirements, was brought straight into a district hospital or nursing home unit in the locality.

Reforms are taking place and changes are being made in the way care is being delivered. The impression I get from some of the arguments I hear is that people see the position as static and it is simply a case of providing more beds. Even with the current bed complement, we have a greater throughput in our hospitals than we had previously. This is because things are being done more effectively. If we were to stick to traditional models of health care delivery, quite apart from the crisis we are trying to contend with, we would not have the funds in any event to deal with the issue in that way.

Notwithstanding the debate on the issues, we all recognise that we have to lead change in these areas if we are to provide for the future health care needs of the population as society ages. This is a real challenge facing us, whether in terms of pension provision, health care needs or in other areas.

Specific questions on specific projects are best put to the line Minister. I have set out the health policy framework to which we are trying to work and which I believe to be necessary if we are to deal with the circumstances that are arising with the budgets the taxpayer will provide for the foreseeable future. That is how I see the matter.

The other question was on the electoral commission. Work on that is ongoing within the line Department. It is a programme for Government commitment that will need to be developed during the course of the remainder of the term of the Government in the coming two years. It is an issue that is being worked on.

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