Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I propose to share time with Deputy Sandra McLellan. Today's debate on the programme for Government should only be an opening opportunity to address a programme that covers a wide range of issues, that raises many questions and that needs to be fully teased out and explained, with the relevant Ministers making themselves available to the Dáil to answer questions on their responsibilities within the programme.

This is especially the case in the area of health care. The Minister is unable to be in the Chamber today. The policy changes proposed in the health section of this programme are very far-reaching. Unfortunately, the programme raises as many questions as it answers on the approach of the new Government to health care. The programme appears to be a compromise between the insurance-based models put forward by Fine Gael and Labour. The commitment in the programme is to develop a universal, single-tier health service that guarantees access to medical care based on need, not income. That is a fundamental principle and on that point we have common ground. That is a principle Sinn Féin has long advocated in this House. The key difference is that it is our strong view that such a health service can be delivered equitably and efficiently only on the basis of public provision, funded from fair taxation and with an end to the State subsidisation of the private health care industry.

The insurance-based model, which is the centre-piece of health care in this programme for Government, is highly problematic. Experience from other countries, including the Netherlands on which Fine Gael bases its approach, points to the danger of insurance companies being given an undue role in determining the level of care received by health service users. It is important to examine what is happening in the Netherlands, where the insurance-based system has run into huge problems with half a million people uninsured or defaulting on health insurance payments. Private health insurance companies are finding ways to circumvent the ban on risk selection. The universal health insurance basic package in the Netherlands costs €1,194 per person. Employers deduct a further 6.9% contribution from income. It is estimated currently at approximately €5,000. A total of 41% of people surveyed recently in The Netherlands said that the quality of the health system has worsened since the introduction of universal health insurance in 2006, while only 8% indicated that it had improved.

The Government may argue that this programme is a compromise and that it does not fully adopt the Dutch system. However, the problems with insurance-based systems have been well identified and the programme does nothing to allay those concerns. On the contrary, it is alarming that the health care section of the programme contains no costings - something on which other parties have pointed the finger at Sinn Féin in the past - apart from the single instance relating to the limited initial extension of free GP care.

When Fine Gael initially published its fair care plan it promised to provide further details, including costings, but that has not been done. Perhaps before the conclusion of the debate a Government spokesperson could indicate when we will see those detailed figures and projections. It cannot be argued that Fine Gael lack the resources to provide the necessary expertise to elaborate on its policy given the enormous sums of money the party has spent in the recent general election.

Many of the aspirations and proposals in the health section of the programme are commendable. I wish to put that on record. Sinn Féin has committed to constructive opposition. Where we believe there is something meritorious of praise, we will say so. I include in that the extension of free GP care to all, within the Government's term of office. That is a very big commitment. We are told that the extension of free GP care to certain categories of patients in the first two years will cost €32 million. However, what will happen after that? Presumably the promised extension of free GP care to all within the lifetime of the Government will be dependent on the negotiation of a new GP contract.

We are told that all of the measures will be transitional, until the introduction of universal health insurance by 2016. What will happen in the meantime? Will the Fianna Fáil-Green Party health cuts be reversed? Will the recruitment embargo in the health services be lifted? Will the payment for working student nurses be fully restored? I welcome the commitment to compensate the women excluded from the Lourdes hospital redress scheme. Finally, I must ask about symphysiotomy and whether there will be an inquiry.

See this speech in context