Éamon Ó Cuív (Galway West, Fianna Fail)

I wish to share time with Deputy Cowen.

I hope we continue to have reasoned and analytical debates on health issues because once one goes into government, one suddenly realises how complex is the health system, the huge input of people into it and the need to work incrementally to improve services. The first thing that should be recognised is the huge improvement in health services, which has happened for many reasons, many of which are related to preventative measures. People are living longer and much of that is not related to hospital provision but to better housing, nutrition and so on. When debating people's health and well-being we should never lose sight of the extraneous factors that have a significant effect on how long they live and on their quality of life.

If we could all get more citizens to quit smoking, for example, and to moderate alcohol use, we would solve more of the health problems in the country than all the debating in the House would ever do and we should not lose sight of that factor. The Government will spend €12.5 billion on health services this year and the issue is how to obtain value for money. I pay tribute to the vast number of people who work in our health system for their commitment and dedication. The majority of health care workers do their best no matter what role they play.

I also believe, however, that as human beings we resist change in our work practices, even when it would make the job easier and flexibilities would generate a better outcome. It is human nature to initially resist change and it is, therefore, important that the Government uses the Croke Park agreement to bring about change in how health service staff work. I recall when trying to introduce change in the company where I worked that I used to often say to employees that by using technology smartly, they could make the job easier. One often was not asking people to work harder but to adopt change and new technology in order that their job would become easier and produce better results.

Greater flexibility is needed in rostering and, in particular, in the use of expensive technology. We can all work to make sure that expensive technology is used for many more hours in the week than it is used at present.

The Minister on coming into office had the great idea of introducing universal health insurance. One of the wisest things I was told by a management consultant, although I am not a big fan of such gurus, was that we were obsessed in this country with changing the structures and the names and that we would get much further a great deal faster if we tried to make the structures that we have work better. We often waste a great deal of energy changing the structures and having all the same people working under some great new structure, but what we need is to make sure that the structures in place work better.

There was a cogent argument for setting up a national health service as opposed to the health boards having regard to the idea of setting out objective service levels to which people are entitled, regardless of where they live. Setting an objective service level taking into account resources and spreading them in order that everybody would get access to an even service is the sensible way forward. An analysis of waiting times for the ambulance service will show that the waiting times vary dramatically between the old health board areas and it does not seem to have any particular relationship to the dispersal of the population but seems to have historic relationships. This should all be standardised and no person regardless of where they live should have to wait longer than a certain time for the ambulance service. That principle should apply to primary care services and to being seen by public health nurses. There should not be uneven service levels that are historic where there is over-abundance in one area and deprivation in another. The same principle should apply to home care packages, the home help service and community nursing homes in respect of which there is concern that many of them will be gathered, as it were, into big centres.

Long before the granting of medical cards to people over the age of 70 I believed that when a person reached pension age the chances of his or her income increasing dramatically was very slight. I could not understand why the health service could not follow the good example of the Revenue Commissioners in that when one is over the age of 66 and makes a tax return the Revenue Commissioners write a letter advising that there is no need for the person to make a further tax return unless contacted by the Revenue Commissioners who would only contact the person if they saw his or her name in the newspaper having won the lottery or some such thing. Otherwise, they accept the position as outlined in the tax return. The waste and worry caused in processing renewal applications from people who were 99.2% certain to have their card renewal was not worth a candle. The Minister would be much better putting the same resources into ensuring that those who have variable incomes are means tested at a reasonable frequency and get quick decisions.

I know the Minister was in Galway recently. He will know that there are a number of issues that affect Galway in particular.

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