Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

That is the issue about which I have a concern, as do many other people. We have also seen what happened in respect of St. Luke's Hospital and Wexford Hospital. I highlight these cases to show that as matters stand, politicisation takes place. The Bill creates circumstances in which the provision and location of services will be fundamentally in the gift of the Minister. Such decisions will not always be based on best clinical outcomes or strategy, but on political reasoning. We are creatures of politics who think about votes when we make decisions in the House. The national cancer strategy would have been torn to shreds had it been left to the House to decide where services should be provided. Notwithstanding that there are concerns among people in Letterkenny and Sligo, most people will accept that the national cancer strategy under Professor Tom Keane was very successful. It has delivered positive clinical outcomes and used resources effectively and efficiently because it was not politicised. In his short time in office, the Minister has politicised the delivery, funding and location of health care services. It is there for all to see.

The legislation represents a transitional arrangement following which the HSE will be subsumed into the Department in its entirety. We continue to await the White Paper on universal health insurance. I hope the Minister will indicate when it will be published. It is of critical importance. While the Minister claims to have a mandate to provide for universal health insurance, we still do not know how much it will cost. We have no idea what measures the Minister will propose. The structures being put in place are based on something about which the Minister does not yet know anything. It is something about which no one knows anything and regarding which we will have to have a very long think. The Minister is talking about not only a restructuring but a fundamental shift in the way we fund health care services.

Only today, the VHI announced it will increase the cost of private health insurance cover by 6%, which may cost the average two-parent, two-children family up to €300. The Minister may talk about universal health insurance, but his policies to date have acted as a counterweight to its introduction. The Minister should seek to make private health insurance more affordable to encourage people to take it up. We made the point in the context of debate last year on the Health Insurance (Amendment) Bill that no policy is emanating from Government to negate the massive inflation in the cost of private health insurance to make it affordable. Families are being put under enormous pressure to sustain private health insurance and in some cases are dropping out. The figures demonstrate this trend. It will put further pressure on the public health system as those people will have to be treated in any event. An income stream is being diminished and further pressure is being put on the public health system.

If the White Paper were published, it would be a starting point to stimulate a debate on how health provision will be funded in the years ahead. We have seen officials travel to Germany, Holland, Canada and the United States of America. They have been all over the place seeking to find a universal health model which fits the Minister's view and is suitable for implementation in Ireland. We are two years down the road and making legislative changes to fit the model without having put in place the foundations on which can be placed the building blocks of the Minister's reform projects.

The small hospitals framework is another key component. Hospital trusts must be compatible with that framework. Trusts and small hospitals must be interlinked to serve, benefit and complement each other. I have asked previously if there would be a correlation between the two and the Minister indicated there would. Again, we await the publication of detail on these frameworks, which are also of fundamental importance.

In the meantime, while we are waiting for those reports to be published and the Minister's ideas to come to fruition in terms of the hospital trusts, funding to hospitals is provided on representation from one Minister to another. In light of the scarce resources that are there, it does not make sense for the Minister not to fund hospitals that may need funding in terms of the framework for development of smaller hospitals and to complement the establishment of the Minister's proposed hospital trusts.

While we wait with bated breath for these reports, this legislation gives the Minister sweeping powers to intervene or, in many cases, interfere. This is something about which I have grave concerns. The reason I say this is because when the Minister first arrived in Hawkins House, one of his first acts was to sack the board of the HSE. It was his prerogative and he did it with gusto.

See this speech in context