Thomas Pringle (Donegal South West, Independent) | Oireachtas source

I am sharing my time with Deputy Finian McGrath.

As the Minister said when introducing the Bill, it is a building block. It is a transitional Bill that is part of the Government's programme to reform the health service. Apparently the intention is to give the Minister more control over the health services. In the past year, we have seen what more control of the health services means in practice for the Minister. We witnessed the debacle of the prioritisation of primary health care centres that led to the resignation of a Minister of State at the Department of Health. New areas in the Minister's constituency were added at the last minute to the list without the knowledge of any of his Cabinet colleagues or, it seems, the HSE.

Two hospitals building programmes were announced by the Minister for the Environment, Community and Local Government, Deputy Hogan, and the Minister for Public Expenditure and Reform, Deputy Howlin, before the HSE even knew they were being prioritised. Is this the type of governance that the Minister is talking about? I have no doubt that we will continue to see this type of action from the Minister. If the examples I have given are not bad enough, it should be noted they are not what the Minister intends in this Bill. The Bill will provide for the establishment of a new management structure in the health service, creating a tier of directorships that will operate alongside the existing HSE structure of national directorships while he prepares to abolish the HSE. We are told this will be done without any extra cost to the Exchequer. What will happen in the transitional period? Will there be a freeze in the work of the health service as staff wait to see how the structural will emerge? We saw this before when the HSE was established. This led to years of inertia during which many workers and decision-makers at local level were unable to determine where decisions should be made or by whom.

A change of the magnitude that the Minister is proposing needs to be managed, and an organisation such as the HSE should have a change management team in place. This should cost money if it is done right. How can an organisation of almost 100,000 people change fundamentally without incurring any cost? The building block that this Bill is supposed to be a part of is a move to the universal health insurance model that the Government wants to introduce in the image of the Dutch model. In this system, we are told money will follow the patient. I remind the Minister of what his predecessor, Ms Mary Harney, said when introducing the Health Bill 2004:

It is our generation’s chance to put patients first in the design of the management of health services. It is our chance to put in place modern, effective management to make the best use of these tremendous resources we are applying to health and to get clear value and clear results for that money. It is our chance to create a system where money can follow patients and where outcomes can be measured.

Those words will sound very familiar on the Government side of the House. They have been uttered by the current Minister, Deputy Reilly, on many occasions and have been the mantra of Fine Gael Members for years. I, for one, hope the Minister's plans go the way of the previous Minister’s plans and that, in years to come, the health service will be reformed to move away from the universal health insurance model.

Universal health insurance will not be part of a system that will enjoy the faith of the people and I will not support the Government's effort to introduce it. Unfortunately, the Government is moving on the road to create the system, and this Bill is one part of that programme. The rolling out of the hospital groups is also a step, with the English system of trust being established. This will drive the move to privatising the health system and handing over control to private health insurance companies. The programme for Government sets out that the hospital purchasing arm will merge with the National Treatment Purchase Fund to become a new purchaser of public patient care in the period of transition. It seems the Department of Health will purchase hospital care for public patients from the hospital groups, and this will fit nicely into the model of the universal health insurance companies.

For many reasons, the move to universal health insurance will mean health care will become more expensive and access will be restricted for citizens. When universal health insurance was introduced in the Netherlands in 2006, there were 13 health insurance companies operating there. Today, there are five. This is in a country with a population of 18 million. What do we expect to see in a country with 4.5 million people? The State will provide limited care for people who cannot afford it, with perhaps two companies operating and profiteering to the detriment of those who have no choice but to purchase from them.

In 2006, in the Netherlands, the average health cover cost approximately €1,000 per citizen. Today, it costs over €3,000 per citizen. How does that equate to progress? In the Netherlands universal health insurance buys a basic package of healthcare and it now has a system where citizens must buy top-ups to increase their cover. We will see the same happening here, but probably more quickly.

In discussing this Bill in the House, many Fine Gael members have complained that we are spending over €13 billion on the health services and that this cannot continue. There is much talk from them about how the health services must spend the funding in better ways and must achieve more for less, but all they are doing is using these fancy phrases. I have not heard any of them identify where is this waste and give concrete examples of where savings can be made.

By all accounts, there has been tension between the HSE and the Department of Health on where savings can be made. The Department and politicians claim that there are billions of euro to be saved from the elusive "efficiencies", and that other great mantra of "getting rid of waste". The HSE claims that it cannot do much more and maintain services without the Government tackling the matters over which the HSE has no control. The response of the Minister has been to introduce the so-called graduate nursing scheme, and that will be rolled out to other health professionals, cutting the wages of front-line health workers in order to save peanuts.

If there is to be one good outcome from this Bill, it will be that the Department of Health would not be able to hide behind the HSE and accept that the Department is not funding the service adequate. I believe the Minister should have more control over the health services and he should also be accountable for how the health services work. So should healthcare providers. The real problem with the HSE is that there is no accountability and there is a lack of clear information, and in a country of our size the type of treatment one can expect to receive depends on where one lives. One need only look at the debacle over catchment areas in Dublin hospitals that I highlighted in this House last year.

The health services may have reached, or even gone beyond, the level of cuts that they can sustain, unless, of course, there is this considerable waste and inefficiencies, of which we hear mention but of which we never hear any detail. In my county, for example, Letterkenny General Hospital is probably one of the most efficient hospitals in the country. Over 90% of procedures in the hospital are non-elective, yet the hospital has started each of the previous two years with a budget millions of euro short of what it needed to maintain services. This has been softened slightly this year with an increase in the budget allocation. This year Letterkenny General Hospital will only start the year €1 million short of what it needs to maintain the services. The fact is if we want a health service that is up to the standard of the best in Europe, it must be paid for. If the health service improves outcomes and becomes more efficient by treating more patients and ending waiting lists, then it will cost more, and there is no way of getting away from that.

The Government should be driving a debate about what type of health service we want and how much it would cost to provide it. Do we want a health service that is driven by private health insurance providers charging thousands of euro per citizen and driving the levels of treatment available with the State picking up the cost for those who cannot afford the premium? Or do we want a health service that is free at the point of contact where every citizen can access treatment as required in a system that is led by medical need where citizens can access it based on equality, not wealth? The second option may cost more but I believe that the Irish people would be willing to pay for it if they believed that it would be implemented.

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