Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I am delighted to have an opportunity to speak and will not delay the House for very long. Over the years during which the Leas-Cheann Comhairle and I have been Members, we have heard many solutions to health service problems, and they have varied in extremity. They included the now-famous abolition of the health board system, which was regarded as the answer to everybody's prayer. It was argued that it would be much cheaper to run the health services under the HSE but we now know this did not materialise.

I was less enthusiastic about the proposals than others over the years because, unfortunately, I had seen the failure of so many bright ideas on the way. The present Administration has done a reasonably good job in achieving targets that were almost impossible to achieve in an extraordinarily difficult economic climate. The tide has been against the changes the Government is trying to introduce. Within reason, it should be acknowledged that a reasonable attempt is being made to change things for the better. It is not easy to do so because there is no area of government like the health service that creates its own inflation to the same extent. It is almost impossible to watch, as the Minister and I will remember from our days on the Eastern Health Board. However, it used to be possible to monitor in a far greater way the changes as they took place and to identify emerging costs at an earlier stage.

Health inflation costs will have to be borne in mind. I have tabled scores of parliamentary questions on this issue.

The age profile must be distributed evenly among the private health insurers. I am not so certain that is happening. When community rating was introduced and competition was brought into the marketplace, the intention was that it would improve the circumstances for the consumer, but we know that did not happen. I cannot get answers to parliamentary questions on the degree to which the age profile rotates between all the insurers, because that is the basis on which everything stands. We hear daily that old guys like myself should not really have private health insurance because we are a burden on the system. That fails to recognise that during the 1970s, 1980s and 1990s, when interest rates were at 17% and 18%, we had to pay high rates for health insurance while at the same time paying interest rates on mortgages that were equally exorbitant. It should not be forgotten that there were burdens in those years as well and that the families of the 1970s and 1980s had to pay a heavy price for private health insurance, so there is nothing unique about it.

The contributory costs must be assessed, acknowledged and monitored daily, because there is no other way to do it. When there is an increase or a proposal for an increase, the administration in the health service must get involved immediately, because it takes on a life of its own. For instance, if HIQA inspects a nursing home - I have tabled parliamentary questions on this as well - it will say that in order to achieve the highest quality and standards in health and safety, it will subdivide wards to modernise them, despite the fact that many people in those wards do not want that done and that it has nothing whatsoever to do with health and safety but with somebody creating a situation that will cost more. The result is that the staff-to-patient ratio is increased to that extent that it is no longer viable, we have fewer patients in the institution and it become less cost-effective. This happens on a regular basis and I cannot understand why it has not been arrested.

I refer to the private versus the public health sector. I am not at all satisfied that adequate supervision has been applied to the extent to which both sectors contribute to dramatic increases in the cost of private health insurance. I do not want to go into the details of any of the cases with which I have dealt - I am sure every Member of this House has dealt with such cases as well - but I can assure the Minister of one thing, namely, that some of the bills I have seen for procedures, even minor ones, in public and private hospitals are appalling. If anything is to be done to curtail the escalating costs of the health service in this country, that area will have to be targeted as a matter of urgency. I have spoken to scores of people who have had experiences of that nature, as I am sure every Member has, when the cost of the procedure was such as to frighten them and place a burden on them which they could barely handle in terms of premiums.

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