Peter Mathews (Dublin South, Independent) | Oireachtas source

Yes. That order owned the hospital grounds. I grew up in a house at the top of Nutley Lane, off the main Stillorgan Road, and my mother still lives there and I remember that work on the site of the hospital when it was at the early foundations stage was stopped for a few years because there were no funds or resources available from anywhere to continue the building. It then got off the ground and the structure was built.

Ireland is at a point now where we sometimes try to put a template of appraisal over whole sectors of society such as the delivery of the health service, with modern, demanding standards over established facilities that have evolved little by little over time - physically and financially and all the complications that come with that. The Bill we are debating is the outcome of a health reform agenda set out in the programme for Government, including the commitment to dissolve the HSE and transfer its functions to other bodies as part of a wider move towards the establishment of universal health insurance. Let us think about that.

The objective in that statement is to get to universal health insurance. Deputy Shortall asked whether l universal health insurance will be operated by an overall insurance body or by an amalgam of different insures in a competitive marketplace because then we will be subcontracting to free markets the funding of the delivery of health services. Perhaps it would be better to take the clean state approach and try to estimate for a population of 4.5 million, given the demographic profile of that population, the sorts of illnesses and continuing medical services that might be required now, in the medium and longer term and put measurements on that. That would indicate that a physical amount of delivery of services might be costed in parameter or outline terms. Then we would have an idea of the scale of the budgetary requirements over that time profile.

This is an interim measure towards the goal of universal health insurance. I have a question over what type of overall universal health insurance we will have. Will it be a disparate free market model or a State insurance model like the State pension? In the interim, for best efficiency and effectiveness of the cost consciousness of what we have in place, we need to revisit the accounting systems. The best way to do that, as an interim measure, might be through activities-based accounting rather than the approach of noting what was provided last year, estimating roughly what might be needed next year and putting forward a tranche of money and getting it approved by central funding. That is part of the proposal in this Bill, namely, to move it out of the separation between the HSE, which was some sort of amalgam umbrella of the geographically divided health boards, and the Department of Health. That has become an awkward balancing and contrasting appraisal. The idea now is to get it into one sweep under the Department of Health and to try to standardise, in template-type form, to get uniform measurement over the activities within the various elements of the hospitals and other location set-ups for the delivery of health.

It is a big budget - it is a behemoth. It is €13 billion and 80% of it comes from cental funds and other bits come from insurance funding. As Deputy Shortall pointed out, there will be an attempt to juxtaposition that funding and account must be taken of recognising the requirement by the insurers of a profit margin. To that extent, there will be additional costs to the public. It might be better to revisit this and go back to the first page, the blank page, and say that we will have some form of funding that will be a universal-based one but it will be along the lines of the State pensions provisioning and in the meantime we will get a handle on the activities in the delivery of health services.

The health services comprise not only the delivery to patients of care and the carrying out of operations but the education of the people who will be continuing to service that sector - the education of the nurses, paramedics, medics and specialists. A holistic approach is needed and should be undertaken in a disciplined way, even as interim measures take place, and they should be interim measures and recognised as such.

The overall measurement and presentation of budgetary requirements can be expressed differently than they have been to date. I find that throughout all Departments there is a sequential way of describing things that is presented in a legalistic manner. One has to fight one's way through the sentences instead of reading them in an overall mapping sense. Armies have the huge requirement of logistics.

Historically, the armies at Stalingrad, where there were 800,000 men on both sides on the front line, which is a total of 1.6 million people, had to be logistically provisioned. The way that was done was not by the sort of paragraphing and legally inclined language we see in legislation. Rather, it was very much in terms of maps, bar charts, pie charts, columns, figures and headings. I believe that could also be helpful in appraising the overall medical sector. When one sees things visually in headlines, columns, graphs and proportions, it is easier to understand the scale. One can then support that with drilled down detail. At the moment, it is a sprawling, moving octopus. It does not make sense and is very hard to measure.

The figure of €13 billion is easier to get a handle on because it can be seen as a proportion of the overall budget. As Deputy Shortall pointed out, 80% of that is just over €10 billion, so one is beginning to see things in proportion. That €10 billion is from the Central Fund and the other €3 billion is divided over the health insurers and direct contributions. The Minister knows what I am getting at, so we will not fight over the detail.

Again, when the Minister speaks of 500 consultants, what does this look like in the context of the overall head count? The HSE and the Department of Health may have 135,000 people, so one can see the divisions and where the scale of expense lies.

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