Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance) | Oireachtas source

Faced with, on the one hand, the repeated mantras from the Government about reform, the legislation supposedly enacting that reform and the promises about the transformation of the health service, including universal health insurance and free GP care, and faced then, on the other, with the disaster of what is happening on a day-to-day basis within the health services, the overwhelming sense we get is of the band playing to distract people on the Titanic while the ship is sinking. It is a case of shifting around the deckchairs, trying to distract attention but, in reality, the ship of the health service is sinking beneath the waves, with the users of that service sinking with it.

I do not think that is an exaggeration. The evidence is piling up day in, day out, week in, week out, of how serious the crisis now is in the public health service. We have chronically long waiting lists for people needing important operations. We have an ongoing trolley crisis; every day of every week hundreds of people are on trolleys in accident and emergency units across the country. We have constant reports of resource shortages and staff shortages in hospitals throughout the country. We have the absolutely shocking situation of dramatically high mortality rates in Portlaoise as well as the situation in Roscommon referred to by Deputy Naughten. We have leading consultants in hospitals in Dublin saying that the hospitals are now unsafe. We have doctors in the accident and emergency unit in St. Vincent's hospital confirming what some of us said, namely, that the downgrading of accident and emergency services in smaller hospitals like Loughlinstown was leading to a crisis in the so-called centres of excellence that would endanger the lives and health of patients. We have medical cards being taken away from chronically sick people. We have respite services being removed from families with disabled family members. We have disability services being cut back. Everywhere, the health service is under attack and falling apart, and patient safety and patient health is being threatened.

We have all of this and, yet, surreally, side-by-side with that, we have these promises of wondrous reform and transformation in the health service, and the utopia which we can look forward to of universal health insurance and free GP care. Really, at this stage, these promises of reform and of universal health insurance have no credibility whatsoever.

Frankly, if the Titanic of the public health system is sinking beneath the waves, there is just beneath the surface of those waves something else that maybe explains what is really going on, and that is the sort of stealth submarine of privatisation lurking beneath the surface, ready to take advantage of the crisis that is being engineered in the public health service. It is only in that context that one can understand the mess and the confusion that surrounds all of the talk of universal health insurance, but with no tangible reality to those promises, and understand that the real agenda is privatisation.

Of course, it is set out in the brief for the Bill that all of this - these restructurings and changes in governance, in funding and in the Votes of the HSE and the Department of Health - is linked to the plan for universal health insurance.

We must be honest with people and the truth is beginning to emerge. Universal health insurance is another name for compulsory private insurance forcing yet another tax on people to pay for services they have already paid for through their taxes. The figures that are beginning to emerge show that what many ordinary people will be looking at is a new tax of €1,600, €1,700 or €1,800 per year to line the pockets of private health insurance companies. This is really what is going on.

We have just heard criticism from Fianna Fáil that what is at stake in this Bill is the politicisation of the health service as against the wondrous model of the HSE. That is obviously nonsense and the Government would certainly have a point if it said something needs to be done about the HSE. If Fianna Fáil asked questions about the health service and what is going on in it and the Minister said that this is the HSE's responsibility, Fianna Fáil would be the first to jump up and down and say the Minister should take responsibility. I do think the Minister should take responsibility but the problem is that the abolition of the HSE that is being proposed and engineered is not to remove bureaucracy and inefficiency. Rather, it is to replace one form of bureaucracy, inefficiency and waste and a failed model for delivering health services with another model that will inevitably produce bureaucracy, inefficiency and waste and prevent the resources getting to the front line in form of resources for hospitals and health services, staff and beds - all the things that actually make a health service function. We will just move from the bureaucracy of the HSE to the bureaucracy of the private health insurance companies and providers competing with one another to make money out of the crisis of the health service.

I do not understand why on earth the Government would want to move towards this. In particular, I do not understand why the Labour Party would go along with it. I do understand Fine Gael's often repeated and fairly openly stated belief that one must marketise things and bring market forces, competition and the for-profit economy to bear on just about every aspect of human activity and endeavour and the provision of services. That is what it believes and has always believed. It is implementing that belief with gusto everywhere it can but what I cannot understand is why the Labour Party is going along with this when we know where it leads and when we know that all it can possibly do is line the pockets of private health insurance companies and load up the costs of accessing health care for ordinary citizens. The evidence is everywhere. Anywhere one has these sorts of models, be it the Netherlands or the US, when one effectively hands over health services to private health insurance companies under whatever model one cares to construct, they suck up enormous amounts of resources in the form of profit, administration and billing - all the things that do nothing whatsoever to deliver health care to people.

The US, which has the most developed version of universal health insurance model, spends more on health services than anywhere else in the civilised world but its health service is a mess because 40% of what is spent in the health service goes into the pockets of the private health insurance companies and providers. It means big salaries for the executives, lots of money for consultants and huge amounts of money soaked up by advertising and billing - all the things that inevitably follow if one brings market principles to bear on the provision of a vital public service. That is a disaster waiting to happen. It will clearly benefit those private health insurance providers but it will do nothing to improve the quality of health services delivered or access to those. It will not remove the two-tier system as we know because whatever basic basket of services are provided, those with money can then top up if they can afford it to access the other services that would be needed. Alternatively, one just has to jack up the overall cost for everybody or introduce charges for everybody, even those who cannot afford it. That is inevitably where this leads. Why does the Government remain committed to this model when there is no example of it working and delivering efficient health services to everybody who needs them?

Of course, there is a model we could look to, which is the model of a national health service. Is it not obvious that if one funds a health service directly from the taxes of people on a progressive basis according to ability to pay and this money goes into providing a health service that is available to everybody, and one does not have the middle man of private health insurance companies and all the bureaucracy, administration and profiteering that inevitably goes with that, one will have a better health service and that a higher proportion of the resources that go in will go to providing the actual health services that we are trying to deliver? Of course, the National Health Service in Great Britain in the post-war period was the example of that, such that even Conservative governments have not been able, despite their best efforts, to undermine the principle of a national health service. They have tried to chip away and introduce stealth privatisation but even the most conservative and middle-of-the-road people have held the line and said they want to defend the principle of a national health service because health is too important to be left to the market.

There are certain things that must be provided for everybody because they need them and health is a such a service. I simply do not understand why the Labour Party turns its face from that model and goes along with the Fine Gael plan to carve up the health service for profit. I hope that, at some stage, the Government will tell us how all this is going to work because any serious scrutiny of it will make it clear that it cannot work. The Government never answers that question, namely, how it can justify the middle man of the private health insurance companies and providers creaming off profit from the provision of health services. How could that possibly be more efficient? It cannot be. In reality, it is undermining health services generally and the public health service and helping to create the crisis we now face.

What we need to do is provide the front-line services, staff, resources and beds. That is how one removes bureaucracy. It might seem like a philosophical point but it is one that is obvious if one thinks about it. Where does bureaucracy come from? Why does one get a bureaucracy? The answer is that one gets a bureaucracy if there is a shortage of resources and one must ration those resources. One then needs loads of bureaucrats to ration them. If one does not have a shortage of resources, one does not need a massive bureaucracy to ration out scarce resources. They are just provided by right because people need them. That is the problem with all of this restructuring of funding and governance models, moving from one failed model of organising the health service to another and now proposing another one that will not work either.

This is literally just a case of shifting around the deck chairs on the Titanicin an attempt to solve bureaucratically a problem that is fundamentally one of resources. If 6,000 staff, 2,500 beds and €3 billion are cut from the health service and the Government plans to cut a further 7,000 staff and €1 billion this year, there will be a crisis in the service. It is obvious. The only beneficiaries will be private health insurance companies. The people who rely on the public health service will be endangered, as they are now, and there will be more unnecessary suffering for the service's users and stress for its staff. There will be further disasters and scandals like those we have seen in Portlaoise and so on. It is inevitable.

I do not know whether the Government will just keep trundling along with this endless and fairly meaningless stream of supposed reform Bills and pi in the sky promises of what will be delivered in seven or eight years' time when what it needs to do now is provide resources and do away with the plan to privatise health services and carve up a vital human service to benefit private, for-profit corporations.

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