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

With regard to the effort to reduce costs or not have them escalate, about which the Minister has spoken, and the competition in the multi-pair system and multi-provider system, I cannot understand how the Minister believes that will work. The means by which it will work are very unclear in the strategy document. It is very unclear that those who provide the care - the general practitioners, nurses and consultants, for example - will address all the pertinent issues. Who will pay them and how will they be paid? How will staff earn according to their grades? Consultants who are currently working in both the public and private systems, for example, will not be able to do so at all under the system under discussion. Will such consultants be compensated by the universal health insurance system? Alternatively, will they pack up and leave for elsewhere? No thought has been put into this. This is the difficulty.

The Minister claimed he has achieved a lot in regard to the reduction of waiting lists. Last year, there was a surge in waiting lists and then they were reduced. The reduction was because the National Treatment Purchase Fund, or its current equivalent, bought many services through the private system. Therefore, it is simply not the case that the public hospital system is delivering on its own all the time.

There is a cross-utilisation of resources in the sense that the public hospital system has contracted work out to the private hospital system, and that has been happening on a continual basis. I am not saying it is a bad thing, but when people are waiting, they should be treated. However, the Minister has been saying waiting lists have reduced dramatically. They have been reduced because the Minister is contracting that work out to the private hospital providers. The idea the Minister would give himself a clap on the back as if he had almost transformed the whole system simply is wrong. There are people in the public hospital waiting system, day in, day out, and they are being transferred into private hospitals for treatment. That is what has been done for the last number of years through the National Treatment Purchase Fund and it should continue to be done until such time as we have a public hospital system that can actually deal with those long waiting lists within its own capacity.

That is the key area the Minister should be targeting for the next number of years. He must ensure people are not waiting. Whether it is treated by contracting out public or private services, people deserve to have treatment when they need it.

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