Paudie Coffey (Waterford, Fine Gael) | Oireachtas source

I welcome the opportunity to contribute to this important debate. Health services should always be a priority for any politician or public representative. This debate is well worth having.

I wondered about certain things as I listened to Deputy Smith's contribution. His party was in government for 14 years, at a time when unprecedented levels of money were available. I do not normally play politics, especially when we are discussing health services, but unfortunately I have to say it was very hard to listen to the Deputy's criticism of this Government. At a time when a very restricted budget is available, the Government is trying its damnedest to reform the health system in the best interests of patients. The previous Government did not avail of the opportunity it had over 14 years to reform the health service, to put the patient first and to deliver a service we can be proud of.

It is sad to have to say there is a two-tier health system in this country, but we all know that is the case. Under this form of health apartheid, those who can afford the high cost of private health insurance can access essential health services while those who do not have enough money have to remain on waiting lists for long periods of time. The progress that is being made on waiting lists, in spite of the budgetary restrictions we are facing, will not suffice in the absence of major reform of the health service. We need to put the patient first and treat him or her as the priority.

We need to make the best possible use of the resources in the health sector to deliver a high-quality and efficient service of which the people can be proud. Reform does not come easy. It involves change, as we all know. Change often leads to concern, doubt and uncertainty. I do not underestimate the challenge the Government is facing as it seeks to introduce universal health insurance. I believe all public representatives have a responsibility to be honest and open with the electorate. The health services should not be used as a political football, especially at this time.

The publication of the White Paper on Universal Health Insurance gives us a welcome opportunity to engage in a debate on this issue. Under the proposed health insurance model, the State will have to play an important role in protecting those who are most vulnerable. It is acknowledged in the White Paper that the State's role will involve paying for children, students and people on medical cards and their families and subsidising those on low incomes. All insurance companies will be required to offer a standard package of health insurance that will cover all key services, such as hospital care, GP care and maternity care.

The system of community rating that is to be introduced will ensure that no insurance company can discriminate on the basis of age, sex or health status. The State will also be responsible for regulating the system and ensuring safety and quality are maintained to the highest levels. It will also be responsible for funding services that will not be covered by universal health insurance, such as long-term care, mental health and disease prevention. Public hospitals will remain under public ownership. They will be given much more freedom to run themselves. That is to be welcomed.

I have mentioned some of the challenges that exist. A public debate on the primary care sector is taking place at the moment. The Government has given a commitment to deliver free GP care to those under the age of six. Its long-term intention is to deliver free GP care for all. I appreciate that there is a genuine intention to be proactive in terms of health. The best place to do that is on the front line in the communities. GP practices should have a role in educating and building health awareness within our populace so that we do not have to react to long-term illnesses like diabetes at a later stage. Substantial resources can be required to deal with complicated illnesses that develop at a later stage of life. GPs on the ground are voicing their concerns. As I have said, change and reform are always accompanied by uncertainty.

I ask the Government to reassure the public that a quality primary care service can and will be delivered through GP practices, which will require resources. Everybody knows there is capacity and flexibility in the system to introduce specialist nurses in areas like diabetes care. Rather than taking up the time of our GPs, we should train our nursing staff to deliver services in specific areas of expertise. The same thing applies to consultants. We should train our GPs to do minor elective surgeries so that such practices are taken out of our acute hospitals. I would have no issue with that. If we are to manage that process, we are going to need all stakeholders, including GPs and their staff and the public, to buy into it. I believe these reforms will work as long as they are managed and resourced well. We should all remain focused on them.

I would like to speak about acute hospitals. As the Minister knows, there was a great deal of concern in the south east when the new hospital boards were announced last year. We were told that Waterford Regional Hospital, as it has always been known, would be taken into the southern hospital group. I welcomed the reassurances we were given by the Department of Health and the HSE last year to the effect that Waterford Regional Hospital would become a university hospital. The appointment of people to academic posts will enhance the hospital's capacity to bring in trainees and enhance services in specialised areas like accident and emergency, orthopaedics and cancer care.

I have a particular concern with regard to cardiology. In 2008, the cardiology unit at Waterford Regional Hospital had just two days' cover. In 2014, the same unit has five days' cover. The entire region is still not covered at evenings and weekends, unfortunately. I ask the Minister to ensure the appointment of a cardiologist at the hospital will happen as quickly as possible. I understand that someone is to be appointed in September. Cardiology services need to be available at Waterford Regional Hospital 24 hours a day, seven days a year, to service the whole south-east region. This should be an essential component of equality of access to health care, particularly emergency services.

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