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

Like other speakers,I am delighted to have an opportunity to speak about this particularly welcome legislation. I compliment the Minister for Health, Deputy Leo Varadkar, and the Minister of State, Deputy Kathleen Lynch, on their efforts in moving on the health service as nothing remains as it is. In recent years it was very easy during the difficult times to be critical of everything that happened. It was very easy also to have the solution to everything and know what could be done, while knowing very little about the cost of how to do it. Even in those very difficult circumstances we should congratulate the Government and the Ministers responsible for seeing fit to proceed in this fashion at this time. Of course, it is not the solution to everything. Neither is it the conclusion of the matter. I accept that it is not the adoption of universal health care that was originally intended, but it is part of the way and a step in that direction. Those who have criticised the starting position have asked about children aged over six years. However, one could also ask about children aged under six. One could equally have the same degree of anxiety about serious illnesses in children aged less than six as those over six. We are, however, moving in the right direction. The same is true of people aged over 70 years. In the first instance, it is a question of providing reassurance. People who may feel a little vulnerable and isolated, who are not in the best of health, can at least have one service readily available to them, namely, the GP service. That is something good which will ultimately save money because it will cost less rather than more to address the health needs of those aged over 70 years. As attention can be paid to people at an earlier stage, earlier diagnoses can be made and action taken which might otherwise be too late. It is also in keeping with the 21st century that we move in that general direction.

In recent days I heard criticism from speakers on the other side of the House. They referred to the Dutch system, the French system and various other models of health care around the world. There are nearly as many models as there are economic theories. The same was evident in the context of the economy. Reference was made to the Icelandic system, the Swedish model and the Danish model. One would not find as many models at a fashion show. Even in difficult times of financial stress we can learn from what has happened before and work within the exigencies within which we are forced to work and, in fact, improve the quality of service all around, which is what is happening.

The general perception appears to be that the quality of the health service is not as good as it is elsewhere. That is not true. There may be a difficulty in getting into the system or appointments and there may be waiting lists, but, with one or two exceptions, everyone admits that once a person gets into the system, the quality of the service is good. While comparisons can be made, in this country we have the best in the business when it comes to dealing with any medical issue that arises. Unfortunately, we live in an era when criticism comes easy. It is very easy to criticise all those who make the odd mistake, or more than one, but we have the ability to provide the best services in the world, as we have proved many times.

An issue that has come to the fore in recent times is the logistics of delivering the service. I have always believed it is a management issue. The simpler the system is, the easier it is to manage and the better, more effective and efficient it is to operate. The Leas-Cheann Comhairle will be aware that if we were to arrange a waiting list system for constituents to visit us in our constituency offices, we would never get our day’s work done because the queue would get longer. A system must be found in the health service to eliminate waiting lists. I can never understand what happens. If there is a waiting list, it grows. There is something wrong if that happens. One can ask whether it is because we do not have enough personnel to deal with it or because the population is growing and the demand is greater or is it a combination of the two. Whatever the reason, it is part of the equation and it should be possible to deal with the issue effectively. We heard about the UK model also. The NHS becomes overloaded, too, and also has waiting lists. Accident and emergency departments become overcrowded in the United Kingdom also. We are not unique, therefore, in that regard, but that is not to say we should not improve because we do need to improve in these areas.

I have spoken previously about primary care which is a hugely important part of the health service. From a previous incarnation I have experience of the operation of the health service, but I accept that it is not medical experience. The management of the system is important in terms of how to deliver a good quality of service to an increasing population. The population is nearly double what it was in the mid-1950s and there has been a considerable increase in demand on the health service. I presume there are fewer hospital beds because thousands of beds were available previously. Medical science and the method of conducting operations have changed.

It does not necessarily mean that fewer beds is a bad thing. It is a question of how we deliver the service to those who are there. I compliment the Minister’s recent initiative on nursing home services. I hope that will percolate through to all our hospitals that have been experiencing overcrowding in accident and emergency departments. Overcrowding and disorganisation in the accident and emergency department does not make for a good reputation of a hospital or for the confidence of the general public. This has happened before: in the middle of the boom there were between 3,000 and 6,000 people on waiting lists for between two and five years. It is no harm to monitor the situation from time to time and consider how to move on.

I believe in ensuring that adequate nursing home beds remain available at all times with the potential to accommodate an overflow in the event of a serious epidemic such as flu. I do not understand why sometimes hospital wards are closed. That does not make for good, efficient or safe delivery of services. There should be an ongoing evaluation of the requirements and best practice in that area. The general public recognises that we must pay for a service but thinks that because we pay taxes a certain amount should be free. There is nothing free in any service. As time goes on the cost increases. We must become more efficient and effective in delivering the service.

I compliment the work done and the quality of the service given by all the practitioners in the health service. Reference has been made to the young doctors and practitioners who go overseas after qualifying. That is sad and should not happen. We need to deal with it, otherwise we will have a seriously depleted health service which will lack the enthusiasm, dedication and energy of that new generation of practitioners who should be coming on stream in the health service here. I also compliment GPs throughout the country. They can be cantankerous from time to time. We all can I suppose. Many GPs have built up a high quality of service over many years at great cost to themselves. It is not unusual for such people to start work at 8 a.m. and to be still in their surgeries at 8 p.m. or 10 p.m. They also do house calls. I welcome the provisions being made now and hope there is general support for them and that we will see the evolution of a modern health service as befits the 21st century.

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