Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I wish to acknowledge the ready support for this motion from Fianna Fáil, Sinn Féin, Independents4Change, People Before Profit, the Green Party and a number of Independent Members. In total, 89 Members from the Opposition benches supported the motion and I thank them for doing so. I also welcome the fact that once the new Government was in place, the new Minister for Health, Deputy Simon Harris, was happy to come on board, with some minor amendments to the motion. He pledged the support of the Government, Fine Gael and the Independents who support the Government. Quite unusually therefore, we now have a motion before the House that is supported by almost 150 Members. This unprecedented circumstance is an indication of the willingness of everybody to work together in a collaborative manner to try to find solutions to the many problems that dog our health service.

I will not take up time speaking about the many problems in the health service, because we are all too familiar with them. Our wide-ranging health services cover a significant number of different areas, in most of which we find difficulties. There are many reasons for this. Historically, there have been funding issues, but the main problem is that we do not have any overall coherent plan for the health service, in contrast to what happened in the United Kingdom after the war when the Labour and Tory parties agreed on the National Health Service. While there have been ups and downs with that service over the years, by and large people in the United Kingdom are proud of the NHS and would not contemplate its abolition. This applies in the political arena also and although the Conservatives may have cut funding at times, there has always been agreement on the model of health service and nobody has suggested the NHS should be abolished. The problem here is that we have no agreement on the model for our health service. Down through the years, our health service has evolved in an ad hoc way, to the point where it is now quite dysfunctional. There is no political consensus on the kind of model we need for the service.

This has resulted in a situation where every time there is a change in government or a change of Minister, each new Minister introduces a new plan. However, that plan does not have political consensus and when the Minister begins to implement it, that causes an enormous churning within the health service. Over the past 20 years therefore, the health service has been in a constant state of flux. This is bad for the health service and for the patients who depend on it. However, it is also very bad for those charged with delivering the service, because there is huge uncertainty about what the future holds. By an large, people are not quite clear where they fit into our quite dysfunctional health service. This is a major factor in regard to the ability of the State to retain staff in the service and to attract staff who have emigrated to return. The service does not make Ireland an attractive place to live in and it is not a good model for the delivery of services.

We have an extraordinary situation where some 38% of the public are dependent on the public health service and they encounter long waiting lists for practically every service. On the other hand, some 46% of the public pay thousands of euro every year in health insurance. This health insurance amounts to significant additional taxation. This kind of two-tier health system is unheard of in any other European country and would not be tolerated elsewhere. It is unknown in any other European country that sick people would not get speedy access to proper health services. Health services function in other countries and people have a right to expect their governments to take responsibility for basic health services and for ensuring there is a good quality health service in place that is available to everybody, irrespective of whether people can pay for it. This is the standard in the rest of Europe and there is no reason we cannot have a similar high quality public health service here. Any talking down of the Department of Health or description of it as a ministry nobody wants or as an Angola is a political cop out. Irish people are entitled to a quality public health service that is available when they need it and there is no reason we cannot provide that kind of service.

It is important there is cross-party agreement on this kind of approach. If people sat down together to design a health service, they certainly would not design the kind of dysfunctional service we have here currently. That is the reason we now need to come together politically to identify the most important things we need to deliver in terms of our health service and decide how to go about achieving that. The most important section in our motion is the recognition of the need to establish a universal, single-tier health service which treats patients on the basis of health need rather than on the ability to pay.

In setting out to achieve this ambitious objective - one realised in most other European countries - I hope the new committee will work on the basis of considering the high level issues that come into play in this regard. Over the coming weeks, the normal Oireachtas committee on health will deal with day-to-day issues arising in the health area. However, we need to have a high level debate and to reach agreement on what our health service should deliver and how we can achieve the kind of health service that will provide a universal, single-tier health service.

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We must also consider how we can transition from the current system to the new single-tier system over a period. How can we do that in a planned way so that, irrespective of whether there is a change in Government or of Minister, it will not all be thrown up in the air again? We must work towards an agreed consensus.

The other aspect of the motion deals with the need to reorientate the health service. Our health service is very hospital-centric and provides care predominantly at the most expensive level, that of acute hospitals. This puts an emphasis on preventative medicine and early intervention to ensure that, as far as possible, people can access the health service locally in their own community through their primary care services. There is no doubt that an approach where there is a front-loading of primary and community care delivers the best health outcomes and the best value for money.

In short, the second high-level objective is to introduce a single-tier health service, to agree on the most appropriate funding model and on how we reorientate the health service towards primary and community care and to model that and phase it in over a reasonable period. Everybody agrees there should be more emphasis on primary care as it will save money and there will be better health outcomes but we need to work out how we are going to go from the present system to the new system in a phased, ordered way. We need to work out how we can do it in a way that ensures services are not diminished in any way and that we move smoothly so that resources are switched from hospitals to primary care.

It is a tall order to come up with recommendations within a six-month period but it focuses people's minds. I would hope that all members of the new committee would approach this task on the basis of looking at the evidence, rather than listening to the many vested interests that have dogged our health services down through the years. We need to look at objective evidence to see what works, what our experience has told us and what is best practice in other countries, from which we can learn. We should do it in an open manner and in a way can keep the vested interests at the door. We should use the resources available to us in the shape of the ESRI, the department of public health in Trinity College Dublin and a number of other experts in the field and there is plenty of expertise around.

Finally, it is important the committee be resourced properly so that we have access to the best possible research and evidence to underpin the recommendations and so that we can move forward to achieve the single-tier health service that Irish people deserve.

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