Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

Re-reading this after our meeting yesterday really set the alarm bells going in my head. In 1990 in Britain, the direct management of health services by health authorities was ended and replaced with purchasers and providers, turning hospitals into trusts with borrowing powers, their own finance, human resources and public relations departments. Good luck with that if the Government tries it here.

Professor Pollock noted in her contribution that since the duty of the Secretary of State for Health to secure and provide comprehensive health care was removed, the rate of privatisation and closure of NHS services has been accelerating. This cannot be allowed to happen here. This is not how we build a foundation for a universal single-tier health care. It will do nothing only undermine it. Handing over control of our hospitals and services to stand-alone hospital trusts is a highly inefficient way of delivering health care and has the danger of introducing new costs that are not experienced in public systems. Performance, it is noted, will be key in these new trusts but the level to which this relates to quality of care leaves a lot to be desired. With all the programme for Government talk of financial management and private sector providers, these trusts are at risk of becoming wrapped up in looking at income and finances rather than integrating with health services, health outcomes, prevention and primary care.

These trusts will essentially have the power to generate income privately and, as a result, may choose to use their beds, staff, capacity and resources solely for that purpose. They can feasibly enter into ventures with corporations, sell land and buildings and lease them back. What will be created from these programme for Government proposals is a substantial redesign of the health services towards the private sector - a health service franchise opportunity, more or less. Universal health care does not sit comfortably with the creation of these trusts and the long-term reliance on the private sector to address health inefficiencies. We cannot create a situation where the use of these services does not mean increased patient choice but rather increased choice of patient.

In research undertaken by Graham Kirkwood and Allyson Pollock on private provision inequalities in Scotland, it was found that use of the private sector in Scotland was associated with a decrease in direct and in-area NHS provision and may have contributed to an increase in age-related and socio-economic inequalities. Instead, the claim made by NHS Scotland's 2003 white paper that the additional use of the private sector would provide sustainable local solutions to long waits, which might sound familiar to some people here, is not supported by the evidence.

On the contrary, the level of local provision by NHS boards decreased, while boards which made the greatest use of the private sector for elective surgery experienced the largest reductions in direct NHS provision. It will not be necessary, therefore, to reinvent the wheel in this area.

In this state previous waiting list initiatives and injections of cash to the system had a localised or short-term effect but failed to challenge structural inequality. This cannot be allowed to continue. We cannot continue to use the private sector indefinitely to alleviate pressure on waiting lists as this is neither a permanent nor credible solution. The Minister has stated previously that we need sustained investment in waiting list initiatives. The solution to the crisis in public health care is investment in the public system. The Minister seems to believe the National Treatment Purchase Fund is the solution to this deepening problem. Outsourcing is not a long-term solution to the problem and privatising more health care services will simply not work, as the research to which I referred proves.

The real solution to the crisis lies in the recruitment and retention of staff and the reopening of beds closed in hospitals by successive Fianna Fáil and Fine Gael-led Governments. Investment in the public health service is needed, not only to provide more resources and capacity but also to directly challenge and eliminate structural inequalities. Building adequate capacity across the health system and eliminating unequal barriers to access will require significant and sustained public investment. The private sector will not do this because it is not interested and does not have the capacity to do so. If we rely on the private sector to fix the problems in the health service, we will be on a hiding to nothing.

It is important to be clear in our deliberations that authoring a blueprint for a ten-year vision for health care and delivering a universal health care system is not just a question of funding but also one of political will and determination. Irrespective of the good will and hard work of the committee and what it may produce collectively or separately, the co-operation and backing of the Minister and the Government will be required. I do not mean that members should be given a pat on the back or a star in their copy books for their efforts but for a significant political buy-in.

The committee is fortunate to have high calibre delegates appearing before it. If the Minister and the Government proceed with their plans while the work of the committee is in its infancy, this will be a futile exercise. For my part, I would like to take on board the counsel of the committee's delegates when producing our recommendations and I sincerely hope they will form part of the Government’s plan.

There are very large swathes of the programme for Government to which I cannot sign up. I do not know how anyone could sign up to it, but that is the Government's business. I will not sign up to an agenda for privatisation, whether it be an outright process or takes place through the backdoor. Privatisation is completely at odds with the realisation of a universal health care system. If he is serious about the committee coming together to work collectively on a vision for the health service, the Minister must clarify that any move to privatise the health service in the form of the programme for Government plans must be shelved. The committee cannot gain legitimacy and respect or develop a comprehensive programme of work if it is precluded from doing its work by the Minister and the Government pursuing contrary plans.

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