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

I welcome the opportunity to speak on this issue. Normally, when we have had health debates in this Chamber over the years, by and large, they have been partisan and contentious and were often used for political point-scoring. Deep down, however, everybody would still have strong views on health and the health services available to the people. Therefore, while people are partisan and politically motivated, it is a fact that health comes into play for every citizen at some stage in his or her life and he or she will come into contact with the health services.

Traditionally, people would have expressed varying views on how we fund the health care system. It has evolved over many years and no political party can say that we have the ideal health system or that we will get to it in a short period. The establishment of this committee will give us an opportunity to remove the partisan approach that is very often taken to health debates in the House and allow us to come up with a substantial document that can reflect a real advance in how we see our health care strategy developing in the years ahead.

Of course, while we talk about a ten-year strategy, with the best will in the world, and even with a lot of resources, it will take us a long time to get to where we would like to be in terms of capital investment and increasing the number GPs, allied health professionals and clinicians. Therefore, it is not just about developing a strategy but about underpinning it with real resources in the coming years. I would instance the issues of training, education and expanding capacity to ensure we have enough clinicians to do the work and underpin the strategy as it evolves.

The motion that established the committee stated we are talking about a universal health care model. Of course, when we talk about universal health care, we have to define what that is, which is difficult. What does the term "universal" mean? Will everybody be entitled to everything? What will be free and how will it be funded? The universal concept would suggest that this would be the case but if one looks at most countries that have tried the universal model, very quickly there is some form of rationing or there are delays in the process, the service is underfunded and under-resourced and waiting lists increase. While universality is the concept, unfortunately, the position with regard to delivery is very different. We will have to be honest in terms of the type of system we want and how we commit resources to it and fund it. Will the system be funded out of general taxation with a direct subvention every year to whatever health agency will be running it? Even the most affluent countries in the world that have moved towards universality, such as France, have found it exceptionally difficult to consistently fund the health services to the standard they would like.

Regardless of whether we like it, almost every country in the world rations health care. Decisions are made that mean some people have to wait or are unable to access all forms of health care. This morning, the Oireachtas health committee discussed medicines and the high-tech drugs coming on stream. In that context, there is now a pharmacoeconomics unit that effectively assesses the impact medicines will have on the longevity of an individual patient and makes a decision on whether that person should receive the relevant medication. While receiving the medication could extend a person's life, decisions are sometimes made that do not allow the medicine to be made available to an individual. That is a severe form of rationing of health care to individuals who will die if they cannot access certain forms of medication. That is the extreme but we ration health care on a daily basis. It is a tragic reality of living in a world where we do not have enough resources to fund the health care system we would like.

The committee will report at some stage. I hope it will take a broad view of where we would like to go in terms of a universal health care system. A difficulty will then arise as to how we fund it and how much it will cost. As a country, Ireland is quite good at developing policy and already has quite a body of health care policy. Our difficulty is ensuring that we follow through. Whatever comes out of the committee's final report, if the recommendations are accepted by Government and the wider Parliament, some implementation body should be put in place to monitor the ability of whatever Government is in office to move towards that.

The committee has outlined 12 work streams, some of which will clearly be more important in terms of how the patient will experience health care in the years ahead. To take primary care, we have a very fine document, the primary care strategy, in respect of which there is broad buy-in regarding what we need to do to ensure that the vast majority of health care is provided in the least complex areas, at the lowest cost and in a way that is most beneficial to the patient. We all accept that. However, we have not moved the budgets and resources accordingly since the primary care strategy was conceived in order to ensure that primary care has the capacity to do what was intended under the policy. A major shift in resources is required but also a change in mindset at governance level in the HSE and the Department of Health to ensure that acute hospitals are not always front-loaded with funding while we starve primary care. This inevitably feeds the cycle of patients ending up in the acute hospital system because primary care cannot cater for them. Primary care, integrated care and chronic disease management are critical components in moving to a system where primary care has the capacity to deal with many of the issues in the community setting.

Some of the evidence we heard in the presentations today was very interesting. Much of it is not novel thinking; it is just very logical thinking in terms of how we deliver care. One area where I would like to get advice and a view from the Minister is in regard to the hospital groups and hospital trusts. The Minister said he does not want to take any more decisions on structural changes.

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How far down the road are we going in terms of hospital groups and the establishment of hospital groups? Are we now moving to a situation whereby we will establish hospital trusts? During the committee discussions hospital trusts have not come to the fore in terms of something that is needed. They should be established immediately. Are we to delay the commitment on the roll-out of hospital trusts in order that we do not have to pare back on something that has just been established? I urge the Minister to examine the matter and to ensure we do go down the wrong road in the view of the committee. If we had to reverse engines in a short time it could create difficulties in terms of the final recommendations of the committee.

We should take the ideological element out of the discussion on health but I worry that might not be possible because some people refer to private health care as unable to provide the service that is needed. To be honest, much primary care is provided privately. GPs are not employed directly by the State. That is an issue that must be examined. In negotiating contracts we must bear in mind chronic disease management, community care, social care and the demographic changes that will happen in the near future. All of those issues must be taken into account. While the unions are negotiating on the GP contract it is important that the Irish College of General Practitioners should examine the contract negotiations from a clinical perspective. I urge the Minister to take note of the point. I raised the issue with the college last week and its spokespersons were of the view that they should have some say in the matter also. The motivation from the union's perspective will be to try to achieve the best outcome for members, although I accept that the patients will be foremost in their mind. That said, there could be slight conflicts of interest in terms of what is good for the patient versus what is good for the doctor. The Irish College of General Practitioners should have at least an oversight role in terms of the broad clinical issues that might arise out of the contract.

I compliment and congratulate Deputy Shortall for the part she played in having the committee established by the Dáil. I acknowledge the work that has been done by the staff. It is clear that the committee is a significant undertaking and it might take a little longer than we anticipated. However, we have a deadline and we are determined to meet it.

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