Mick Barry (Cork North Central, Anti-Austerity Alliance) | Oireachtas source

I am a member of the committee. We have heard a range of very valuable and interesting witnesses. I will talk in this session about a key witness from whom we heard this week, namely, Professor Allyson Pollock, the professor of public health research and policy and the director of the global public health unit at Queen Mary University of London. The committee asked Professor Pollock to make some observations on the direction in which health care is being taken in this State. Specifically, we asked her about the provision in the programme for Government for the establishment of hospital groups, the formation of trusts and the ability of trusts to raise private finance and to contract in. She felt that was very reminiscent of the US health care model and of the privatisation measures that have been introduced in the UK since the early 1990s. She felt the experience in the UK in particular has completely discredited those ideas and has left hospitals and hospital groups with major debts. Some 75% of trusts in the UK are now in debt and 15% of their income is now allocated to servicing debt over the next 30 to 60 years. In fact, the majority of private finance initiatives have been forced to do a U-turn and go back in house again to get the best services. Another major problem was that the top priority for those groups became income generation rather than health care provision.

She made a very sharp observation which I want to read into the record of this House. She said, in respect of a single-tier health care system, "It is important to note that no country in the world has delivered [a] universal [single-tier] health care [system] through the market, for-profit provision or private insurance." That is a particularly important quote. I want to read into the record of the House another quote from Professor Pollock, "My understanding is that given the committee's commitment to articulating a vision for a universal single-tier health service, [a national health service] Bill for Ireland is the essential first step in a ten-year plan."

The reason she said it was a first step was that moving towards it slowly over a period of five or ten years would give time and space to powerful vested interests to campaign against it and to wreck it. Therefore she recommended a Bill for an Irish national health service as a first step.

She suggested that such a Bill should include placing responsibility on the Minister to deliver universal single-tier health care and should name the services that would be provided by the State in a basket that could be added to over a period of time, funded by general taxation which, she remarked, the World Health Organization had stated is the best way to fund such a service.

The role of private health insurance came up in that discussion. She made an interesting observation that in the UK less than 10% of the population availed of private health service insurance because of its National Health Service. There is not a need such as we have in this country where 44% of the population avails of private health insurance.

She raised interesting points about developments in the health service in Canada where private health insurance has effectively been banned. She felt there was a powerful case for that because it diverts resources from the public health service. In this State, for example, 20% of beds are private, diverting services in terms of not just beds, but also staff from the public system. That could not be done without providing a proper public system on the basis of a national health service.

Interesting points came up, not just from Professor Pollock, about the funding for such a model. While in some ways extra funding would be needed, in other ways huge savings could be made. For example, private health care is more expensive than public health care because of administration, invoicing etc. In the US between 30% and 50% of costs are down to administration whereas in the UK under the old NHS model, that was 5% to 6%. Therefore, it is not necessarily the case that a national health service would mean a massive increase in funding.

In some ways Professor Pollock's contribution yesterday has raised very sharp questions for members of the committee. Opinions will need to be formed and decisions made in the not too distant future as to whether there is agreement on the idea that we need an Irish national health service and a Bill to introduce it as the immediate first step. I am convinced of that argument. I have long been a supporter of that argument. The committee will now need to address that issue as part of its deliberations in coming weeks.

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