Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance) | Oireachtas source

This debate, the committee's deliberations and more importantly coming out with a real strategy and plan to deliver a health service that works for all our citizens could not be more critical.

One has to put a human face on these things. I know everyone has cases and people they have to deal with. I have tabled several parliamentary questions over the case of a young man, Mark O'Brien, and indeed his father, William O'Brien. I believe he was on national radio recently describing his situation. This is a young man with a very rare disease and as a result has strokes constantly. He is very severely debilitated by this condition. It is acknowledged that he has a need and he is looking for home care hours.

When we send the parliamentary questions to the Minister, we get the reply that the budget for home-care hours is at capacity; that is it. He has a desperate need. Mark's father, who is much older and also has a very bad heart condition, and his wife have to travel on a train when their health is not up to it from Shankill to Dún Laoghaire to look after their son. As Melisa in my office said when William, the father, is going to see his son Mark because he does not have the home care and he comes into our office to plead with us to try to get these home-care hours, he is completely out of breath because he has a bad heart and lung condition himself and indeed probably needs somebody to look after him rather than have to go and look after his son, but the budget is at capacity and that is it. They are actively seeking money. This is just not acceptable.

When hearing these debates and the different categories of issues in the health service one's head can get fried and one can get drawn into thinking, "Well, I'm not an expert; I don't really know. It's all very complicated. How do we solve this? It's going to take a long time. There are so many different things to balance."

What Professor Allyson Pollock said is absolutely fantastic. She said that we have to start from basic principles. If the basic principles are right, everything else will fall into place. She said it starts here in this Parliament passing legislation to the effect that we will set up a national health service and the health services will be delivered on the basis of need and not on the basis of budgets or money and trying to balance private interests against the public system and so on.

In preparing my interventions on the health debate over the past five years, I have been lucky enough to have a doctor, who happens to be a member of our party, giving me advice. I would always be looking for the complex stuff from him and saying is it not really much more complicated. He says no, it is really simple; we just need a national health system. There has to be a commitment for that. It needs to be provided for free and delivered on the basis of need. If that principle is established and that is legislated for, everything else will follow. In the long term it will save money or certainly will not cost more. There may be more upfront costs to get this established, but it will actually work out cheaper.

In her comments Professor Allyson Pollock, a very eminent person, underlined all the points we have been making in the past five or six years. She explained it in simple and clear terms. She said, "no country in the world has delivered a universal single-tier health care system through the market, for-profit provision or private insurance." No country in the world is capable of delivering it and yet we still cling on to that system. She went on to explain why:

That is because it is in the nature of markets to operate through selection and exclusion. They transfer risks and costs back to service users and inevitably deny care to those who need it most. Risk selection and exclusion is built into the design of market bureaucracies.

She went on to cite the US system as the worst example of this where health expenditure represents 8% of GDP - much more than countries that have a national health service model such as the UK. The US spends much more than any other country but it denies one in five of its population access to health care. She said:

overtreatment and denial of care, health care fraud, catastrophic costs and spiralling health expenditure are features of the US health care system... more marketisation, higher administration and transaction costs, the greatest inequalities in access and health outcomes, a lack of coverage and the highest out-of-pocket payments.

All of these could be comments about our two-tier system. We have €3 billion in out-of-pocket payments because of user charges in accident and emergency departments and prescription charges. Some €2 billion of Irish health expenditure, which is one of the highest, goes to the private health insurance companies. We have all the unnecessary billing, all the administration, all the advertising and all the profit taking. It is all waste and money that should be going into the national health system. If we adopt the principle and legislate for it, all of those resources can be diverted into delivering the public health system that we need.

I agree with the emphasis being placed on primary care, integrated care services and so on, but let us not allow this to be the reason we do not provide more resources in hospitals. The reality is that acute hospital bed numbers per head of population here are way below the European average. Building up primary care services should not happen at the expense of investment in the provision of staff, beds and resources in hospitals.

My final point is on the wider question of capacity if the two-tier system were to be changed to a single tier system. I have previously made the point that all over Ireland there are private health care facilities that are empty or unused while there are people on lengthy waiting lists or waiting on trolleys in public hospitals. If we were to nationalise these facilities and makee them part of a single tier, publicly controlled universal system, we would have the capacity, beds, staff and resources to deliver the type of health service people need and want.

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