Sandra McLellan (Cork East, Sinn Fein)
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Question 9: To ask the Minister for Health if he will provide an update on the current state of preparation regarding his plans for universal health insurance [26387/11]

James Reilly (Dublin North, Fine Gael)
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The Government is embarking on a major programme of reform of the health system. The aim is to deliver a single-tier health service supported by universal health insurance to ensure equal access to care based on need, not income. There are a number of important stepping stones along the way, each of which will play a critical role in improving our health service in advance of the introduction of universal health insurance.

A key immediate priority was the establishment in June of the special delivery unit, SDU, under the leadership of Dr. Martin Connor to drive down waiting times for patients. A great deal of work has already been undertaken in this regard. The resources of the National Treatment Purchase Fund, NTPF, will be refocused to align with the work of the SDU, allowing for a progressive improvement in the performance of the nation's hospitals.

A further fundamental element in the reform process involves significant strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients. The phased implementation programme will be overseen by me as the Minister for Health and the Minister of State with responsibility for primary care, Deputy Shortall, assisted by a project team of officials from my Department and the HSE.

Reform of the funding system for hospital care will also be implemented. A money-follows-the-patient funding mechanism and a purchaser-provider split, whereby hospitals will be established as independent, not-for-profit trusts, will be implemented. To achieve this, a number of initiatives are already under way, including a patient level costing project and a pilot initiative in respect of prospective funding of certain elective orthopaedic procedures at selected sites. I intend to establish an implementation group on universal health insurance, details of which are being finalised and will be announced in due course.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Government promised a White paper on universal health insurance "early in its term". That was the phrase used when this proposal was first mooted. When will the White Paper be published? To be specific, will that be before the end of this year? Within the next three odd months, when can we expect legislation to be published? Will it be one item of legislation or will it be a number of items? Has the Minister any idea of how this matter will present in the time ahead? Will the White Paper include financial projections? This is an important question. Are these items in preparation and will this entire matter be taken into account in the spending review that I presume is under way in the Minister's Department in advance of early December's budget? Is it as immediate and presenting as that?

James Reilly (Dublin North, Fine Gael)
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We made it clear during and since the election campaign that completing this development would take two terms of Government. The idea that we will have a White Paper before Christmas is a non-runner, as that will certainly not be the case. The Deputy's questions were not unreasonable, but these measures will not be delivered within the timeframe to which he alluded. They are a number of important stepping stones along the way. We must build a proper primary care structure. We do not have sufficient primary care centres or a new general practitioner, GP, contract. My colleague, the Minister of State, Deputy Shortall, will oversee work on the latter. We need to move the care of the chronically ill from the hospitals back into the community. The contract needs to reflect this. Equally, we need to introduce a money-follows-the-patient system of budgeting for our hospitals so that we can have greater transparency and accountability.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Into what does "two terms of Government" translate? Is it two general election terms, per se? The Minister should be clear with the House.

Michael Kitt (Galway East, Fianna Fail)
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That is not a question on health.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is a reasonable question and I am sure the Leas-Cheann Comhairle is also anxious to get the answer.

James Reilly (Dublin North, Fine Gael)
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I would be delighted to answer.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We will not have a White Paper Christmas in 2011, but tell us-----

James Reilly (Dublin North, Fine Gael)
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We might have a white Christmas.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We may have one soon. What exactly is the Minister's expected timeframe for the publication of the White Paper on universal health insurance? How will the legislation present? Will it be one or more items of legislation? Into what does "two terms of Government" translate in the Minister's mind?

James Reilly (Dublin North, Fine Gael)
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I am sure it might be three years in the Deputy's mind. In mine, it means ten years, but this does not mean that introducing these measures will take ten years.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Some of us might not be here.

James Reilly (Dublin North, Fine Gael)
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I would love to be in a position to deliver full universal health insurance by the end of this term, but I am a realist and a pragmatist and I know it will not be possible. However, we will be well advanced along the road by the time of the next general election. For this reason, I stated that a second term would be required to bed things in fully. It is too early to say how many items of legislation will be required. This policy will be implemented incrementally to ensure this development is done properly instead of rushing matters and causing problems down the road.

We are committed to achieving this. For the first time ever, a political party has acknowledged that bedding in a policy will take two terms. Generally speaking, it is not seen as a successful political tactic, but we are determined to make it happen because people deserve it. As we have often done in the past, we are asking everyone to share the pain. We want to ensure that, at the other end, everyone shares the gain.

Michael Kitt (Galway East, Fianna Fail)
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I will briefly allow in Deputy Kelleher, as I want to move on to Deputy Keating's question.

Billy Kelleher (Cork North Central, Fianna Fail)
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One could also say that the Government is trying to kick the can so far down the road because it knows that it will not be able to implement the political promises it made as quickly as it claimed.

Róisín Shortall (Dublin North West, Labour)
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That is not true.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Dutch model was very much espoused before the general election. What is the position thereon in the context of the instructions to be given to the implementation body? Will there be clear guidelines given to the body about the type of universal health insurance the Minister requires? Will it come back with proposals as to the type of health insurance it recommends the Minister should consider and discuss in the context of a White Paper, as referred to by Deputy Ó Caoláin? This is a fundamental change to how we go about funding health services. Will there be a proper, open debate when the report is produced?

James Reilly (Dublin North, Fine Gael)
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Absolutely. I welcome debate and full discussion. One should bear in mind it took the Dutch 20 years to achieve their model. We are learning from their mistakes and what they did right. Therefore, we do not need to reinvent the wheel. None the less, Ireland is a very different country, geographically, culturally and in terms of population. We know there are many variations on the Dutch system that will not work here but that the core of it can and will. We must ensure we have a properly regulated health insurance market before we proceed. There are many aspects to be considered. There will be many full debates as the various parts of the programme are put together so we can realise what I believe is a worthy aspiration, namely, that everybody in the country will have access to medical care based on need, not on what they can afford.