Maurice Hayes (Independent)

I would rather he read this because he will not be able to take it all in today. If the Minister of State reads that report he will find that it deals with many of the issues that we have been concerned about, particularly the question of trying to square the circle between accessibility and excellence of treatment. I commend the Minister, Deputy Martin, and I urge him to put his hand to the plough and to stick to the task. It is time to go ahead and make the change.

The great tragedy is that the Fitzgerald report of 40 years ago was not implemented. If it had been, we might not now be dealing with many of these issues. The reports which have been put before the House deal with a range of issues but there is a danger that people believe managerial and administrative changes will be enough. At the end of the day, that may only be a rearrangement of the deckchairs on the Titanic. We must enable very gifted, dedicated and able people in the medical, nursing and allied professions to treat patients. That must be the outcome. From the amount of money that has been put in over the last number of years which has not been matched by outcomes, it is quite clear that there must be change. It is important that attitudes are changed, not the labels over people's chairs nor the titles they have.

Any service industry knows that the ones that succeed are customer-driven. They are cost effective and are capable of dealing with change and that must be the test. These are difficult, complex issues and difficult, complex sets of relationships. Overnight success and change cannot be expected. The person who has to make the difficult choice is the consultant sitting across the table from a patient. Where there is incessant demand and limited resources, there are difficult and tragic choices that have to be made. The object must be to engage the people who are making that commitment in the choice and in the discussion and that is the essence of the Brennan report. It is very important that it is handled sensitively.

I would not agree with all the Brennan report conclusions and say that a patient must be either private or public. I believe there is room for people to have the option of saying they will buy in so many sessions. I believe that private medicine should be practised in a private hospital, not in a public hospital. It should be a fully-fledged and insured hospital that does not then depend on the public hospital as the safety net to pick up the bits.