Sean Barrett (Independent)

For 14,000 acute beds there are 17,000 administrators. If one is given a so-called semi-private bed, a phrase which defies definition - it means a patient is given a bed in a corridor and may be moved somewhere else later - the total cost of that bed provision is greater per night than that of staying in the best hotels in the country. I had a constituent who was charged €10,000 for the cost of a bed for a seven-night stay. Our hospitals are massively uncompetitive. All the restrictive practices that the Minister, Deputy Richard Bruton, is trying to deal with in the hospitality sector exist in multiples in the Irish health service. It is a nest of restrictive practices from beginning to end. The first such practice we must address is access to medical schools. In my college we have received letters from women who got 600 points in their leaving certificate and were denied access. They could be working in those hospitals today. That is a restrictive practice. The deans of medicine, mostly men - I believe they are all men - decided that the leaving certificate favoured women applicants; they got away with that item of gender discrimination and designed another test, which allows more men to get into medical school. Keeping people out of medical school leads to the kind of situation we face today. Such reform is seriously necessary.

There is no demographic bonus being enjoyed by this country. There is Canadian research which would indicate that we should be able to get a bonus of 2.9% of GDP on health expenditure because, as has been said, our population is younger than anywhere else. Countries, which have a large number of old people who need to access the health service more, are able to do it on much smaller budgets than we are. The whole system must be taken apart. I agree with Professor Crown that the employment of PR consultants, quangos and bureaucracies has not served this country well.

One could ask how we can reform the health service. Politicians do so at their peril. That has been the case with every Minister for Health since Noel Browne. He thought it was the church that undermined him but I think it was the medical profession. Every Minister for Health has been undermined by the 111,000 people who work in the health service. They serve themselves very well. The cost is huge. We have 2 million taxpayers and a budget of €16 billion. Each taxpayer in this country is entitled to €8,000 in health services each year but is not getting it. I wish the Minister of State, Deputy Shortall, and the Minister, Deputy Reilly, every success, but it has been a political graveyard because of the opposition of the incumbents. The patient cannot introduce reform because the patient is ill and worried.

I thought that one of the ways we should have done it - I hope the Minister will consider the model as he moves towards insurance - was through competing private insurance companies. If the BUPAs of this world can insure both old people and young people for less than the VHI, I welcome that, but the Department has always defended the VHI as its in-house monopoly health insurance company. The insurance companies could extract some of the monopolistic rents out of inefficient hospitals and high-cost producers and pass them on to the consumer. The Department's stand was exposed in the Supreme Court when it decided against the anti-BUPA legislation but by then the situation had dragged on for so long that BUPA had left the country. We will need competing health insurance companies so the consumer can choose between people who are good at extracting monopoly rents out of the health services and those who are less good. Having a monopoly health insurance company owned by the Department, which is responsible for the high costs of the service in the first instance, never made economic sense and it should not have been the subject of so much legal proceedings by the Department.

We need a reform agenda. We will be most disappointed if nothing is done within the two years to which the temporary legislation applies to remedy the defects in medical schools and in de-emphasising hospitals. Why is there not a GP in every clinic on a 24 hour basis? It is just a normal service. Who mythologised general practitioners that they think they can go home at 5 p.m. and that nobody ever gets sick in the evenings? We should move towards a substantial transfer out of hospitals to general practice which would generate significant savings to the health budget. That should be considered. I agree with the remarks of my colleague that trainees should not be front line staff in some hospitals as this measure seeks to ensure on a temporary basis.

I hope the Minister of State, Deputy Shortall, and the Minister, Deputy Reilly, will not be blown off course because this is a major national problem. I am sure the IMF will tell us that our health service is a disaster in economic terms. It is way over the odds in expense and massively over-manned. It has doubled its staff numbers since the 1980s. I sometimes wonder - it is not an entirely rhetorical question - if that is the problem of the health service - the fact that 111,000 people are trying to do the job of the 55,000 who used to do it in the 1980s.