Róisín Shortall (Dublin North West, Labour)

I convey the apologies of the Minister for Health, Deputy Reilly, for his inability to attend this debate. He is attending a funeral in the UK and, on that basis, I trust Senators will excuse him. He regrets he is not in a position to be here given that he was in the Dáil throughout yesterday's debate.

I thank Senators for their thoughtful contributions, many of which were based either on the valuable experience of public representatives who worked at the coalface to respond to issues raised by constituents, or the more specialist expertise exhibited by Senator Crown in particular. That 20 Members contributed to this debate on a Friday morning is a measure of the importance they attach to the health service and its reform. Notwithstanding the small number of political points scored, I welcome the wide agreement across the House on the need for significant reform. There is agreement that our health system is seriously dysfunctional in a number of aspects and needs urgent and radical reform. The big regret is that the opportunities to address some of these fundamental problems were not availed of during the boom years when plenty of money was available to conduct a root and branch examination of the health service. I wonder almost every day why these problems were not tackled when the money was available to do so.

I do not suggest that the Bill is a panacea. It has been described as a sticking plaster and it represents an immediate and urgent response to a specific problem that has to be solved in a matter of days. It does not purport to address the wider problems in the health system. These problems have been known for many years and analyses of them are provided in umpteen reports. There is no question about the need for better planning in our health service. Manpower planning is an area that has been identified by several speakers. I was shocked at the lack of data available to me to examine the kind of services we want to provide in the future, and I am not satisfied by the roll-out, planning and forecasting of manpower and levels of services. This is an issue I want to address at an early stage with the Department of Health and the HSE.

There is no question that we need to reform fundamentally the way we deliver health services. The system does not at present provide an acceptable level of service or achieve best outcomes for patients. This model of health care is not fit for purpose. The challenge is to meet the best interests of patients and, to do so, we must remove the vested interests. We must take an evidence-based approach to decision making and tackle the huge bureaucracy that is clearly not responsive to the needs of patients. We must also be cognisant that we are in the process of introducing reform at a time when there is no spare money. Achieving good value for money should always be an important consideration but it is to the forefront of our thinking now. We have to achieve value for money across the system and there can no longer be protected or vested interests. Everyone must be made accountable for the level of service they provide.

The programme for Government gives a clear commitment to fundamental reform. We are committed to introducing universal access on a single tier basis in order that people have access to an appropriate level of health care based on their medical need rather ability to pay. We must switch to a system in which money follows the patient rather than continuing to pay block grants to hospitals irrespective of their efficiency or activity. By making the money follow the patient, service providers will be incentivised to increase activity and provide services that are more efficient and cost effective. It is a misrepresentation to describe what we aim to achieve as the Dutch model. The model which we propose in the programme for Government is a hybrid and cannot be compared exactly with those of other countries. It is based to a certain extent on the Canadian and French models and it draws from a number of different systems around the world. It is an insurance-based model involving competing companies.

I appreciate Senator Crown's frustration about the time required to implement fundamental reform. It cannot be done in the short term and the Government is realistic about the timescale that will be required to introduce the reforms that everybody agrees are required. For this reason, we have set out a timescale of five to six years to introduce full universal health insurance. It would have been easy for the parties that now make up the Government to have promised short-term reform during the election campaign but, given the size of the health service, that is simply not possible. We want to turn that ship around and fundamentally reform the way in which services are provided. That cannot be done in the short term and this is why we have set out medium-term objectives for what we want to do.

This does not mean nothing will happen over the coming five or six years. Immediately after entering Government, the Minister, Deputy Reilly, and I set about ensuring no time would be lost in introducing reform. The special delivery unit which we have established is expected to make rapid progress in addressing the blockages in the system that prevent the reduction of inpatient and outpatient waiting lists. I hope we will start to reap the benefit of these reforms in a matter of months. In the longer term, the special delivery unit will investigate ways to deliver services across the hospital system and in primary care settings through changes to work practices and hours of operation which will allow us to get better returns for our huge investment in the health service as well as better outcomes for patients. That work is under way and we will see its outcome over the coming months and years.

In terms of moving towards an insurance-based system, an implementation body was recently approved by Cabinet and will be set up in the coming weeks. It will carry out the short, medium and long- term planning required to provide fundamental change to the delivery of health services.

The results of an examination of the health insurance market being undertaken by Goodbodys------