Róisín Shortall (Dublin North West, Labour)

I thank those Senators who contributed to this interesting debate. I am encouraged by the Senators' contributions. We are all at one in identifying abuses in the systems, problems in the services and the need to reform them.

The provisions in the Bill are exclusively technical in nature providing for a one-year extension of the interim scheme of age-related tax credits and community rating levy for 2012. They include small modifications to the scheme to allow for a more precise level of support for community rating.

The broader issues in regard to risk equalisation will be dealt with in the coming year by the Minister for Health. The concept of risk equalisation will be more vital than ever in the context of a universal insurance health system. The programme for Government includes a commitment in this regard.

In addition, the Minister for Health is particularly concerned to ensure claims costs are kept to a minimum to mitigate any requirement to increase premiums. He has approved the commencement of a review of claims costs to address this critical market issue. It will commence presently.

The aim of reform in the health area is to deliver a single-tier health service which will ensure equal access to care, based on a person's need and not on their ability to pay. The programme for Government provides for this in a universal health insurance context. These major reforms will require detailed preparation and intensive work over time. The Government is realistic about the timescale involved and believes it cannot be done in a short time. It is also being ambitious in aiming to introduce full universal health insurance in the early stages of a second term in government, if this Government is lucky enough to be given that opportunity.

However, there are several important stepping stones along the way and each of these will play a critical role in improving our health service in advance of the introduction of universal health insurance. Given the complex nature of what is planned, the Government has approved the establishment of and terms of reference for an implementation group on universal health service. The details of the group are being finalised and it will commence work shortly. Its work will pave the way for the introduction of universal health insurance in the medium term.

Significant reform of the acute hospital system is planned. The special delivery unit was established in June 2011 to unblock access to acute services by improving the flow of patients through the system and to put in place a systematic approach as a priority to eliminate excessive waiting times in emergency departments. This has been identified as an absolute priority. The special delivery unit is establishing an infrastructure based on information collection and analysis, hospital by hospital, so we can know the situation in real time. New systems have had to be implemented to collect this important data. This will allow us to begin to embed performance management into the system to sustain shorter waiting times. Accurate data systems are integral to assisting in the introduction of such fundamental reform.

The National Treatment Purchase Fund is working to support hospitals in the delivery of a 12-month maximum waiting time for inpatient or day-case surgery by 31 December 2011. The Minister, Deputy James Reilly, has stated on several occasions that he is committed to meeting that objective and every effort is being made to ensure this happens by the end of this month. We expect to be able to move forward to reduce further that waiting time, year by year. A further critical aspect of reform of the acute hospital system is the implementation of a new, more efficient funding system for hospital care which will be a mechanism whereby money follows the patient. This will end the block grant payment to hospitals and the lack of transparency as to what it actually buys. For example, we will have a unit cost for, say, a hip replacement. This will enable a drive-down of costs and achieve better value for the taxpayer. It will include a purchaser and provider split, whereby hospitals will be established as independent, not-for-profit trusts. Various initiatives to facilitate achievement of the money follows the patient funding system are already under way.

The programme for Government provides for a significant strengthening of primary care services with the removal of cost as a barrier to access to general practitioner, GP, services. In line with this commitment, access to GP care without fees will be extended in 2012 to claimants of free drugs under the long-term illness scheme. This week's budget allocated €15 million to start this important and fundamental reform programme. Up to 56,000 people will benefit from this initiative.

Full universal health insurance is a medium-term project which is under way but the reforms promised on opening universal access to GP care are reforms we intend to deliver in this term of government. It is the Government's intention to move the bulk of chronic disease management away from hospitals to the local primary and community care setting. This will be the real game changer and will be responsible for introducing real reform in the health service.

The purpose of the reform provided for in the programme for Government is to have early intervention to encourage people to access care at an early stage and achieve better outcomes, earlier diagnosis and a much more user-friendly health service. People want to receive health services locally and their local health professionals. This also entails having a much more cost effective health service. This is what we intend to achieve in the term of this Government.

I thank Senators for their thought-provoking contributions. Senator MacSharry referred to a figure of €100 million owed by health insurance companies to hospitals. I am not sure how he arrived at this figure.