James Reilly (Dublin North, Fine Gael)

Although I am not entitled to interfere in the day-to-day running of the VHI, as its sole shareholder I will demand on behalf of its customers that there should be serious discounting of the fees charged by consultants when they carry out procedures in private hospitals that could and should be carried out in primary care facilities. I do not mind whether such procedures are carried out by consultants or general practitioners. It is utterly unnecessary for this side room fee to be attached.

Issues relating to administration and the costing of things also need to be considered. Procedures have changed and become more efficient. If I mention any particular procedure, a certain group of individuals will be very cross with me again. I do not want that to happen. I believe everybody is doing their work as best they can. We need to revisit many of the things that are happening. I will not get into the specific details. Everybody knows that archaic payments are being made for many things that often do not require the presence of a doctor. One of the clearest and easiest things that is done in our hospitals is phlebotomy, or the taking of blood from people who have haemochromatosis and need to have a pint of blood taken from them at regular intervals. The VHI pays a big fee for this, even though it is done by a nurse most of the time. It should not be done in hospital. It should be done in general practice. Many such matters have to be addressed.

I have covered the question of the centralisation of means testing for medical cards. I remind the House that local staff who have an understanding of people's needs and requirements were left in place to deal with people. There was a concern and a worry that people would have to deal with a computer, which would be very disengaging.

Many speakers, including Senators Crown and Barrett, expressed concern about the health professions admission test. I am very unhappy about it because it is grossly unfair. I am prepared to say publicly that all it has done is led to the development of another industry and another course. I know of people who failed it the first time but passed it the second time after taking a special course. I want to see it changed. I will discuss that with the Minister for Education and Skills. If somebody who wants to study medicine works hard enough to get 600 points in the leaving certificate, that should be acknowledged. I accept Senator MacSharry's point that people who get 600 points are often pushed by their families into studying medicine rather than history, politics or something else. That can happen. If such a person wants to study medicine, however, he or she has bloody well earned the right to do so.