John Crown (Independent)

I would like the Deputy Leader to seek clarification from the Minister for Health on two issues, the first of which relates to an emerging policy of public patients being stripped of their choice of public hospital. That is occurring in this country. It has serious implications for many citizens who would like aspects of their care to be provided in hospitals other than those geographically defined as being their local hospital.

On an allied issue, I would like the Minister to clarify how many non-clinical staff in hospitals are allowed to look at the medical records of patients in our hospitals. It has come to my attention on a number of occasions that people with various medical problems who have been seeking medical care in institutions outside their local areas have been told they can no longer be treated there. Some of my colleagues in this Chamber have asked me to make inquiries in this regard on behalf of their constituents. I have now learned that several staff in my own hospital were brought in for a chat by representatives of the hospital administration. They were told in no uncertain terms that patients who come from outside the catchment area of St. Vincent's Hospital - according to some interpretations, it appears to be a small area confined to Ross O'Carroll-Kelly land - should not be coming to the hospital but should instead be decanted to hospitals closer to where they live. A critical issue of choice for public patients arises in this context. People choose hospitals for many reasons. They may choose a good hospital near to them, which is often the appropriate thing to do. They may also choose a hospital with expertise in a particular area in which they are troubled, such as one with expertise in a particular disease or skill. They may also have issues of confidentiality. Some people do not wish to be treated in the hospital beside where they live where everybody knows them. Finally, some people have personal, painful and legitimate memories of sad things that happened in hospitals that can leave them a little psychologically coloured with regard to going back to that hospital.

The reason this is happening is because of the inflexibility of budgeting structures in the HSE. The hospitals get a fixed budget at the beginning of the year, so the natural way to deal with financial shortfalls as we experience the economic downturn is to turn away customers. What other enterprise tries to turn away its customers? However, that is what our hospitals are doing. They are trying to force patients to go elsewhere. In addition, a perverse incentive has now emerged in that hospitals that do not meet waiting list requirements will be fined. Therefore, where a hospital tries to do the decent thing and provide a service on a shoestring budget for people coming from long distances for treatment, waiting times will increase because more people are going to it, resulting in the hospital being fined for being good. This is the opposite of what should be happening in the system, that quality should be incentivised. This is what is classically called a perverse incentive - where people are incentivised to be bad or mediocre.

Will the Deputy Leader seek clarification as to whether there has been a "from the top" change with respect to the right of citizens to go to any hospital in the country to be treated and whether that right is being respected by the individual administrations of hospitals? On a related matter, are members of the finance departments of hospitals allowed to trawl the records of patients in those hospitals.