Sean Barrett (Independent)

I welcome the Minister. I always appreciate his visits here. He probably has the most demanding job in Irish public life. It was compared to a certain country in Africa at one stage. I commend the Department for the great documentation it sent us on key trends in health in Ireland. Towards the end of the document it is stated that per capita expenditure on the health service in Ireland, despite the belief the that Minister is Dr. Scrooge, was at €3,781 in 2010, which is a little less than in Belgium but more than in Finland, Italy, Japan, Spain, Sweden and the UK and approximately the same as in France. We must face the value for money issues and I am delighted the Minister is doing so. The drugs bill of €2.3 billion is approximately one eighth of the total expenditure because we have a large amount of private health insurance and large numbers of over-the-counter medicines are used. Another 88% will undoubtedly occupy the attention of the Minister and it is what is recommended by the IMF.

I support the Bill and this is inherent in the comments I am making. We do not want to solve one problem and create a bigger one. According to departmental sources, in 1980 we ran the health service with approximately 55,000 staff; it now has 104,000 staff. The total increase was 87% but in clerical and administrative roles it was to an index of 195%. We went from having 5,000 administrators in 1980 to 16,000 at present. This must be addressed. A metaphor for the Irish health service is Dr. Steevens' Hospital near Heuston Station, which was a fine hospital that was converted into offices for administrators. When one is ill one does not look for offices for administrators; one looks for the care of health service professionals. This is a problem we must address.

We must also address the issues in the Milliman report. On the previous occasion when the Minister came to the House he told us he brought Milliman back to the Department and the VHI because it found a lack of budget-consciousness which accounted for the high cost of health insurance in Ireland. The version of the report that the Leader received for us is heavily redacted, but a piece on page 31 which escaped the redactor states that for medical inpatient admissions the VHI average length of stay in 2009 was 10.6 days but the international well-managed standard is 3.7 days. This is a vast bill for the Minister to have to cover. The average length of stay for well-managed surgical inpatient admissions was 3.7 days but the VHI average was 7.5 days. The money spent on €1,000-a-night bed-and-breakfast for people kept in hospital unnecessarily comes from the Minister's budget for care of patients. We have enough hotels to look after people. This must be examined.

The pattern indicates that the defence by the Department of its in-house health insurance company had the normal effects of creating a monopoly. When Aer Lingus was protected it was extremely expensive to fly. I would like a situation whereby competing health insurance companies could say they recruited all of the old people but because they did not pay over the odds for drugs - they had read the Minister's speech in the Seanad on 19 July 2012 and read the Milliman report - they found they could give a better deal on health costs. This would benefit us all because it would introduce a competitive element so the VHI would have to respond and examine its high length-of-stay costs and expensive drugs which the Minister seeks to control. Like other Senators, I look forward to working on this over the vacation and coming back to the Minister.

I like the decision taken today on the abolition of the HSE. How many wrong turns did we take? We did not like regional health boards because they were too bureaucratic, so we created the HSE, but the bureaucracy grew. It is time to think fundamentally about what our destination should be. Mine would be to make the hospital the individual unit and let two or three hospitals compete. If similar patients get out of one hospital faster and are treated by the drugs advocated by the Minister today rather than very expensive drugs, people would get to know this. Perhaps too much centralisation took place and there was too much bureaucracy.

Like other Senators I will be thinking about and working on the Bill in detail. An emphasis on cost-consciousness is required because, as I stated at the beginning, we do not stint on health expenditure here. Even in the dire circumstances in which we find ourselves we have chosen models which are excessively based on hospitals. I support the Minister's attempts to move this out to the community. It also seems to be excessively bureaucratic, given the large growth of bureaucracy since 1980. If in this context cost-consciousness has not addressed the cost of drugs despite the fact that they account for one eighth of expenditure, let us start with this and put a new emphasis on the patient and value for money. It is possible to combine the two, which is why I welcome the Bill.