Sean Barrett (Independent) | Oireachtas source

I move amendment No. 1:

In page 3, before section 2, to insert the following new section:
"2.?The Health Service Executive shall cease to exist on 1 January 2014.".

The Minister and I have had many interesting debates, including debates before he became Minister for Health and I became a Member of this House. The great Fintan O'Toole chaired one debate we had in TCD. It is a great pleasure to welcome him and wish him well in the task because, as I said the last day, it is probably the most demanding job in Irish public life.

The Minister said the last day that he envisages the demise of the Health Service Executive, radical reform and the introduction of universal health insurance. I share the Minister's goals but would it not be better to put a sunset date on the Health Service Executive, which we are agreed should go? As approximately half the population has commercial health insurance and more than one third has a medical card, could we speed up the introduction of full coverage for people for health insurance? I hope that health insurance involves competition because the Milliman report showed that protecting one monopolist as health insurer was not a sensible policy. There are many issues like extended average length of stay, the lack of scrutiny of claims and so on. I know the Minister has sent Milliman back into VHI to see how efficiencies can be gained. I think they will also be gained by having a choice of insurance providers.

The Minister and I would probably be in agreement that it is an expensive health service, as the Department of Health's own data shows. We spend 11.4% of gross national income on health while Finland spends 8.9%, Sweden 9.8%, Switzerland in 11%, Denmark 11.3% and Norway 9.6%. Colleagues, like Senator Crown, might disagree with the UK system but it is getting a universal health service for 9.6%. Even Germany, which was mentioned the last day, is a couple of percentage points ahead of us. We have a very expensive health service which must deliver and that is why I support the Minister in his reforms. I realise that attempts to reform the health service have been seriously damaging to the political careers of very many Ministers for Health. I certainly feel a duty that if the Minister is trying to reform the system, he deserves my support.

One of its faults is that it is excessively bureaucratic. The number of clerical and administrative staff in 2011 was more than 16,000 while in 1980, it was 5,400. The total staff in the health service between 1980 and 2011 went up by 87%. That is against a 195% increase in clerical and administrative posts, that is, 2.24 times.

I support the Minister in his reforms. My amendment is purely a suggestion and I will not push it. It should be accepted that we implement the reforms the Minister wishes faster. That is the purpose of the amendment. I think it is called a "sunset date" in US legislation. Alfred Kahn, in the context of the Civil Aeronautics Board, said that if one leaves bureaucracies around, one gets function creep and they will invent other things to do. Is it not better to tell them it is all over on a certain date? It might not necessarily be the date I have put in the amendment.