John Crown (Independent) | Oireachtas source

I will not say too much this evening other than that I would share some interest in seeing a little clarification on the decision-making process that was involved in the primary care centres, but I will not be supporting this motion. I am not a party member. I was a fairly vocal critic of aspects of policy of the outgoing Government. Since coming into this House I have worked very closely with members of the dominant party in the previous Government and have forged good working, personal and professional relationships with them and I am glad we were able to advance a number of issues related to health care and other aspects. I look forward to working with Senator White on important legislation relating to retirement age. I have been privileged to work with Senator Daly on our anti-smoking legislation and with Senator MacSharry on legislation seeking increased clarity, transparency and consistency in the approval of cancer and other high-tech drugs.

However, on this occasion I will not be supporting this motion and I hope there will be an understanding of my position on this. While there is a need for clarity on the decision-making process that went into the primary care centres, the wording of this motion is unduly critical, censorious and makes certain assumptions about the process which are not as yet borne out by facts in the public domain. As such, I cannot support the contention that the Government unilaterally ignored well-established criteria. I look forward to hearing the Minister's exposition in the House today as to exactly what those criteria were.

There is something else I want to say and it is a very instructive illustration of how the process of politics works. I must admit that on a personal level I am far less cynical about the politicians who occupy these two Houses than I was before I became a Member of this House. I am, if anything, more cynical about the process of politics. The systems which have been put in place have enforced certain behaviours, namely, that of flip-flopping. When people are in opposition they will oppose cutbacks, when they are in government they will enforce cutbacks and when they are back in opposition they will oppose them again. Patronage will be dispensed by parties in power and it will be opposed by those in opposition until they are back in power when they will again dispense it. In our political system where in truth - do not take this personal, guys and girls - there is very little between the parties ideologically or in terms of convictions, matters such as patronage become issues. There is inevitably built into the reality of the system a certain amount of playing of politics and parochialism. One can understand how Roscommon hospital which lost its 24-hour access might feel there was a gap in terms of pre-existing medical care which needed to be plugged and that a primary care centre would legitimately provide some of the coverage for that. I look forward to hearing what has to be said about this.

I like giving the Minister a little back stiffener every time he comes into the House and I want to give him another one now because his reform programme is one that I support. To give Members a quick picture of the vision, some people see things and ask why and some see the others and ask why not. Let us look at the "why not" argument. Let us imagine a system where everybody has a single negotiable insurance instrument which may be provided by a private insurance company or by the State, one which is based on a fixed percentage of one's income where richer people subsidise the poorer people but at the end of the process everybody has a solitary instrument, a card, a computer chip or whatever, which gives them the same rights of access to the same health systems without any fear or favour, that they can go to any institution they wish and take part in the same waiting process and, hopefully, they will not be waiting in such a system. Some of the hospitals and doctors they elect to go to might be employees of the State, employees of the universities or other not-for-profit private entities. Some may be completely private practitioners. There will be sufficient policing in place to make sure that there was no cherry-picking or price gouging, that there was not supplier-induced demand, as we call it in health economics, where doctors prescribe unnecessary procedures in order to increase their throughput and line their own pockets. It is a system which has complete empowerment of the patient at its core. The patient chooses where he or she goes. It is not chosen by some nameless bureaucrat. It is a system which involves tackling the greatest vested interest in our health system now, which is one that never gets mentioned, which is the permanent government, the bureaucracy, the Civil Service and the HSE, a group which needs to be challenged. It is a system which would put in place patient-derived forces which would have the effect of enforcing responsible behaviours on doctors, which would open the market by employing more doctors and which would end waiting lists because people do not get paid until they do what they say they will do. They do not get paid for being merely in a job; they get paid for producing.

This is the vision that we need put in front the Minister. I will support him on his journey to it. I am very keen that he will try to accelerate that move, that implementation. I am sure there would be goodwill all around the House for that. I see a number of other issues which arise on the way to that nirvana as being perhaps more in the nature of distractions than true progress. We are hoping that the Minister will accelerate this process and move quickly because this is not some vague goal we should think about in a second term of office. This is something we need to acknowledge, as is what we need to do to fix the system. Palliative administrative and bureaucratic band-aids over the system we have now will not fix the fundamental problems which are inequity, poor quality and inefficiency.