James Reilly (Dublin North, Fine Gael) | Oireachtas source

I do not want to delay progress, but I must challenge some of the assertions made by Senator Cullinane. I apologise for not addressing some of the issues he raised in the context of bigger hospitals and money following the patient. I believe smaller hospitals will be well able to compete and will have an advantage in this area. We intend to ensure that people are not sent to have procedures carried out in bigger hospitals where they could be carried out in smaller hospitals. This is part of the underlying principle of treating the patient at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. We do not want people with inguinal hernias and gall bladders being sent to Waterford or Galway when they could be treated in Roscommon, Clonmel or wherever.

I believe the money follows the patient. I have the document on that and it will be ready to go to the Government shortly. This is another big step on our road to reforming the system. Senator Cullinane mentioned Sinn Féin's plan and I would welcome sight of that plan. I reject what the Senator had to say about the consultant contract. The talks at the Labour Relations Commission, LRC, were very successful. For the first time, we have an agreement that consultants will be contractually obliged to work any of the hours 24/7 as opposed to Monday to Friday from 9 a.m. to 5 p.m. I accept what Senator Burke has said, that many consultants have been doing this pro bono, not as part of their contract. The clinical programmes which encourage this sort of work practice saved us 70,000 bed days last year, the equivalent of ¤63 million. I acknowledge the work done by the consultants. However, I cannot run the health service on a pro bono basis, which is why the LRC talks were so important.

Another benefit arising from the LRC talks is the fact we now have clinical directors with real powers, in terms of directing their consultant colleagues and how and where they work and in regard to their obligations. Furthermore, because consultants are leaders within the health service, they are now leading from the front, which will make it easier for other members of the caring professions to follow suit in terms of showing flexibility around rostering, etc.

Some Members seem to assume the Government is fully adopting the Dutch model, but that is not the case. We are designing an Irish model of universal health insurance that will best meet the needs of the Irish system and citizens. As I said before, when it came to the insurance model, we looked at the Dutch model, when it came to the patient safety authority, we looked at the Danish and Canadian models, when it came to the trust model for hospitals, we looked at the United Kingdom model and when it came to how we could improve performance within our service and the special delivery units, SDUs, we looked at the North of Ireland model. We do not have any one system. We are choosing the best elements of the other systems that we believe will best suit our purposes.

Of course, Senator Cullinane is entitled to his view, but that does not make his view a fact. The fact in the case of the Dutch system is that the cost increase is due to the extension of the scheme to cover dental care. I do not accept the amendment.