Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

We can take a number of measures to reduce liability costs. The Department of Justice and Equality is introducing legislation to allow for periodic payment orders. In Ireland people receive a big lump sum up front, which can be very large and costly, whereas in other jurisdictions payments are made periodically over time. This is less costly and allows the courts and others to assess a person’s needs, instead of guessing what they will be for the rest of his or her life. I would like to re-examine the possibility of having a no-fault system in the case of cerebral palsy and birth injuries because the current position is very unsatisfactory. Parents who have children with cerebral palsy have to go to court to prove negligence and it can be many years before they obtain a settlement. There must be a better system all round for us to look after children with cerebral palsy. Some work was done on the issue 13 years ago, but it was not followed through. The time has come to revisit it.

For the medical profession in general, it is very important that we adopt a greater duty of candour. Doctors and hospitals should not be afraid to tell patients if something went wrong and explain it. Doctors and hospitals can sometimes be too defensive and fear being sued. When litigation occurs, it is often compounded by the fact that patients were not given all of the information or treated disrespectfully. There is enormous evidence to support the view that where there is candour, mistakes are admitted and restitution is offered immediately, the litigation we have seen does not occur. I understand Senator John Crown’s point on doctors in training, which may or may not be true, but I have yet to see evidence to support the view that many adverse events occur because of the high number of doctors in training rather than consultants. It may be that consultants do not take responsibility for what has happened to patients under their care and do not show candour and honesty in explaining to patients what happened and offering restitution. The Senator’s separate point, that fully qualified consultants would provide better and safer care than those in training, must be logically true; however, I do not know if there is a direct link between this and the high level of litigation in Ireland.

Senator Colm Burke asked about people who were registered and out of the country. I do not have figures, although the Medical Council produces very detailed figures which may include the information sought. Because of continuous professional development, CPD, requirements it is increasingly difficult for people to maintain their registration when they are no longer in the State. As far as the Bill is concerned, those who are out of the State will not be required to have insurance in Ireland.

There were questions about the number of incidences of people being on the register but not being insured. Although the legislation does not yet require it, the Medical Council asks doctors, at the point of annual retention, whether they are indemnified and follows up with those who are not. Very small numbers – two or three – are registered but say they are not indemnified. There could be more who say they are indemnified but are not and that does not become apparent until a case arises. If other professionals such as dentists, therapists and nurses are working in a State or private hospital or for an agency, it is expected that their employers would cover their insurance. However, we will see more nurses such as clinical specialists and others operating independently and they will need to be insured.

Senator David Cullinane mentioned the GP protest. I am under no illusions about the fact that GPS are under pressure. Their incomes have decreased and their workloads increased. It is also important to know the facts. While many young GPs may be emigrating and many GPS are approaching retirement, the number of GPs contracted to the HSE is at an all-time high, up from 2,258 at the end of 2010 when the Government took office to 2,416 today. We have never had more GPs contracted to the State and looking after GMS patients. Listening to some of the commentary one would think the number of GPs was decreasing. While it may need to increase faster, it is certainly not decreasing.

Similarly, the amount of money paid by the Government to GPs under the GMS scheme has increased from €438 million in 2011 when the Government took office to €447 million in 2013. GPs will, rightly, argue that they have to see more patients because there are more patients with medical cards than before. While that is true, funding has not been cut to general practice in cash terms since the Government took office - it is the reverse - and people have to do more for more, not more for less. There is an opportunity to provide more resources for general practice. The Government wants to do this by extending GP care to all those aged under six years and over 70 and has initiated contract negotiations with the IMO on a new replacement contract to replace the Childers contract which, believe it or not, is still in operation in general practice. I hope the IMO and GPs seize the opportunity to obtain more resources for general practice because they might not be there forever; they might not always have a Government or a Minister in office that is as committed to general practice as the current regime is.

The protest today is by the National Association of General Practitioners which does not have a negotiating licence and is, therefore, not involved in the talks. The IMO is.
There were some good questions about records being online and people having access to them. The fundamental problem in Ireland is that most records are not available online. We still largely use paper records in the health care system and hospitals. There has been enormous under-investment in information and communications technology, ICT, in the health service in the past decade or so. I assume this is due the aftertaste of the personnel, payroll and related systems, PPARS. It did not go as wrong as people claimed, but it did go wrong and became very expensive. As a result, there has, unfortunately, been huge under-investment in ICT in the health care system. General practice has embraced IT and most GP surgeries will have electronic patient records, but that is not the norm in hospitals where there is a huge distance to catch up in ICT. However, it is intended that the new children's hospital, the design team for which I launched today and which will be under construction by the end of next year, will be fully electronic and virtually paperless when it opens. In the case of children, at least, we can start the process of putting records online.
Another initiative that will be rolled out from the start of quarter one of 2015 involes the individual patient identifier or health identifier. Everybody will have a single number which can be used to identify him or her. It will be a little like a personal public service, PPS, number for health. There are many reasons one cannot use the PPS number, into which I will not go, but it will be similar to it. It means that we will be able to identify people. At present, if one is attending a GP practice and one or two hospitals, the records do not talk to each other. The first step in doing this is to have an individual health identifier for everybody. It will be very messy because there are different systems throughout the country and somebody will have to tag this new number to all of these records. It will be far easier with children. We hope to register with it all children under six years of age next year, but seeding the old data and getting to these numbers will be complicated. It is not a project that should be rushed.
Senator John Crown made a number of points. I do not have time to deal with all of them, but I will address a few. While I acknowledge that the health service is consultant-led rather than consultant-delivered which is a fancy way of saying most of the doctors the patient sees are in training and not specialists, we have more consultants than ever working in the health service. There are also in total more doctors than ever working in the health service. Although there has been a recruitment embargo in the health service in recent years, it does not apply to doctors. A record number of doctors and dentists are working in the health service. As that fact is not well known, it is important to highlight it. In contrast, the number of management and administration grades has fallen to a ten year low. One would not think this when one sees what passes for media commentary these days, but it is the case.
Over time we will have to increase the number of consultants considerably and reduce the number of doctors in training somewhat. However, the first step is the far more practical one of filling the 200 vacancies across the health service for consultants. We are finding it very difficult to recruit them for a number of reasons, not all of which are financial, but finance is part of it. I hope the IMO will ballot in favour of the new salary scales, thus allowing us to fill these 200 vacant posts next year. Currently, they are filled through agencies and by locum consultants at enormous cost for reduced quality. That is the first thing to be done. If we can get it done next year, it will be good progress.
On the general issue of health reform, I am a strong supporter of universal health care. I agree with Senator John Crown and many other Members of the House that it is not a radical idea. It is the norm in almost all of the western world. Ireland missed the boat in embracing the concept in the 1940s and 1950s for various reasons. There are many models and the German model is as good as any. I will not go into the detail of it today, but I will in time. The first step for this country is the introductio of universal GP care. I hope to make this a reality in the coming months in extending GP care without fees to young children and everybody over 70 years of age. People will only believe universal health care will happen when they start to see practical things such as this. We have had many White Papers and plans, but it is only when people see it start to happen that they might start to believe it.
On the wider issue of universal health insurance, the Health Research Board, with the assistance of the Economic and Social Research Institute, ESRI, is doing detailed work on universal health insurance and its cost. We hope to have the findings of this work by the end of the first quarter of next year. It is an interesting piece of work which will give an indication of what the cost will be. As Senator John Crown said, it might well cost a little more and we should not tell people anything other than this.
One can use many statistics such as gross domestic product, GDP, and gross national product, GNP, per capitaand so forth, but health services in Ireland are under-funded relative to most such services in Europe. It is not the case that one can deliver universal health care simply through efficiencies. Universal health insurance will involve cost and payments. What we must do is calculate the cost for individuals and families and work out how they pay for it. Whether it is the German model proposed by Senator John Crown - a percentage of income and an opt-out for the better-off - or a compulsory insurance system, as is the case in other countries, if there is to be a proper debate on it to find out what people want, it will be necessary to have figures to show them what it would cost. I hope to have them next year.
The difficulty in making it happen in 18 months, of course, is that the public system must be reorganised and become competitive in order that it can compete with private hospitals for patients. It is not in that position and the hospital groups are a big step in the direction of making the public health service competitive with the private health service. However, there are many other issues involved. We are locked into public pay scales and other terms and conditions that do not make implementation straightforward. However, as far as the Government and I are concerned, there is no departure from the vision of universal health care. That is still what we intend to do, but we will try to be very practical about it in the short term.