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

I was asked about primary care centres and the incentives for people to use them over their emergency departments. Incentives do exist because the charge is lower for primary care centres than for an emergency department. If one attends one's own GP or primary care centre then one does not have to pay an ED charge at all. A big job must be done around educating people on where is the right place to go and when because they do not know. That is not their fault and we need to educate them.
We also need more investment in minor injury and local injury units. I have had the pleasure of visiting the hospital in Roscommon and noticed that it is possible for people in Roscommon to attend the minor injury unit and be seen very quickly in an hour or so. That is the same in Nenagh and Ennis. The units may not be open all night but they are open most of the day. People in Dublin do not have such an option unless one is willing to go to VHI SwiftCare and pay quite a lot to do so. We need some more investment in these injury units and also in the ambulance services.
A Senator mentioned the application process for medical cards. Yes, it is highly imperfect. There are different applications, as Members will know, for the doctor visit card, for the over 70s and the under 70s. It is proposed, under the revised system, to have one application for all types of medical cards, including for long-term illness. The first test, which remains the main test, is the means test. If a person does not qualify under the means test then immediately a secondary assessment can be done as to whether a person qualifies, based on medical need or medical hardship. That assessment will have the input of the local health office which is crucially important. Part of what was lost in centralisation was local input. None of this has gone to Cabinet yet so I probably should not say anything more about it.
Senator van Turnhout mentioned the ESRI-RCSI report for the Irish Heart Foundation on early supported discharge for stroke patients. It is a very good report and I would like to try it out in one region if the money can be found in the HSE's budget. It makes intuitive sense to me that if a patient is discharged early from hospital after suffering a stroke and rehab is done in the community or at home that he or she will do better. Like so many things in the health service when people present savings, on examination they turn out not to be savings at all. What is positive in that report is that it is cheaper for somebody to be given their rehab and so on in the community rather than in hospital. That is true but the saving only arises if one closes the hospital bed and lets the staff in the hospital go. If one keeps the hospital bed open and keep the staff in the hospital one still has to pay for them so one then gets two sets of costs. One often gets this argument as well with lay discharges - that it would be much cheaper for the person to be in a nursing home rather than, as they say, blocking a bed in the hospital. That is only true if one closes the bed in the hospital. If one does as one should do, which is use the bed for somebody on a waiting list then that means one gets an extra person into hospital and one is then met with both costs. In reality, that is often why savings do not arise when people posit them because what happens when one frees up hospital capacity is it gets used by other people who need it and people on waiting lists. If we do the right thing then let us do the right thing because it is the right thing to do and not because we think there will be savings that do not add up on scrutiny and detailed financial analysis.
Senator Barrett quoted my Department's annual report for 2010. I am not sure if those international comparisons are in the report because I looked at the World Bank's figures the other day on health spending per capitaand Ireland was way behind countries like Australia and so on. For Australia it is US $8,000 per head but we have US $3,500 per head.
Often when one does make comparisons we do not compare like with like. For example, in Ireland, as we all know, the social care budget for home helps, and all the rest of it, comes out of the HSE but that is not the case in the United Kingdom which funds such services through local authorities. Also, when taking account of how money is spent in the health service one must take account of where all the money comes from. In some countries all the money comes from the taxpayer or the exchequer. In other countries, like Ireland, funding comes from a mix so there is some from the taxpayer, some from the insurance companies and, particularly in Ireland, quite a lot out of pocket. One must take account of all the different streams of money that go into a health service. They are not readily comparable. I suspect that Ireland is probably somewhere in the middle. We are not a high or low spending country on health but we are somewhere around the middle. We probably do not spend it as well as we ought to.
I ran out of space to jot things down at this point but I will follow up the issues of stroke services and telemedicine stroke machines being left in boxes that were raised by Senator Mullins. I am not aware, in detail, of the home help issue. Is it a retirement gratuity? I will check out the matter. I have not seen any correspondence on it yet.