Sean Barrett (Independent) | Oireachtas source

I welcome the Minister to the House. Looking at the notes on this issue prepared for Members by the Oireachtas Library and Research Service and updated on 15 February, the Minister inherited a situation where Irish expenditure on health is actually higher than the OECD average: $3,890 as against an average of $3,484 for the OECD. The United Kingdom figure is $3,289. There are resource allocation issues. That is a big budget. Most recent Ministers for Health have been an endangered species. They are pursued as if they were Scrooges, looking for new ways to grind down the sick and the poor.

There is a budget, which seems large. Other commentators would say that if one takes into account that the Irish population is younger than typical in an OECD country, there are genuine questions about what is happening here. I welcome the Minister's contribution on this. Is there excessive hospitalisation? That is expensive. Have outpatient appointments replaced GPs? I have heard people, including the Minister's predecessor, say there is evidence that GPs are deskilled in the neighbourhood of major hospitals. It is easier to refer a patient on to a consultant at the hospital rather than tackling the problem oneself. I am worried that we have been running down GPs to some degree and giving away their services for free to the under-sixes and over-70s, regardless of income. I would not have implemented either of those policies. Do we have hospital wards that are designed for nine beds but which the people upstairs only allow eight into, putting pressure on emergency departments? Senator Moloney has mentioned care for patients in their own homes. Can we have clinics attached to pharmacies, for example, and break down the huge hospital monolith, of places with huge premises, many of which were built relatively recently at huge capital costs? We need step-down facilities. Since I raised it with the Minister recently on a Commencement debate, many people would say Baggot Street Hospital is there to replace a number of beds as a step-down facility. It would probably cost about €40 million. We have these facilities. That is a shortage in the system. We have highly-trained and skilled consultants and nurses.

It raises the question of whether the Irish inpatient hospital population needs to be there, whether there is something wrong and whether management can do something in co-operation with doctors and nurses. The numbers prepared by the World Health Organisation, WHO, and the OECD, which the Minister's Department publishes each year and which the Oireachtas Library and Research Service has updated, show there is a big budget, which is generous in comparison with OECD countries. It should always be more, but that reminds me of a definition I read a long time ago. The WHO definition of health was that one should feel perfectly splendid all the time. I am afraid that is not the real world and the Minister has scarce resources over many competing uses.

Now is the wrong time to ask, when strikes are pending, but is there a way that very big budget could be turned into more healthcare with the co-operation of nurses and doctors? Are there excessive layers of administration? Every time somebody makes a comment like that, each of the groups involved says that it is not responsible, but overall the budget is high per head, as those numbers show, at $3,890 in 2012 compared to an OECD average of $3,484. The United States is outstandingly high - that is the way it has decided to go - but many other OECD countries are able to run a health service without the kind of political agitation and distress caused to people by ours. Could we do better out of that budget? If the Minister can, I wish him the best of luck with that and every success and support, but I do not think the problem is entirely one of budget.