I will broadly support the Bill while taking on board all of the reservations raised by Senator Barrett. The only hopeful way to consider this legislation is to view it strictly as an interim measure until the big bang of major reform into a universal, single-tier insurance-based health care system occurs. I hope it occurs yesterday. The Minister has committed to it being done in the next term of Government, but I again urge him to try to ensure it occurs as quickly as possible. The dysfunctions that are exemplified on a daily basis in our health system will continue until it is fixed. There will be much opportunity cost for the time, effort and energy to be expended in trying to patch up this badly broken system until we usher in the new system.
If one wanted contemporary evidence of the level of dysfunction, one would open one’s ears and eyes, read the newspaper today and listen to the proceedings of the Oireachtas health committee. In The Irish Examiner it was reported that a consultation process has begun between the HSE and HIQA, and what a critical mass of incompetence becomes involved when those organisations get together. It has resulted in a recommendation that doctors should refer fewer patients for surgery and we should effectively triage referrals to those which will have greatest impact. That is in response to the fact that waiting lists are getting out of control and issues of cost. Among the procedures targeted are tonsillectomy, which has historically been a grossly overused procedure. The Minister knows that in modern medical practice, very few people are referred inappropriately for tonsillectomies, and those who are referred will seldom have the tonsillectomy. There has been a colossal decrease in the use of the procedure. Chillingly, in a country where the incidence of malignant melanoma and the mortality for malignant melanoma has doubled, there is also talk of curtailing people being referred for assessment and removal of skin lesions. In many cases a good GP can be certain that a lesion is not a melanoma and does not need to refer the patient, but in some cases a doctor may not be sure because he or she may not have the expertise to see the kind of subtle lesion that only a plastic surgeon or dermatologist could deal with. I am troubled by this. It would be different if we had a colossal problem in this country with gross overuse of surgical resources but we have the smallest number of surgeons per head of population of any country in the western world. This is not where the problem lies. The issue is that we do not have an appropriate system for matching the expenditure with the required level of activity.
A second contemporary example occurred at this morning’s health committee meeting when we discussed the cystic fibrosis unit. As the Minister knows, over 2005 and 2006 forward planning was initiated for the provision of an appropriate cystic fibrosis unit following the recognition that the existing facilities in the national adult centre at St. Vincent’s Hospital were inadequate. Based on international guidelines, this should be a 34-bed unit. There is a 20-bed unit, with a promise of 14 additional beds, and we asked for validation today of that promise and that the commitment is being honoured. Neither I nor Senators Zappone and van Turnhout – the instigators of the discussion this morning – were in any sense reassured that we had heard any degree of comfort that the 14 beds would be provided. The distinguished representative of the HSE and the chairman of administration at St. Vincent’s Hospital told us there would be further crisis meetings on various evenings next week.
This is prolonging the politics of the last health care atrocity; it is crisis management. The unit has been planned for years and open for five months. The system as it currently stands is not geared to making appropriate forward planning and everything is done on a reactionary basis. The sooner this reform is introduced, the better. We will through gritted teeth support this Bill in order to keep the VHI afloat until the big bang occurs.
Members should be aware of what we will sign up to when we get universal health insurance. It will be very different and everybody’s relationship to the health system will be fundamentally different to how it is now. Some hospitals will thrive and some will fail. There will be no logic in having national consultant contracts and people will have different kinds of contracts depending on the people for which they work. The system will cost more but it will be much more efficient. It will be of higher quality and it will be fair. We must aim for that and we must get it going as quickly as we can, as until we do we will have repeated health care atrocities, scandals, wasted measures and interim measures in crisis management. I wish the Minister the best and hope he will complete this ambitious reform, which I know he has taken to heart, as quickly as possible.
