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Dáil
‹ Leaders’ Questions.

Public-private healthcare and patient access

Summary

Higgins criticised the two-tier system, arguing private hospitals select profitable procedures while very ill patients rely on public hospitals, and cited a woman waiting months for a colon examination. The Taoiseach defended public capacity and services, outlined further bed provision and medical-card coverage, and disputed the criticism.

The reality is that the Government stands over a two-tier health system which it sponsors and nurtures. That is having a grievous impact on the plight of public patients including those who are very ill. For the most part private hospitals do not cater for the very ill. They cherrypick the profitable procedures and the very sick and those requiring high maintenance are directed back into the public health system.

In recent weeks, everyone became familiar with the gut-wrenching case of a Kilkenny mother who was obliged to wait eight months for her colon to be examined. That delay will cost the woman in question her life. This is the reality faced by people who are not wealthy and who are dependent on a proper public health system.

Did it ever occur to the Taoiseach that there is a good reason that the section of consultants who want to operate in the private health system cannot take the Minister for Health and Children seriously when she lectures them on the need for a public-only contract? Such lectures on her part ring hollow because she is doing everything in her power to shift an increasing level of resources into the private hospitals where these consultants wish to operate at the same time as having contracts to work in public hospitals. The metaphor of the fox lecturing the members of the pack for casting their eyes over the henhouse comes to mind, particularly in light of the fact that the Minister has already directed the fattest chickens in that direction. Now she is telling consultants that they cannot move in this direction because she wants them to remain in the public sector. It is important to note — this is sometimes overlooked — that doctors are committed to public-only health care.

The problem does not relate to the quality of health care or the dedication of those who work in the service, but to access and capacity. The Taoiseach did not indicate the date on which the full complement of 3,000 beds will be provided and I want him to do so. Is it not pathetic, when it is clear that the population is burgeoning, that the HSE is only now discussing carrying out of a survey? Have the HSE and the Government been asleep for the past several years? When will that survey take place and when will an accurate number of additional beds required by our increasing population be provided?

Comment on this

I stated earlier that the overall survey relating to a population of 4.25 million and rising is under way. The HSE will present its report on the survey when it is completed. I also indicated that 1,500 have already been provided and that approximately 350 private beds and 446 public beds will be provided this year. Arrangements have been made to provide approximately 400 additional beds next year. I also referred earlier to the 5,000 private beds in public hospitals.

This matter is not as simple as the Deputy thinks. The length of stay by patients in all our hospitals has been dramatically reduced. In the past, people were obliged to remain in hospital for between 14 to 16 days in respect of quite minor procedures. An enormous level of day surgeries are being carried out at present and the figures have risen by hundreds of thousands. The old system — even that which obtained five years ago — does not necessarily apply. That point has been made by medical and nursing organisations. It is because of the efficiency and skill of the members of these organisations that the number of day patients being treated has increased while the length of stay has decreased.

Comment on this

Why then did the Taoiseach state that an additional 3,000 beds are needed?

Comment on this

I am aware the Deputy is an expert on medicine. We can discuss the matter later. Day and inpatients are being dealt with in much shorter periods. The relevant staff have, therefore, maximised the return from our acute hospitals.

Deputy Joe Higgins is correct that because of the standard of services on offer in our public hospitals, the huge numbers of staff that have been committed and the deployment of modern equipment, people who are seriously ill are far better off in public hospitals than they would be in their private counterparts.

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Why are public hospitals so dirty?

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Deputy Joe Higgins is correct that the standards on offer in and the capacity of our public hospitals are of a level of which we should all be proud. We should continue to put resources——

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I did not say that.

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That is what I heard the Deputy saying. He stated that, because of the standards on offer and the resources available, one would be far better off in a public acute hospital than in a private hospital and he is correct in that regard.

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The Taoiseach is rewriting the script.

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Is that why the Government is intent on building more private hospitals?

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That is not to take from the fact that hundreds of thousands of people opt to pay health insurance to various companies so that they can access private care. There is nothing wrong with that.

Some 1.3 million people have medical cards and 60,000 people have doctor-only cards. I congratulate the parties opposite for at last seeing the wisdom behind our decision to introduce doctor-only cards. The Opposition berated me last year and stated that such cards are worse than useless.

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The Government did not issue any of them.

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We issued 60,000. I would have issued one to the Deputy if he had been under the limit.

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A total of 200,000 were supposed to be issued. There is a shortfall of 140,000.

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I will ask the Minister to increase the limit in order to take account of that fact. This development has been of major assistance to the service.

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