Joe Costello (Dublin Central, Labour)

I compliment the Fine Gael Party on bringing forward this motion, which relates to the most recent crisis to affect our health system. We have witnessed many such crises during the past decade. There is an obvious solution to the crisis in the health service, namely, to get rid of the present Government and introduce a new system. The Labour Party has that policy prepared, and it is the way we should proceed. We need a new policy, a new Government and a new Minister, and we need to begin the work immediately. As soon as the election comes and we can begin that, the better.

It is incredible that the Government should have presided over the closure of so many hospitals, such as in my own constituency, as well as the closure of many wards and beds at a time when the population was increasing. It is incredible it should have imposed a whole new tier of administration on top of the existing one without first removing that existing tier, resulting in a non-functioning administration and management system. It is incredible that the Minister for Health and Children should have declared a national emergency in regard to the numbers of people waiting in accident and emergency units throughout the country in 2006 yet, four years later, we have a record number in the same units. She promised that within six months of her ten-point plan she would have dealt with the problem but the situation has reached an unprecedented level four years on.

The patients who come into the emergency sections of the hospitals are often elderly and fearful but the conditions they experience in their immediate interface with the hospital are appalling in many cases. In those circumstances, any senior Minister would have resigned long ago and handed over to somebody who would do something substantial with the service rather than allow it to collapse upon itself, as it has, and to remain in crisis over an entire decade. It is a disgrace that we should still be in this situation despite all the money that is spent annually on the system and all the promises that are made.

The Irish health system is a Third World system in a First World country. We had all the years of the Celtic tiger to get it right but the money was squandered. We now find we are faced with hikes of up to 45% in premium costs for VHI's Plan B and Plan B Options. These are the most popular plans which people would have embarked on perhaps decades ago, and of which those who are now elderly and more likely to be in need of care are in receipt. Such elderly people are the ones directly affected and they are being targeted - that is the sum total of all of this.

It is outrageous that the Minister should target the most elderly in our society, who have been loyal members of the VHI over the years, many for decades. They paid their premiums year after year yet what are they now told? The Minister for Health and Children tells them they can shop around. That is not what community rating is about. The situation is that VHI's customers are being thrown to the wolves. Many of them will either have to abandon their policies, reduce their premiums or take on and incur costs for which they cannot pay. This is what the Minister is doing with this unprecedented hike in VHI premia.

It is not good enough for the Minister to, on the one hand, tell people to shop around and, on the other, to justify it by saying she is preparing the VHI for privatisation and fattening it up for sale. Is that the way to treat patients, subscribers and customers? This is the sort of thing that was done with Eircom by the then Minister, Deputy Mary O'Rourke, when it was privatised some years ago. We can see what has happened. Whatever system we had then, we have a much poorer system now and we are lagging behind the rest of the world in terms of broadband procurement and provision.

There must be a major question mark about the actions of the Minister. It seems that, essentially, she does not care about the people with whom she is dealing. She cares only about putting in place an ideological policy position. It is the last dying kick of the now defunct PDs - privatisation at all costs and the marketplace rules. She is now preparing the VHI for privatisation. That it will damage the loyal customers and make them concerned and fearful is not taken into consideration. They are told to shop around and that they will get more or less the same somewhere else. Why were they in the VHI in the first place? What is the sense in a company operating unless it has some loyalty towards and protection for its customers, who have been loyal to it? For the Minister at this time, just as she is about to leave office, to unilaterally say costs are going to be hiked up so much that, effectively, people will not be able to pay is not acceptable.

It is not good enough that the Minister has delayed so long in providing risk equalisation legislation. While she states in her amendment that it will be produced some time in the coming 12 moths, she will not be around to deliver on it - we know that. She had three years to do it but she has done nothing. One cannot effectively talk about having community rating unless the statutory basis for risk equalisation is provided for. What needs to be done to protect and underpin a fair system has been neglected. The Minister has done the opposite in that she has put the cart before the horse and is now privatising the VHI when she should be providing a statutory system that would ensure equality within the health service. That has not been her priority, however, which is a reflection of the manner in which the entire health service has developed in the decade under her aegis.

It is time for a fresh start and the fresh start must have a fresh vision and a new policy. The Labour Party and Fine Gael have put forward two new policies which have many similarities, including a universal health insurance policy where the patient, equity and fairness are at the core, where the money follows the patient, where vested interests do not rule the system and where the system is not in control, whether that be a management system such as that of the HSE, which is dysfunctional in itself, or whether it is the main players - the GPs and the consultants - who have traditionally dictated the manner in which the health system operates in that it has been built around them rather than being built around the patients. It is time to put all of that to bed and put patient care at the core of a new health system.

See this speech in context