21 February 2007
Dr. Henry: Making empty beds is one thing but making them with patients in them is quite another. It is not just that one must deal with the patient and make the bed, it is the fact that one might discover something that is of great importance while doing so. We are in a difficult position vis-à-vis nurses. It was very difficult for them to go on strike on the first occasion and I recall senior nurses weeping on my shoulder at the thought of doing so. It will not be difficult on this occasion.
Nurses will be able to prescribe in the future, which is perfectly acceptable, and the Minister referred to them ordering diagnostics. We already discussed the rationale - brought forward by the Minister - for having more consultants, namely, that people would be in better decision-making positions and would, we hope, have more confidence in respect of discharging people and ordering diagnostics. If junior doctors are not confident and tend to refer too many people for X-rays - I am aware of a survey which indicates that a junior doctor is seven times more likely to order an X-ray in respect of a case than a consultant - we must accept that a similar position will obtain with nurses and that this will give rise to an additional expense.
I am greatly concerned by the fact that there has been a major increase in the amount of money being spent in the health services and that one does not often obtain any idea regarding what something will cost. I wish to refer to the National Treatment Purchase Fund, in respect of which I spoke on previous occasions. This fund operates under a veil of secrecy, which is wrong. One can discover what the VHI, BUPA and VIVAS will pay in respect of procedures. However, one cannot discover what the National Treatment Purchase Fund will pay. The fund's annual report for 2005, the most recent issued, indicates that €64 million, a considerable amount of money, was spent and that 18,000 cases were treated. The administration costs relating to the fund are low, which means approximately €3,500 is being spent per case.
The only really expensive procedures among the top ten listed in the report are joint replacements and cardiac surgery. If we allow €10,000 per procedure - which the VHI would consider generous - in respect of joint replacements or cardiac procedures involving 2,000 patients, the total spent would come to €20 million. When this figure is subtracted from the overall amount of expenditure - that is, €64 million - €44 million is left. Among the other procedures listed in the top ten are those involving procedure scopes, tonsillectomies, varicose veins, skin lesions, hernias and grommets, none of which is expensive. The most common procedure carried out in 2005 related to cataracts and a total of 2,256 patients were involved. To have a procedure carried out on a single eye cost €3,000 in the most expensive of private clinics, while €6,000 would ensure a patient could have both eyes operated on. If we add up the figures in this regard, we find that a further €10 million has been spent. This means that €30 million of the overall budget has been accounted for and that the other €34 million was used for procedures involving skin lesions, hernias and tonsillectomies.
The VHI will pay far less than €1,000 - this includes the fee for the services of an anaesthetist - in respect of tonsillectomies, regardless of whether they are carried out on adults or children. Allowing for expenditure of €1,000 per case, this means we paid €1.5 million for the 1,351 tonsillectomies carried out under the National Treatment Purchase Fund. Where is the money going and why can we not be informed with regard to the type of commercial deals the Government is making?
I was obliged to undergo an MRI scan - Members will be delighted to discover it was perfectly clear - at the Blackrock Clinic at a cost of €259 to the VHI. I telephoned the VHI because I thought there had been a mistake only to be informed that this was the cost under the deal it had negotiated. In my opinion, it was a pretty good deal. Are taxpayers being obliged to pay way over the odds for procedures carried out under the National Treatment Purchase Fund? It is not right that we are being denied access to some form of ballpark figures in respect of individual procedures and that an overall sum is being provided. Procedures relating to skin lesions, grommets and varicose veins cannot cost more than a few hundred euros. The cost of hernia operations must have increased dramatically, particularly when one considers that only 253 were carried out under the National Treatment Purchase Fund. I cannot understand why such common procedures cost so much. I really resent what is happening in this regard.
In addition to what I have just outlined, I understand that GPs are going to receive access to diagnostic services in private facilities. That is great but they should also receive access to such services at public facilities. If a GP refers a patient to a public hospital for an X-ray, there is no cost. GPs should have access to diagnostic facilities at public hospitals. Why is it not possible to extend the use of diagnostic equipment into the evening? Most patients requiring diagnostic procedures are ambulatory and would be well able to attend at a hospital after work. I cannot understand why patients are referred to private facilities but I presume the Department has done a very good deal in this regard. The cost of X-rays at these facilities varies from €54 to €112. At which end of the scale will the Department of Health and Children pay? This is very important and there is no reason that we should not be informed of such things. I resent it very much. The practice in the Department of Health and Children at present appears to be strongly towards the privatisation of the treatment of patients.
I refer the Minister to an editorial in the Canadian Medical Association Journal 2004 by Steffi Woolhandler and David Himmelstein from the department of medicine, Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts. One cannot get a better address. They discuss the privatisation of health care in the United States and what it has cost. They state that "investor-owned firms have come to dominate kidney dialysis". Where did we hear that previously? It was in Ireland, where patients now go to private facilities. They also dominate nursing home care. That is also the case in Ireland. As I told the Seanad a few nights ago, when I was in the casualty department of St. Vincent's Hospital there were several patients there who looked as if they had been brought there by private facilities because it was felt that they were near the end of their lives. They were, and they should have been left at home in bed. I checked on this later and discovered I was correct. The editorial also refers to inpatient psychiatric and rehabilitation facilities.
We could not choose a more expensive way. Health care in the United States costs 15% of GDP, and 8% of that is private. In Japan and Sweden, two countries which the highest longevity rates in the world, private health care accounts for 1.6% of GDP. I wonder if we are getting value for money in some instances. Why can we not get the figures? I am sure Senator Quinn would not adopt this type of attitude towards his suppliers, whereby they would send him supplies and ask for a blank cheque in return. Why should we have to do it? We simply want to be told what the prices are for hip operations, coronary bypasses, tonsillectomies and so forth. If it is commercially sensitive information, let the suppliers argue between themselves. They will know what the average is. Many of the private hospitals at present are enormously dependent on the National Treatment Purchase Fund for their survival. The Minister is aware of that.
I am glad we are increasing the number of doctors qualifying from our medical schools. It took 30 years to increase the numbers, but it is most important. However, there is a problem with intern places for people to complete their qualifications. We must supply them with intern places. There is already a serious shortage. When we were told they could no longer take up intern posts in England, I went over to argue with the Medical Council about it. Unfortunately, I discovered that we had banned English students from filling intern places here about 20 years ago. That finished my argument on that score. It is an important issue.
I am pleased more consultants will be appointed and I wish the Minister well in her negotiations on the consultants' contract. Given that 70% of consultants are public only at present, I am sure something can be worked out with the other 30%. I wish the co-located hospitals could be step-down facilities rather than acute hospitals side by side with acute hospitals. I express that wish as a patient, not as a doctor. All our high care equipment and expertise in acute areas, such as intensive care, should be located in a single area. The private investors could make far more from running a step-down facility. If I could find out who they are I would send them a note to that effect. They might then take it up with the Department. It would be better for them, better for us and better for the patient. Everybody must think ahead; we will want the best treatment possible from the health service. I wish the Minister well with the changes she is trying to make.
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