Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 14 Feb 2013

Vol. 792 No. 3

Other Questions

Prescription Charges

Dessie Ellis


6. Deputy Dessie Ellis asked the Minister for Health if his attention has been drawn to the fact that there is a double charging of the prescription charge on medical card holders where the prescription item, as prescribed by the general practitioner, is not available in the milligram dosage prescribed, for example, 15mg of a given tablet available only in 10mg and 5mg, 7.5mg of a given tablet available only in 5mg and 2.5mg, that is each of the examples shown the patient concerned was charged €3 rather than the €1.50 per prescription item; if he will clarify the situation and instruct the pharmacy sector to charge only per item as prescribed; and if he will make a statement on the matter. [7454/13]

Due to the very difficult and challenging economic environment, the Government approved an increase in the prescription charge from 50 cent per item to €1.50 per item with effect from 1 January 2013, subject to a cap of €19.50 per month for each person or family, for prescribed drugs, medicines and appliances reimbursed under the general medical services, GMS, scheme.

Further details would be required before a definitive answer could be given as to whether the charge has been applied correctly in this case. In particular, the name and strength of the medicinal product concerned would be essential. If Deputy Ellis, or Deputy Ó Caoláin on his behalf, wishes to provide this information, I will arrange to have the matter investigated further.

I have already received a written response that did not ask for that detail. It is my question that was nominated by Deputy Ellis. I have seen the evidence that there is a double charging of the prescription charge on medical card holders where the prescription item, as prescribed by the general practitioner, is not available in the milligram dosage prescribed, for example, 15 mg of a given tablet available only in 10 mg and 5 mg, 7.5 mg of a given tablet available only in 5 mg and 2.5 mg. This was because the pharmacy was not in a position to provide the tablets as single items but as two. Instead of being charged €1.50, the card holder was charged €3 for the single item.

My question is straightforward. I do not believe that was what the Minister intended. I would have preferred if he did not do what he did in terms of increasing it. It should not have been introduced in the first place but it is in place now and we must deal with that reality. I am seeking clarification. If that was not what was intended, could we please indicate to the general pharmacy sector that this was not the charge that was expected to apply and there should only have been a charge of €1.50 rather than the double charge of €3. It is an important point. I call on the Minister of State, if he is in a position to do so, to indicate the intention and whether the Ministers will act on the instance I have given.

Let there be no misunderstanding. I have no difficulty understanding the point. The Deputy said it was simple. I understand entirely the issue being raised. However, I have said I need some more detail to get to the bottom of it and that is what I am asking the Deputy for. It may appear and sound straightforward in the way it is described but I need further information.

I understand the concern of the Deputy. However, nothing is ever completely straightforward in this world. For example, it can arise that a single prescribed item is required to be dispensed in different strengths or containers and it is therefore claimed as more than one item. A prescription charge will apply to each claimed strength of a product in such a circumstance. That may or may not be the type of circumstance that occurred in the case raised by the Deputy. Whereas on the face of it the question may sound straightforward such that we should give an immediate response, in fact we cannot simply give an immediate response. However, I am giving a clear undertaking to the Deputy that if the further information that I have reasonably sought can be produced, then I will certainly look at this issue.

I will take up the opportunity offered by the Minister of State. From a clear recall of the information provided to me that instanced the parliamentary question in the first instance, I can state that it was a single item of same strength and that it was anticipated to be available as a single item by the pharmacist filling the general practitioner's prescription. That it is not available as a single tablet in the milligrams prescribed is not the problem of either the doctor or the patient, but the patient presenting is being penalised on the double. That is my view but I will not labour it. I will provide the Minister of State with the specific information in the instance that has been brought to my attention. I urge that on accepting that it is simple and straightforward, there is a need for the position to be clarified and the pharmacy sector should be advised that the double charge in these particular cases is not permissible.

I thought the Minister was getting rid of those charges.

National Children's Hospital Status

Barry Cowen


7. Deputy Barry Cowen asked the Minister for Health the reason he has left 12 seats vacant on the board to develop the National Children's Hospital; and if he will make a statement on the matter. [7503/13]

The decision to locate the new children's hospital at the St. James's Hospital campus was announced on 6 November 2012. Co-location, and ultimately tri-location with a maternity hospital, on the St. James's campus will support the provision of excellence in clinical care that our children deserve.

Following the announcement of the Government decision, detailed consideration has been given to the project management structures and governance arrangements required to enable delivery of the project as quickly as possible and to the highest quality. In this regard I intend to restructure the national paediatric hospital development board and establish a children's hospital group which will include the three existing paediatric hospitals. The restructured national paediatric hospital development board will focus on the capital project only. The membership of the restructured board will align with this core function and include the necessary capital development expertise.

The required legislation will, inevitably, take some time and as the terms of office of the majority of board members expired on 5 December, I have appointed senior representatives from my Department and the HSE as an interim measure aimed at ensuring effective governance and decision-making for the project. At this important initial transitional stage it is crucial that the project continues without delay. The Government's priority is to ensure that the project proceeds securely to completion as quickly as possible and with optimal results. I am confident that the project management and governance structures now being put in place will enable the fastest possible delivery of this key infrastructure for children's hospital services.

I call on Deputy Kelleher to comment. If you keep to the question we can get both Deputies in on all questions.

I will keep to the question. Everyone welcomes that a decision was finally made on the location of the national children's hospital and that the site designated was at St. James's Hospital. We all remember the debates about the Mater hospital site, the allegations of political interference and all the associated nonsense that was propagated at the time.

The concern is that the Minister is now referring to establishing the national paediatric development board for the capital project and then streamlining with Dr. Jim Browne from Galway to bring the hospitals of Temple Street, Crumlin and Tallaght together. The key question is whether there will be a diminution of services in these three hospitals prior to the opening of the national paediatric hospital at the St. James's campus. This is an issue of key concern because we are unsure when the national children's hospital will be completed. Is there a timeframe, assuming everything goes according to plan and everything that flows from that? My concern, shared by many people working in the hospitals in Temple Street, Crumlin and Tallaght, is that there will be a diminution of services. They do not expect vast capital investment in these three places if they are to be wound down, but in the meantime children deserve the best quality treatment in reasonable surroundings. This is something about which people working at the coalface are concerned.

I am pleased that Deputy Kelleher has referred to Dr. Jim Browne. I believe he will make an excellent chair of the new children's hospital group. One problem has been the need to separate some of the functions of the previous board to get the required result. I assure the Deputy and all those concerned with delivering care to children in this country that there is no intention on our part to have any diminution of care.

As the Deputy rightly pointed out it would be rather foolish to spend large sums of money on capital development at any of the three hospitals concerned, but that does not mean that the care of children there will change, save to say that it will continue to improve and as new developments and techniques become available, we expect that they will become available at the current centres. Certainly, it is our intention to encourage the new children's hospital group to act as a unit. We want to pre-empt some of the difficulties that occurred in the past such as those we have seen on the boards of other hospitals that have come together. We want people to leave behind their old hats and remember that this is a national paediatric hospital. It is not three Dublin paediatric hospitals coming together but a national paediatric hospital and it is appropriate that the chair should come from outside Dublin, and this is the case.

Following in the same vein, does the Minister not understand and accept that there is mighty concern given the fact that the budgetary allocation for Our Lady's Children's Hospital, Crumlin and the Children's University Hospital, Temple Street have been cut significantly in the current year while other hospitals have secured deserved increases? This has occurred against the backdrop of coalface service providers in both hospital sites indicating that they have insufficient resources to maintain and sustain current levels of care provision. It is not about capital allocation but current need. The fact that both of these budgets have been cut is sending out a negative signal.

In a reply to a previous parliamentary question in December on board membership, we identified 64 vacant positions on boards under the Minister's specific aegis. What is the current situation in all of the various bodies? I understand that as of today, there are still four vacancies on the HIQA board. This is incredible after all this time and despite all the attention paid to the large number of vacancies across a plethora of boards that come under the Department's remit.

Deputy Ó Caoláin referred to the cuts to the budgets of the children's hospitals. Let us consider the budgets for all hospitals.

The Minister announced with great fanfare that they had been increased but when one factors in the budget deficits and overdraft facilities, very few hospitals received an increase for 2013.

With regard to the amalgamation of the three children's hospitals, there appears to be a view that we should start shrinking the budgets and extracting greater efficiencies while driving towards the national children's hospitals. In the meantime, however, children are being treated in three different hospitals and they deserve the best financial support we can provide. I hope there is no reluctance to embrace advances in medical technology and pediatric care because facilities may have to be moved to the national children's hospital at a later stage. These matters should not be long-fingered or delayed.

There will be no such effort on our part to reduce the care available to children. I am acutely aware from my involvement in medicine that the window of opportunity for best outcomes for children is often quite short and that several procedures may be required over a period of time. Nothing of that nature will be allowed to happen.

In regard to budgets, had we kept to the normal way of doing business every hospital in the country would have required a 3% budgetary decrease. We gave hospitals a reasonable chance of success because many of the budgets in the past were unrealistic and unattainable. The idea that even though a hospital may have been over budget during the previous year it would face a further 3% cut in the current year was not sensible. We moved on to outcomes.

The common governance structure that will apply to the three children's hospitals during the transition will allow them to act as one in procurement and staffing. This will be hugely beneficial in terms of savings. There are fewer staff and less money in the system. Without trying to make political points, Deputy Kelleher and I know that is the case because of the mess his Government left for the country. We want to focus on patient outcomes not on inputs such as how many doctors, nurses or billions of euro are in the system. We want to achieve better outcomes for patients in terms of how many are treated and how long they have to wait. We have improved the number of people who have to endure trolley waits by 24%. Where children are concerned, the improvement in the number who wait 20 weeks or longer is 98%.

The trolleys are being hidden.

As an elderly lady once said to me, the truth is not fragile and it will not break. The truth is that there have been significant improvements in the number of people who endure trolley waits or have to wait longer than nine months or wait longer than 12 weeks for endoscopies.

The Minister is not addressing the issues raised.

All of these areas have seen improvements of between 95% and 99%. That is something Fianna Fáil failed to do over 14 years when it had buckets of money. We have done it in two years. I thank the excellent men and women who work in our health service for the changes they have embraced. This is something they have yearned to do for years.

When will the Minister fill the vacancies on the boards?

Health Services Staff Remuneration

Seán Fleming


8. Deputy Sean Fleming asked the Minister for Health the latest situation with regard to consultants' pay; and if he will make a statement on the matter. [7505/13]

Consultants play a central role in the delivery of our health services. They are committed to the provision of the best quality care to those who use these services. I welcome the leadership and co-operation shown by consultants in the development and implementation of new models of care through the HSE’s national clinical programmes. Two of these programmes were mentioned by Mr. Dan Barrick, who is one of President Obama's health advisers, in a keynote speech given in Oregon several months ago. Our stroke care programme saves one life per week and pre-empts the necessity for three people to go into long-term care.

My priority has been to achieve effective implementation of the existing consultant contracts so that patients get faster access to services and that better patient outcomes are achieved. In September 2012, following intensive engagement between health service management and the consultant representative bodies at the Labour Relations Commission, a comprehensive set of measures was agreed. The agreement encompasses a range of flexibilities to enhance productivity and efficiency and to maximise the availability of consultants, as key clinical decision-makers. The Labour Court issued its recommendations regarding a number of further issues on 6 November 2012. Two of these relate directly to consultants pay, historic rest day arrangements and the fee for the provision of a second opinion as required under the Mental Health Act 2001. Health service management is now engaged in implementation of the measures covered by the LRC and Labour Court processes. I look forward to all consultants embracing the changes agreed at the LRC and accepting the terms of the Labour Court recommendations in the interest of providing the most appropriate and cost-effective services to patients.

In September 2012 I announced that in future consultants would be appointed at a significantly reduced rate, involving a 30% reduction in the salary previously set for new entrants. The first point of the revised pay scale for type A consultants is now €116,207 compared with €166,010 previously, and for type B consultants is €109,381 compared with €156, 258. I appreciate this is a substantial reduction in the rate payable. However, it is a necessary measure if we are to continue to renew and develop the workforce and to provide consultant level career opportunities for doctors.

I am sure the Minister has read the programme for Government even if he has not acted to implement it. The programme clearly and unequivocally states that the pay of hospital consultants will be reduced. There were negotiations and flexing of muscles but, in the meantime the Labour Relations Commission and the Labour Court dealt with two issues. What is the position on the agreement that the Minister indicated would be implemented by early October? Are all the consultants abiding by the agreement? Have they embraced the new practices as outlined by the LRC and the Labour Court or are the negotiations ongoing? Are all consultants buying into this and what will be done to those who do not abide by the LRC and Labour Court decisions that the Minister welcomed with open arms? They have not exactly embraced the agreement. It is not news to us that consultants are a critical component of the health service but some sort of sanction is required if they do not embrace the new work practices.

Is the €500 payment for second opinions to consultant psychiatrists still in place? It is scandalous if it is still payable to consultants who are already generously paid. What is the position on the payment, what was the Labour Court's recommendation and what has happened since then?

I will first deal with Deputy Ó Caoláin's question. I have already pointed out that it was a matter to be ruled on by the Labour Court and that we do not believe the practice to be sustainable or justifiable.

The majority of consultants are compliant to the best of my knowledge. I am not aware of instances where they are not compliant. I am reluctant to use the word "always" nor am I confident to use the word "never". I would like to be made aware of any instances of non-compliance and I will ask the HSE to take action to ensure the agreement is enforced. The negotiations are over on this matter.

One of the areas I have not mentioned is the power of the new clinical director, which is particularly important. In the past the clinical director did not have powers to enforce or dictate policy.

Now they are appointed and have the power to direct their colleagues as to when they must be available, when they can take their holidays and when they should be on duty. This is a very important part of reorganising the service to ensure it is done on the basis of what suits patients best, rather than what might suit individual providers of care within the system.

The Minister said he would start off by answering the previous Deputy's question, but he did not. He just alluded to it. My question is straightforward. Is the second opinion payment still in place? What was the Labour Court recommendation? Has it been implemented and if not, when will it be implemented? If the Minister does not know the answer, that is okay. I will not scold him over that. He can send me the information when he has had the chance to check it.

In the context of the national clinical care programmes, we all agree consultants are an integral part of the delivery of health care. I do not know of a specific case, but the Minister said there were continuing negotiations regarding the implementation of the Labour Court and LRC recommendations. Generally, is the Minister confident there has been a positive buy-in by consultants with regard to the changes for the clinical care programmes and other work practices?

I will provide Deputy Ó Caoláin with a more complete response when I have had a chance to check the exact status of things. With regard to Deputy Kelleher's point, there are no ongoing negotiations. The negotiations are over. The LRC negotiations have finished.

Are there not negotiations with the HSE on the implementation of the recommendations?

No, there is no negotiation. The implementation of the arrangements will be done through the clinical directors. It is important to point out that the bulk of consultants had been doing this sort of work pro bono, and I thank them for that. They have done an extraordinary job in terms of embracing the new changes. In 2011, they have, through the clinical programmes and coming in at weekends to discharge patients and read diagnostic reports, such as MRIs, X-rays etc., saved €63 million and 70,000 bed days. Last year, they saved €90 million and 100,000 bed days. Therefore, the savings are being made in a real way. I cannot run a service on a pro bono basis and that is the reason the LRC talks were so important so that this issue could be nailed down as a contractual obligation, which it now is. We are getting co-operation on it and I have not heard of any areas where we are having difficulty. If I do hear of such areas, I will, through the good offices of my Department, encourage the HSE to ensure the arrangements are enforced. It is important to remember that this should be about patients and patient outcomes and we are all focused on that now.

Again, I reiterate my thanks to the new leadership emerging through the clinical programmes, the nursing profession, the medical profession and allied care professionals in regard to working in a different way. I would not dream of insulting people in the health service by saying they must work harder or smarter. They already work very hard and that has never been the issue. The issue has been a system which was allowed to evolve in a chaotic fashion that frustrated and prevented them from delivering the care they wished to provide.

HSE Savings

Sandra McLellan


9. Deputy Sandra McLellan asked the Minister for Health if he will detail where the €15 million in savings in probity on local schemes, as outlined in the Health Service Executive National Service Plan 2013, will be applied; and if he will make a statement on the matter. [7467/13]

Sandra McLellan


72. Deputy Sandra McLellan asked the Minister for Health if he will detail where the €15 million in savings in community schemes, as outlined in the Health Service Executive National Service Plan 2013, will be applied; and if he will make a statement on the matter. [7466/13]

I propose to take Questions Nos. 9 and 72 together.

The service plan for the HSE includes two amounts of €15 million to be saved during the course of 2013. Further details of these amounts will be included in regional business plans which are close to finalisation.

The €15 million related to probity is a savings target related to the purchase and use of goods in local integrated service areas, which are referred to within the HSE as "local schemes". The second target relates to a specific procurement initiative intended to deliver €15 million of value to the HSE during the course of 2013. This initiative is still under deliberation and is commercially sensitive and, as such, it is not possible to provide further details at this time.

In reply to a written question from me on this matter on 17 January, the Minister of State said the details of the €15 million savings would be included in what he referred to as "regional business plans" anticipated at the end of January. I am not aware such plans have been issued. I must ask, because there is no end of terminology within the health sector, whether regional business plans are the same as or a part of HSE regional service plans? Are they different from or distinct from these? I have no knowledge of regional business plans, but am familiar with HSE regional service plans. Will the Minister of State clarify this for me? When will the regional service plans be published? If there are also regional business plans, what are they and when will they be published. What are we actually talking about when we talk about the savings to be made across these plans?

With regard to the regional business plans, quite clearly what is intended is that the HSE service plan which has been published requires a working out at regional level and obviously that work is still ongoing. It was not done by the end of January, but its completion is imminent and will be dealt with in due course. I accept it is two weeks since the end of January, but I am sure the issues will be resolved and dealt with in early course. I have some sympathy with the Deputy with regard to the nomenclature and different types of plans. It is important to know the work is done in an efficient manner. I am aware it is close to completion and people are working carefully on it.

With regard to the final issue the Deputy touched on, it would not be appropriate to give too much detail on some proposals. However, the sums it is proposed on local schemes will be achieved by ensuring the process for managing the schemes is more streamlined and undertaken in a consistent and standardised way across the country. This means the focus will be on providing appropriate services and commodities. It is intended that this budget reduction will have no impact on patient services.

I welcome that. However, to ensure I do not go away more confused than when I came in, will the Minister of State clarify the situation with regard to regional business plans as opposed to regional service plans so as to discover whether I have been missing something all these years?

We will do that.

Health Services Reform

Michael Creed


10. Deputy Michael Creed asked the Minister for Health if he will outline the progress made to date regarding the policy objective of universal health insurance; if he will further outline the remaining steps to be taken before this policy objective can be met; and if he will make a statement on the matter. [7484/13]

Nicky McFadden


344. Deputy Nicky McFadden asked the Minister for Health the progress being made towards the eventual introduction of universal health insurance and the elimination of the current two tier system; and if he will make a statement on the matter. [7964/13]

I propose to take Questions Nos. 10 and 344 together.

The Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single tier health service, supported by universal health insurance, UHI, where access is based on need, not on income.

The Department, in consultation with the UHI implementation group, has identified the key building blocks for UHI and arranged them into broad workstreams as follows: primary care reform, hospital structures, hospital financing, regulation of health care providers, health insurance market and overarching UHI design.

Work is progressing under all of these work streams, some examples of which include the drafting of legislation to extend access to GP services without fees to people with prescribed illnesses, the work of the strategic board on the establishment of hospital groups, the significant progress made by the special delivery unit in reducing waiting times for scheduled and unscheduled care, the development of a "money follows the patient" policy, which is due to be published shortly, the development of national health care standards, ongoing work in relation to supporting licensing legislation, and the enactment of the Health Insurance (Amendment) Act 2012 to provide for a new scheme of risk equalisation for the private health insurance market from 1 January 2013. By bringing that clarity to the system, we have allowed a further agent into the market. The reform programme is a major undertaking that requires careful planning and sequencing over a number of years. Full implementation of universal health insurance will take some time to achieve. It is anticipated that the necessary groundwork to enable us to phase in the implementation of universal health insurance, as promised in the programme for Government, will be in place by 2016.

Additional information not given on the floor of the House

The Department is preparing a White Paper on universal health insurance, which will provide further detail on the universal health insurance model for Ireland in addition to the estimated costs and financing mechanisms associated with its introduction. This complex and technical work demands a wide range of specialised legal and financial expertise which the Department is in the process of engaging. The White Paper will be published as early as possible in the Government’s term of office. In advance of the White Paper, my Department has produced a preliminary paper on universal health insurance, which I intend to publish shortly. This will provide a more detailed progress report on work in relation to universal health insurance.

We have been over this ground before. We are waiting for the publication of the White Paper on universal health insurance. The Minister is nearly two years into his tenure as Minister for Health. Before the 2011 election, he spoke about the model he intended to use as a basic building block when funding universal health insurance. That was the Dutch model, as he outlined on numerous occasions. Two years down the road, we are still awaiting the publication of the White Paper. I assume it will be followed by a process of consultation. We are no nearer than we were two years ago, when the Minister was parading the Dutch system around the country, to finding out what exact type of universal health insurance scheme will be used as the foundation of the funding of our health services in the future. There should be a sense of urgency about it at this stage. We are making decisions on primary care, etc., in hospital trusts, groupings and small hospital frameworks, but the fundamental principle of how the health service is to be funded has yet to be made available to us. I ask the Minister to unveil the Dutch model or whatever other model is to be used. We want to know how the health services are to be funded.

We have come back to the White Paper, which would at least be a starting point for a focused discussion on all of this. When will the White Paper on financing universal health insurance be presented? It had been indicated that it would be published in the early part of the Government's first term. When I asked the Minister how long he thought that term would last, he said the plan was to serve for a full five years. That is my recollection of the Minister's answer. The first part of that term has certainly gone by now, but we seem to be none the wiser. Universal health insurance has always been lauded by the Minister and others as a cornerstone of the Government's health policy. Does he accept that when Fine Gael and the Labour Party adopted the universal health care model, the economy was not far from the high point of the Celtic tiger years, when unprecedented numbers of people were taking out private health insurance? We all recognise that the pendulum has swung the other way. Deputy Kelleher mentioned this to the Minister on an earlier Priority Question. As more and more people move away from private health insurance because they cannot afford it, is a fundamental rethink of the Minister's approach not required? Would it not be better for us to debate health funding rather than proceeding with a model that appears to be based on competing private insurance companies? The Minister's former ministerial colleague, Deputy Shortall, has been hugely critical of the competing private insurance model, as distinct from a State insurance scheme, which we would be interested to hear more about if the Minister is willing to discuss it.

It is important to point out that we have to fix the immediate problems in the service for those who have to use it on a day-to-day basis. That is something we are doing. I mentioned earlier that I am focused on outcomes for patients, as opposed to inputs. To that end, I would like to point out again that there were 20,352 fewer patients on trolleys in 2012 than in 2011. That represents a reduction of almost 24%.

By the end of December 2012, the number of adults-----

The Minister is climbing the trolleys.

Sorry; I did not interrupt the Deputy. Every time I want to read facts into the record, he seeks to interrupt.

I do not. That is unfair.

I am going to stay here until I have read them.

I do not seek to interrupt. We have been here for an hour and a quarter.

By the end of December 2012, the number of-----

I do not seek to interrupt on a regular basis.

-----adults having to wait more than nine months for inpatient and day-case surgery was down to 86 from a total of 3,706 in December 2011. This represents a decrease of 98%.

What about the universal insurance model?

The number of children waiting more than 20 weeks for inpatient or day-case surgery was down to 89 from 1,759 in December 2011.

Did anybody over there hear the questions we asked?

This marks a 95% decrease.

The Minister is filibustering now.

He should be speaking about universal health insurance.

The number of patients waiting more than 13 weeks for routine endoscopy decreased by 99% from 4,590.

The Minister of State, Deputy Alex White, can only be embarrassed by this.

Far from it. The reality is that the Deputies continually allude to a single system. I made two things very clear when I was in opposition, and we have made them very clear since we came into government. The first thing, which relates to Deputy Ó Caoláin's question, is that the programme for Government makes it clear that there will be multiple insurers in a competing market. The alternative argument is over.

The Labour Party lost.

Regardless of who may have continued to raise the argument, it is not Government policy.

It is in the programme for Government.

The Labour Party is very much a part of this. It is as much a part of it as Fine Gael is. Its members have been absolutely supportive of it.

That is not the case. They have lost their way.

The second issue to raise is that-----

Deputy Ó Caoláin should read the programme for Government, if he can understand it.

That is the element of the Dutch system which we sought to emulate.

I can pass him a copy of it. He should ask Deputy Shortall about it.

We looked to the Danish system when establishing a patient safety authority. Advances have been made there and in Canada. We looked to the UK in the case of the trust model for hospitals. We first saw the special delivery unit system in operation in Northern Ireland. Far from being based on the Dutch system, our approach is based on several systems. I always said we would take the best element of each system that fits the Irish situation. We are continuing to do that. The funding of the model is quite simple. We are going to raise the funds through the existing insurance premiums and through general taxation. That is how the system operates now. There is no particular mystery to that.

Why pay for it, so?

I must bring Question Time to an end. I wish Members a happy Valentine's evening, for what is left of it at this stage.

Written Answers follow Adjournment.
The Dáil adjourned at 9.20 p.m. until 2 p.m. on Tuesday, 19 February 2013.