Thursday, 8 November 2012

Ceisteanna (7)

Pearse Doherty


7. Deputy Pearse Doherty asked the Minister for Health further to Parliamentary Question No. 225 of 19 September 2012, if he will provide a detailed breakdown, with itemised costs, of the services obtained from Goodbody Stockbrokers for the €333,413 paid by his Department to the company in 2011 and 2012; and if he will make a statement on the matter. [48975/12]

Amharc ar fhreagra

Freagraí ó Béal (9 píosaí cainte) (Ceist ar Health)

In my response to Question No. 226 of 4 October 2012, I outlined how, in 2011 following an EU-wide competitive tendering process, I appointed Goodbody Stockbrokers and Matheson Ormsby Prentice Solicitors, MOPS, as financial and legal advisers to make recommendations on options to address the current imbalance in the private health insurance market. The work undertaken under this contract included the preparation of a report on options for the rebalancing of the private health insurance market and the examination of options for obtaining a more even balance of customers across the market. The request for tenders indicated that matters to be considered included the advantages and disadvantages of ensuring a better spread of risk among health insurers; the structure of the market and how market share and risk were distributed; the position of existing insurers in the market; any possible incentive or barrier to entry into the market by other insurers; any impact of the introduction of a new risk equalisation scheme and revised minimum benefit regulations; and, if recommended in the report as feasible or desirable, how rebalancing might best be achieved.

In accordance with EU public procurement rules, the tender submitted by the Goodbody Stockbrokers-MOPS consortium was chosen as the most economically advantageous proposal arising from the competitive process. The procurement process was conducted in a fair and reasonable manner and each step of the process was overseen by an evaluation committee. The terms of the request for tenders issued for the competitive process required each tendering party to provide a total fixed price inclusive of VAT and all expenses for all the services it proposed to provide. A more detailed breakdown of the costs of the work undertaken by the consortium would consist of commercially sensitive information which I do not consider it appropriate to release.

Many issues affecting the private health insurance market must be addressed in order that it can be stabilised and readied for the transition to a system of universal health insurance, UHI, in the coming years. The consortium has presented a report to me that I am considering in the context of the future structure of the private health insurance market as we prepare for the introduction of UHI.

It is unacceptable that a Department can spend in excess of €250,000 and not give a full account of it to the Houses of the Oireachtas. This was for a report presented to the Minister. I wonder how many pages were in it. If there were 300 pages, it is something else to get €1,000 per page. It is great work if one can get it.

I am of the mind that there is adequate competency within the Departments of Health, Finance and Public Expenditure and Reform to undertake the work allocated to Goodbody Stockbrokers in this instance. I would regard it as almost indicative of a lack of trust in the competence of the Civil Service, the public servants of which are there to carry out that type of work in the ordinary course of events. The blanket excuse of secrecy about commercial sensitivities to hide the full facts of whatever is involved is not acceptable at any time, but particularly in these times when we are discussing quite considerable sums of money. I urge the Minister to set aside this gag, which is what it is, and allow the full facts to be shared and open to full public scrutiny.

Let there be no mistake about it. The reply that I received to the original question showed that the Department paid more than €967,000 to private consultancy firms in 2011. The figure up to September of this year had already reached €897,000. What will it be by the end of the year? We are heading towards the €1 million figure. These are major sums of money at a time when people are suffering because of other decisions the Minister is taking.

The Government is undertaking the most extensive reform of the health service since the foundation of the State, particularly in the context of new hospital groups, the small hospital framework and the methodology with which we remunerate hospitals and give them their budgets, that is, moving from a block budget where everything stops once the money is gone. That system further encourages the retention of people in beds when their acute phase of treatment is over. It does not incentivise hospitals to move them on. We want to change it to a money follows the patient system. Even within the insurance market, current arrangements see public and private hospitals charge per day. I want that changed to a money follows the patient system in terms of paying per procedure. Those hospitals that admit patients on the day of their procedures, look after them efficiently and reduce readmissions and the average length of stay will all benefit.

The company in question won the tender, but I insisted that the Department renegotiate the price downwards. That was done. The information is invaluable to us in planning a complete sea change in terms of moving towards UHI. We all acknowledge and accept that, while there is vast experience in the Department and the HSE, we do not have the full range of expertise that we always need. For example, there is a lack of suitably trained individuals within the HSE in the context of financial reporting. This matter was highlighted by Mr. Mark Ogden in his report and confirmed by PA Consulting Group. The latter has made certain recommendations. I hope those reports will be released shortly in order that it can be seen that we have taken action to correct what has been a glaring deficit since the HSE's inception.

I find the Minister's response incredible. In the same breath he discussed reform and stated that, when the money was gone, everything would stop. That is not good enough. It is not a case of closing down. People have needs. None of us can forecast or plan absolutely for whatever life's cards will deal. The money follows the patient notion is a fallacy. Patients are chasing ever-reducing services and ever more difficult access to same. That is the reality.

The Minister's reply was absolutely unacceptable. Ostensibly this is one of the major so-called reforms the Minister is planning in terms of universal health insurance but the detail is not being shared. Public moneys are being offered to these private consultancy groups but the figures are not reducing. It is time to say that the competency is within the service to carry out this work at no additional cost. That is what we should be reliant on in the first place.

What can I say to the Deputy? He is forever saying that things are outrageous, scandalous and unacceptable and that this and that are a fantasy. I have to put it to him that his own health policies are utterly phantasmagorical because they do not amount to anything other than aspiration-----

The Minister has never bothered to read them.

I did not interrupt the Deputy and I would appreciate it if he would show me the same courtesy.

The bottom line is that money following the patient was implemented last year on a limited and phased basis in our orthopaedic system and it saved us €6 million. That money will be considerably improved on and enhanced as we spread that out across the system.

I am absolutely sure the money spent on consultancies is considerably less since I came into office than heretofore. Without being overly political, a previous Minister spent many millions of euro on consultancies and reports, many of which sat on a shelf thereafter. The reports I have commissioned are being put to good use and are being acted on. As I said earlier, we hope to produce some of them in the next couple of weeks and the Deputy will see the benefit and the actions they have led to.

It is not true that patients have to chase ever-reducing resources. We are improving efficiency in our health service and, as I said earlier, making sure we do not just focus on inputs all the time, which seems to be the Deputy's focus, but rather on outcomes for patients. The Deputy might not like to hear it, as he was the very man who shroud-waved to the best of his ability last January and February as we came to the retirement of 6,000 people from the service - not only did we maintain a safe service, but we improved it.

We have reduced the number of people who must wait a year or longer for an inpatient treatment by 85%, the number who must wait nine months or longer by 91% and the number who must wait three months or longer by 18%. The Deputy can shake his head all he likes but the reality-----

The reality is very different.

-----is the reality. As an elderly lady said to me many years ago, the truth is not fragile, it will not break.

Real progress is being made. The Deputy chooses to join with others and talk of nothing but doom and gloom and say nothing will change except in some wonderful aspirational fantasy land Sinn Féin will create in health without regard to where the money will come from or to how we will reduce the cost of delivering the service in this country. We are improving things for patients. I would be the first person to say we need to do more and that there is much more to be done. I continue to commit myself to that.

I would like to take this opportunity to thank the men and women who work in our health service for the fantastic job they have done, despite a diminishing budget and despite having fewer people.

Written Answers follow Adjournment.
The Dáil adjourned at 5.45 p.m. until 10.30 a.m. on Friday, 9 November 2012.