Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

The Health (Amendment) Bill is not the work of a reforming Government. It is retrograde because it seeks to abolish democratic accountability for the delivery of health services in this jurisdiction. It is incredible that such a proposition has been made separately from the health Bill. As I said, the proposition and the Bill should, at the very least, have been presented in tandem. Such an approach would have ensured the House and wider opinion would have been informed of exactly what was being proposed. We know there will be a health services executive and that four regional bodies will be established to deal with community care. However, there is no democratic accountability.

Such a lack of democratic accountability is best underscored by the Ceann Comhairle's decision to refuse to allow me to move amendment No. 3. I support amendments Nos. 1, 2 and 6 which address the issue of democratic scrutiny and accountability. The Ceann Comhairle has ruled that my amendment is out of order because it is outside the scope of the Bill. It sought to insert in page 3, between lines 36 and 37, the words, "With respect to each function conferred on the Minister by this Act he or she shall be answerable and accountable to the Dáil by means of Parliamentary Questions".

Surely such an amendment does not threaten in any way the equilibrium between the Minister and the Opposition spokespersons. Surely the suggestion is representative of best practice. I am concerned that, like Macbeth, the Minister will wash his hands of responsibility for many of the actions that will be taken by CEOs in the months ahead. It is incredible that the Ceann Comhairle's decision ostensibly means that any attempt to make the Minister accountable to the House for the functions conferred on him by this Bill, for example, by means of parliamentary questions, will be deemed to be outside the scope of the Bill.

We have a serious situation in the North Eastern Health Board which has a significant portfolio of property. The portfolio was built up by the generous contributions of ordinary citizens during the local authority's period of responsibility and jurisdiction over health care delivery in their areas. Before the health boards were established, we had an excellent general hospital while excellent psychiatric services were provided at St. Davnet's Hospital, significant parts of which are under-utilised or no longer utilised.

There are real concerns because there is no democratic accountability. Will CEOs decide to sell properties and redirect the moneys realised to investment in other areas? It may be the case that areas which have not worked hard, suffered and invested over years of penury will benefit. Great contributions were made in most cases at a time when domestic rates were charged and rates imposed on agricultural holdings. We had a better and more comprehensive health care service in such times.

We have been left with a depleted and deficient health care service because draconian steps have been taken by health boards at the behest of the Minister and the representative bodies of the various consultancy groups. A diminution of services at any hospital site diminishes us all, regardless of where one lives. One cannot say it is not happening in one's back garden. The Taoiseach was happy to say he was lucky to live in a community that had easy access to all of Dublin's excellent services. He may like to boast but I do not doubt that many in this city consider the range of services to be beyond their reach in many instances. I mentioned that the availability of health services can be divided into two tiers on a geographical basis but problems arise for most on the basis of their ability to pay. As wealth can buy health in this jurisdiction, suffering is the reality of their day's condition for the many who have to go without.

The Health (Amendment) Bill 2004 offers no solace to those who have struggled to ensure adequate health care provision is within easy reach. We are not talking about all-singing, all-dancing centres of excellence at every hospital but about basic services. All maternity and paediatric services have been removed from Monaghan General Hospital, a notice at the entrance to which advises visitors that they should note that no maternity and paediatric services are provided by the hospital. The reality is that a sign has been erected to turn people away at the gate.

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