Denis Naughten (Longford-Roscommon, Fine Gael)

They took difficult decisions and it galls me to hear references to the vested interests of councillors. I served on the Western Health Board for six years and the only vested interests I ever saw were those of the professional representatives who were only interested in their own angles and what suited them and their own members, rather than the public. If we want reform, we should look at where are the weaknesses within the health service.

The legislation before us will allow health board CEOs to do whatever they want, without being questioned. There will be no scrutiny or accountability concerning any decisions they may take. When I was a member of the Western Health Board, a specific decision was taken concerning St. Brigid's Hospital in Ballinasloe that the lands to be disposed of were to be ring-fenced for psychiatric services in east Galway. Of course, that decision has now gone by the wayside due to the legislation before us. Under the terms of the Bill, the chief executive officer can do whatever she wants to, with the Minister's rubber stamp. I am sure the Minister is not going to upset any CEOs around the country.

The legislation will not provide the type of accountability that is required. Even when democratic decisions have been taken by health boards, CEOs can overturn them, with the approval of the Minister, if they do not like them. The Minister will be given advice and will sign the relevant order without examining the details of specific proposals. The Minister will not be privy to specific details that may already have been agreed. It is disappointing that the legislation does not address that matter.

The issue that kept arising at the Western Health Board was that of value for money. The VFM principle, as it was known, was repeated ad nauseam. The only way one can have such value for money, however, is to provide for some element of accountability for chief executives and the executive health agencies that are to be established, yet that is not the case under the Bill.

The Department of Health and Children has spent €7 million constructing a new accident and emergency unit at the county hospital in Roscommon, yet we cannot get staff to run it. To all intents and purposes, the accident and emergency unit will be closed from July because the Government did not think it was worth its while to open it, even though Ministers are eager to open facilities around the country before the elections on 11 June.

Under the terms of the legislation, there will be no way of providing answers to questions about why that money was spent on the Roscommon accident and emergency unit and why staff were not provided for the facility. As we have seen in the past, many decisions to curtail services are taken during the months of July, August and September. As it happens, the House will not be sitting during the summer so no parliamentary questions — whatever use they might be — can be raised about the curtailment of health services at that time. When the House resumes in October, many of those decisions will have been taken. Parliamentary questions are critically important, even though Opposition Members often receive replies saying that a Minister has no official responsibility to the House for a certain matter. We will receive plenty of those responses concerning the health services because the Minister will have no official responsibility to the House and can wash his hands of the issue. There will be no accountability, although the amendment could provide for it.

We are being asked to take a leap of faith and trust the Government parties. With all due respect, however, how could the Minister of State ask anyone to trust a Government that misled the people two years ago with its manifesto and the programme for Government? Once it got into office it immediately overturned those decisions so that, in the intervening period, the opposite has happened. The Minister of State knows as well as anybody that the decisions that count as regards how the health service will proceed in future will be taken in the next seven months before that new legislation is in place.

The national treatment purchase fund, to which Deputy Gormley referred, is in a crazy situation. For example, University College Hospital in Galway, where there is bed capacity, can carry out procedures on patients from counties Offaly, Westmeath and Longford but cannot do so for patients from counties Galway, Roscommon or Mayo, patients for whom the hospital is supposed to cater. This is because the fund prioritises people on the length of time they are on the waiting list rather than the location, even though there is spare capacity. The difficulty is that resources are not being made available to take in patients. Nurses and beds are available but the hospitals cannot afford to fill the beds except through the use of the fund, whereby patients are taken in from outside the catchment area. It will not be possible to address this situation because of the lack of accountability provided for in the Bill. It is a disgrace that there will be no accountability in regard to the most fundamental service the State provides to the country, namely, the health service.

This is the one issue about which every member of the public is concerned and yet we will get no answers about it because the public has no voice. Instead complaints procedures will be put in place. However, the reality is that appeals and complaints, whether in the sphere of social welfare or to the Ombudsman, in some cases take years to be processed. What should people do in the meantime? Should they remain on the waiting list in the hope that some day they may be called due to an error on a list thereby causing them to be accidentally called for a procedure? The difficult reality is that people slip through the loops in the health services. For example, last week I came across the case of a child who has been waiting for seven years for orthodontic treatment. The child has fallen though the loop, but once this legislation is enacted, accountability and answers to issues arising in similar cases will not be provided.

The crazy thing about this legislation is that it will contradict Government policy and there will be no mechanism to question it. The Hanly implementation Bill provides for the regionalisation of emergency acute services. The national spatial strategy prioritises Athlone as a hub and a new growth centre but it will have no hospital in its catchment area. Portiuncula Hospital in Ballinasloe will be gone, as will the county hospital in Roscommon and Mullingar General Hospital. Can the Minister of State tell me of any employer from outside this jurisdiction who will invest money in a town which has no accident and emergency or maternity services nearby? It is crazy — vast areas of the country will be without medical services and there will be no chance of new investment in those communities because basic services, such as health services, are not being made available. That is the reality of what is proposed in the legislation.

The amendment provides for accountability and it will be voted down by the Government for that very reason — it is against the principle of the Bill. That is the real scandal. I am not approaching this from a political point of view. Supporters of the Government or other parties in this House believe there must be accountability and a mechanism through which people are answerable. There must be some kind of scrutiny. Proposals will be shoved through by CEOs in the coming months. For example, issues like the non-appointment of a third consultant physician at the county hospital in Roscommon, which will see the end of the 24 hour service there from 1 July, or the fact that there are not even pillows for patients in the hospital, will not be raised and there will be no forum or mechanism to do so once this legislation is enacted.

Furthermore, we have no guarantees as to how long this legislation will be in place. We are told it will be in place until 1 January next but many other Bills which have come before the House have been promised on numerous occasions and then continually long-fingered. In many cases, it has taken years for Bills to come before the House. In the meantime, the CEOs can do what they like and the Minister will rubber-stamp their decisions. The Bill proposes this crazy situation which we are being asked to accept.

I ask the Minister of State to accept the amendment to ensure that the people have a say, can get answers and that the new so-called reform proposals will not be forced on the public. People should not be forced to accept the closure of their accident and emergency units, the downgrading of their local services and the regionalisation of those services without some explanation or element of accountability. None of that is provided for because the Hanly implementation Bill will allow for the closure of smaller accident and emergency departments. All this is contrary to what is happening in the United Kingdom at present. We are following its example of ten years ago, when it closed smaller accident and emergency facilities. However, the UK authorities have now found that the efficiencies and quality of service they had in the health service have been lost. They are now trying to row back to where we are now but we are going in the opposite direction and no one will be answerable or accountable once this legislation is enacted.

When the Government Deputies vote this Bill through, they will be voting through the Hanly report and endorsing it as Government policy.

See this speech in context