John Crown (Independent) | Oireachtas source

I apologise for not being here for the earlier presentation. I will also try to be brief.

We clearly need better advocacy services. I am very supportive of it. I am a supporter of transparency and openness in all areas of the public service, from Government down to doctors and hospitals. There should be an automatic right of access to all records which does not have to go through any kind of freedom of information process. Everything should be available to patients. I operate an open records policy for any of my patients who wish to see any aspect of my records. It is the correct thing to do.

I would not want anything I am saying to be misconstrued as being a lack of enthusiasm for an advocacy service. I quote "Titanic" so often that James Cameron may well ask his lawyers to send a letter to me. As RMS Titanicwas slipping between the waves and the 700 passengers there were in excess of the number of lifeboat places were drowning and freezing to death, what they did not need as a priority was an advocacy service. What they needed was somebody to have provided enough lifeboats on the ship in the first place. In a perfect health system, if we ever were to achieve that philosophical nirvana of health perfection, there would be no complaints and there would be no need for advocacy or a complaints service, but we always will have complaints and as a result, we should have this service. However, we should not lose sight of the fact the advocacy service must also advocate for reform of the service. It should not be seen as retail exclusively. It should also be wholesale. It needs to look at the service.

The episode of obstetrical problems in the midlands over the past year or two, of which we are all aware and I do not want to personalise this to a particular tragedy, provided some of the impetus for a renewed focus on the need for advocacy services and reform, but what has to be remembered is that the staffing structure in that unit was bizarre. There is no other country in the OECD or the western world that would have allowed a system to develop that would have been staffed by such a tiny number of consultant obstetricians. There is no other system in the world that would look like the Irish system which has a tiny number. With the possible exception of the NHS which is the second worst, the health service has a tiny number of specialists per head of population compared with any system in the OECD. If one also looks at the incredible disproportionate reliance on good, diligent locum doctors, many of whom were trained abroad and brought their services here, because of the nature of their employment and because of the rapid rotation of locums because we do not have enough consultant positions to provide the critical mass to cover maternity leave, illness leave or holidays, we often have colossal deficiencies in the system which are also plugged by the honest efforts of inappropriately responsible junior doctors. These are the problems. We will need a good advocacy service because it will be really busy.

By all means, one should keep it up but one should not lose sight of the big picture. There is a group about whom the complaints need to be made - Deputy Varadkar, Deputy Reilly, Ms Mary Coughlan, Ms Mary Harney, Deputy Martin, Mr. Brian Cowen, Deputy Howlin, Dr. Rory O'Hanlon, Mr. Barry Desmond and others right to the beginning of the State - because these are the ones who occupied the position of Minister for Health and who, despite repeated warnings, were aware of the extraordinary nature of the public health system, in particular, the public hospital system.

I was elected to the Seanad four years ago with a little idealism and perhaps the tail end of middle-aged youth, thinking we could do something for reform of the health system. We had a new Government which promised reform and which has now welshed and has told us we are not going to have it. For the record, I am despondent. I do not believe the health system is going to get fixed in my lifetime but the witnesses should by all means try to continue to be a powerful force for advocacy, reform and change in it.