Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I welcome the Minister and the officials to the meeting. Before making my remarks I wish to thank the Chairman, the secretariat, witnesses, the Trinity College team and committee members because we did good work. We put great effort into the report and that is fairly obvious on reading it. There are those of us who would have liked to see the report go further in some areas but in the interests of consensus everybody was capable of coming together and making the necessary accommodation with each other.

It would be silly for us to sit here and pretend we did not all watch the "Prime Time" report with horror last night. I raised the issue of stretch targets with the Minister, over a year ago, on 16 November last and it strikes me that what will happen over the next couple of days will be an attempt to somehow shift all of the blame for this onto the shoulders of consultants. Anyone who knows me knows that I have a history in the health service and would not always have been on the side of consultants but in this regard I think the Department and HSE need to step up and take some responsibility because the perverse incentives came from the political system. The stretch income targets were a political instruction. Effectively, the Minister is presiding over a system that not only tolerates the use of public money facilities and public contracts for the provision of private health care but actively encourages it, mandates it and insists upon it.

What I saw on the television last night did not in any way, shape or form surprise me. Of course I was disappointed, shocked and upset, particularly to see a woman forced to sell some of her belongings to pay for private health care, but I could see very clearly this is a political matter as well as a service matter and it would be unfair to people working in hospitals to attempt to paint this as anything other than what it is. In fact the incentive and the mandate to carry out this private work come from the political system. The Minister referred to a culture of deference to consultants. That may or may not exist but they work in the system that the Minister and the officials have designed. The contracts were announced by the then Minister in the Fianna Fáil-Progressive Democrat Government, Mary Harney. They came from the political system.

Nobody in the HSE invented this. It came from the political system and the political system needs to step up and take some responsibility for it as it is continuing. It has been one year since I raised the issue, on which the Minister has said some work has been done. He has not been working on it for the past year, but he has certainly been more than well aware of it.

The Minister has stated he is worried about staff in the health service over-working. I hope this will extend to the working time directive. I have spent a considerable number of hours and days with the working time directive implementation group. We encountered nothing but resistance, as seen in the political system, in trying to make progress on it. There are tens of thousands of staff in the health service who are working way beyond their contracted hours. I am sure they will be very glad to know that the Minister is worried about the matter, but I also think they would probably prefer to know what he is doing about it because there is a recruitment and retention of staff crisis. That is not the fault of the workers on the front line who are doing their very best. Rather than express concern, the Minister might outline in concrete terms what he proposes to do. I sincerely hope it is not more of what he has been doing up to now because, clearly, it is not working.

I have gone through the Minister's statement. He mentioned ehealth. We all read the newspapers at the weekend. Mr. Richard Corbridge will be a great loss to the project. I question the commitment of the Department and the HSE to moving forward in a meaningful way with an ehealth strategy as we are far behind the rest. I know that members of the Government have got into trouble in comparing us with international standards, but it is true that we are well behind when compared internationally. Clever and all as the statisticians in the Department are, I do not think they will be able to pull statistics out of the bag that will contradict what I have said. We live in a state in which patients still bring their files with them. If one goes to Holles Street hospital, one will see women walking in with their paper files. It is nonsensical. Much of what is contained in the Sláintecare report is predicated on being able to make progress in that regard. The fact that we cannot is very disturbing.

The Minister has said he wants to translate the Sláintecare report into a programme of action for the next ten years, which is very much to be welcomed, and that the process is being led at senior levels in the Department. Will he indicate the individuals who will be responsible for driving the process?

As regards the public consultation on the future alignment of hospitals, I have said previously that sometimes what we say here is directly contradicted by what is done outside. On the one hand, the Minister says he wants public consultation on the future alignment of hospitals and, on the other, we read that trauma services will be withdrawn from a number of hospitals, which has caused nothing but panic. People view this as downgrading and services being removed from their communities and it causes a huge amount of worry. On the one hand, the Minister talks about public consultation and, on the other, about moving ahead in making some serious changes; I will not use the word "reform" in this case. Will he outline what is supposed to come out of the public consultation process? It was stated the board would be established in 2018. Will the Minister give us an indication of the position in quarter one or quarter two-----