Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I wish to compliment RTÉ. It has been able to raise a number of issues recently from the outside which should have been readily visible and within the reach of the Minister and the Department at all times. We should not have to wait for a report from anywhere. That is my criticism. Over the past number of years, I have repeatedly pointed to the unworkability of the system we have. I realise that we are going to change and renew the board, but I will return to that shortly. The fact is that the system does not work and can never work. I repeatedly drew attention to that during the discussions on the Sláintecare report. If people think that it will work, they will find out ten years hence that it does not.

I read some of the reports that were produced prior to the abolition of the health boards in 2003 and 2004. Some of the professionals felt it was necessary to get rid of politicians from the boards because they believed they should not be there at all. Public representatives were a bad thing and one could not have them there making such decisions. They were stopping old hospitals in the country being closed and the like. However, we know now that their removal from the structure did not solve the problem. There must be accountability and public representation. On any board there must be the professionals at the centre and public representatives. The three groups, including the hospitals, are merged and then the services are delivered. We are kidding ourselves if we think for a moment that we can superimpose the Sláintecare report on the existing system and achieve a good system. Many members do not agree with me but I believe that the board should be broken up into at least four boards, whereby regional views would be heard at the centre. The people on those boards should also be on a national board. I have spoken about this previously.

I have also spoken about the snags that trip up the system, why the system does not work and why the river does not flow smoothly. We have discussed this in the committee repeatedly yet, lo and behold, RTÉ can produce an investigative report that points to some of the snags in the system. They will remain there for as long as it takes to suffocate the system. There is an urgent need to find out where those snags and barbs are, why the system does not flow smoothly and why people find themselves waiting forever. There would be no need for waiting if we identified those issues. I am aware from my dealings on this in my humble, simple way, because I am not an expert on this business, that countless people on waiting lists are being recirculated again and again within the system. They are in the system or on a list three or four times. There is no necessity for that. They must be dealt with on a once-off basis to eliminate that part of the problem. That is another issue on which RTÉ or somebody else could conduct an investigation as well, to find out what is happening in that regard.

I have spoken to consultants in the public system who are frustrated. I have mentioned this previously. They find that a day in the public system compared with a day in the private system is like comparing chalk with cheese. The reason is that they can get a full day's work done in the private system, because it is too costly to leave theatres and staff idle when people do not turn up for work or whatever the case may be. The private system cannot afford that. However, for some unknown reason that happens in the public system. There is a budget of over €15 billion. While it is not the biggest expenditure ever, it is quite formidable given the size of our population and the size of the service. It is a wake up call to find out whether we target our money to the areas where it should be targeted and whether we get good value for it. Effectiveness comes with efficiency and good value. If we are not effective, we are not dealing with the problems and we will have to deal with the same problems in 20 years' time.

I believe we must show progress in this area. We are all on trial on this issue. This winter is a litmus test of the system as it stands and the extra money being provided. If it does not show results there is a far more serious problem, and pouring more money on it will not solve it. I hope we do not find ourselves three or four months hence looking back and finding that although we spent more money, we did not get a better return. Take the example of the scoliosis cases. Why in that situation was there such a severe problem affecting a relatively small group of people in terms of the overall numbers and yet it could not be resolved? It does not require rocket science to figure it out. The problem was small but it was huge for the individual patients concerned. It has a huge impact on their and their families' lives. We must examine that as well.

I have said enough. The setting of targets is fine. We must set targets and they must be ambitious, but we should never attempt to set targets based on insecure, unsafe and unworkable structures. If we do that, we will only repeat the mistakes of the past. I read the speeches of the Minister at the time the health boards were abolished with regard to the intent behind abolishing those boards. Nothing has changed. During the years that have elapsed since 2003, we had a major recession.

That was not a help, either. The fact is that we now have to stand back.

Incidentally, accountability seems to have been lost. Between 2004 and 2012, there was no accountability whatsoever as far as public representatives or committees of this House were concerned. We could not even get answers to parliamentary questions. That was forbidden and the system was all closed off. I stand testament to this because I objected strongly at the time. I did not wait until now to do so. I was punished severely for it on numerous occasions in the House. If I get angry when I hear some of these things repeated over and over, it is with just cause. I hope we have learned some lessons and become realistic in our outlook. I hope we do not repeat the mistakes of the past by depending on structures that have been shown to have failed. I also hope that, by identifying those unsound structures, we will build a new health system on a sound basis that is accountable, efficient, cost-effective and as good as any comparable service in Europe or elsewhere.