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

There is a notion that the issue of waiting lists has only arisen in recent times. That is not true. I remember dealing with cases in my constituency in 2001, 2002, 2003 and 2004, when people had been waiting for up to seven years for a hip replacement operation. I remember one case in which somebody had been waiting for nine years. They were in extreme pain and had repeatedly tried to gain access to the service. Whatever blocked it at the time did so seriously for persons who were in acute pain. Some people were unable to access the service before they died and they died in pain, which was a terrible reflection on the system at the time. This, therefore, did not start in the last couple of months.

I disagree with Deputy Stephen S. Donnelly on the abolition of the HSE. The Minister's predecessor was right, but he did not press ahead with the next phase to replace it with the structures required. I pointed this out at the time. The HSE was the wrong structure and the decision to replace the health board system was the wrong one. However, it was based on expert opinion from the United Kingdom, based specifically on the situation in the greater Manchester area which had the same population as Ireland. Some of us pointed out that it could not be done in the same fashion because the two were chalk and cheese. One was a vast geographical area, while the other was a compact urban area that was ideal for the delivery of concentrated services in the shortest possible time. The sooner we recognise that we are dealing with a very different system from the one in the greater Manchester area, the sooner we will move forward.

In the control centres of big transport operations worldwide operatives have big screens in front of them on which they can see the movement of traffic. Whenever there is a stoppage they know instantly what to do. The same should apply to the health service, although obviously in a different format. We need to identify the snags which slow the system, thus denying a patient access to it. The HSE should not be regarded as an employment agency but as a vehicle with which to deliver services to patient, the needs of whom are paramount. If we do not realise this, all the talk, re-evaluation and restructuring will come to naught. When there are snags, as with traffic, they cause problems to back up and they get worse and worse. What action can be takem to deal with this issue? Can we focus on it? We could carry out an audit of the weaknesses in the system, but if it does not work for even some of the time, we will not deliver anything. The sooner we recognise this the better. We can play around with it all we want and blame one another for it, but we need to develop a smooth, free-flowing system that will keep patients moving in a circular movement to have them dealt with quickly. What provisions does the Minister have in mind to identify the snags for individual patients and take action to deal with them?

My last point is about overruns. There have been overruns in the health service for the past 20 years. Which disciplines are the most seriously affected and which are guilty of having overruns every year?