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

This is a fundamental part of the restructuring of the health services. My views on the composition of the board have been on the record for a long time. This is not criticism of the Minister or any members of the board or my colleagues. However, I strongly believe that for a board to work, its composition should be drawn from the country at large.

Individually, they should have the required capacity and direct experience in the delivery of the services at local level. The problem the HSE has faced for as long as it has been in existence is its inability to connect with the troops on the ground and to connect them to management. Individual service providers would tell one that. They feel isolated. General practitioners, nurses and consultants would say the same.

Clinicians, as a group, should not have all that much influence. We need to examine where they are coming from as opposed to who they are and how much influence they exert at board level. The approach could well be very dangerous. During my previous incarnation, there used to be long battles between members of the health boards and the consultants, for example, at one level or another. The question was who dominated whom. There should be no domination. There has to be an agreed push forward in the delivery of the health services. As long as there is friction and competition between the two demands, there will always be unease, controversy and gaps in the system that cannot be bridged.

It was alleged by clinicians that politicians should be removed completely from anything to do with the delivery of the health services. That was achieved but it did not create a better system. As a matter of fact, the reverse is the case. By the same token, I have long believed we need a regionalised system and a national board — this board we are talking about now — drawn from the three or four regions. Everything else has been tried but this has not.

My belief, based on what I have seen over more than a few years looking at the attempt to deliver a comprehensive health service that enjoys the confidence of the general public and practitioners within the system, be they doctors, consultants, nurses, physiotherapists, pharmacists or others, is that we have gone away completely from what is desired and tend to rely on expertise. This is not a criticism of the amendment before us. There is a need for expertise and provision has to be made for it but we are missing the crucial point, which concerns the representational value of the individuals on the board, where they are coming from and who they represent. General practitioners on such a board have to represent their clients, and they should. They have first-hand experience of this. If this is not the case, there is second-hand experience. We see headlines all the time about diminishing numbers of personnel in various areas, including rural areas. The general practitioners have direct knowledge and experience of delivering to their clients. My hope and belief is that, within five to seven years, there will be a change. There will need to be a return to the old system. I do not believe the system we have now will work, and I do not believe the revised system will work either. This is my view but it is not a criticism of anybody. We need a wholly committed health service. That commitment requires the inclusion of those who are delivering the services on the ground at board level in one form or another.