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

I will stay within half an hour, seeing as that very helpful precedent has been set. I welcome Mr. Reid and wish him well. He will need all of the good wishes and help he can get. He has a formidable task, one which has not been successfully achieved so far. That is not a reflection on any of Mr. Reid's predecessors but simply a statement of fact that the objectives some of us saw as being primary and necessary have never been achieved. For instance, staying within budget is one thing that has not happened so far. I agree with Mr. Reid that if there is no budgetary structure he can rely on and that he knows from the beginning of the year will be available and capable of discharging the services required, he is going nowhere. He cannot run an organisation in that manner.

Another issue I have raised in the past, as the Ministers know, is the efficacy of the structures of the HSE. I know this is being changed and the Minister will have regionalised authorities within the system. I have always been of the opinion that the amorphous mass of the HSE, which replaced a regional system, has not worked and will never work. I hope I am wrong but I have not yet seen proof to the contrary. My point is that it is like building a wheel in that the further we go from the centre, the less clear the remit becomes and the greater the difficulty of ensuring the outer reaches are capable of operating in the way it was intended and that they are committed to it. For example, the team needs to pull together. Everybody needs to be heading in the same direction at the same time. If we are to run a proper service capable of meeting the needs of the Irish people, we do not need to have different opinions emerge daily as to who should do what, when and how often. Simplicity should be the order of the day as we proceed because complications lead to various culs-de-sac into which everybody will sneak from time to time and emerge when it is opportune. This has to stop. If we do not have a chain of command where responsibility comes from the ground up and the top down, we will not be able to provide a service that meets the requirements of the people of this country or provide a reliable, safe, available and cost-effective service.

I want to revert to cost-effectiveness briefly. Cost-effectiveness comes in many shapes and forms. It comes in the administration of the services in general, the administration of purchasing and the approval of drug refunds. Something we seem to get bogged down in from time to time is a debate on whether we should do a particular thing on the basis of it being too expensive. If it is too expensive, that has to be taken into account and it should not enter the equation in the first place.

If we cannot afford it, we must state publicly that this is a very expensive issue and will have to tax the public somewhat further in order to ensure we are capable of doing this. There comes a time when the buck must stop somewhere.

On the chain of command, I firmly believe it must apply, particularly in the health services where decisions made at the top of the HSE are carried out and applied at ground level without exception. If people are going in different directions, thinking their own thing and identifying different objectives, that chain of command weakens and we will have more explosive issues appearing daily. Incidentally, from 2004 until 2012, one could not debate, discuss or raise a question about the day-to-day running issues of the HSE. Many people have forgotten that, but I have not. I was one of the people who tabled questions daily to challenge that on the basis that we should know whether the system is working properly and within budget and its remit. It is a matter of history that I was ejected from the House on at least 20 occasions on that issue. People think that is funny, but it is not. I was seeking information that should have been available. The matter was smothered at the time. As a result, we have a situation whereby we daily debate the internal running of individual aspects of the health services to such an extent that the chain of command is no longer in command. That is how it works. I am a mechanically minded person with a reasonable understanding of the integrated working of the gear system. The new director general also has a knowledge of that area. The gear system works in a way such that if one element is operating at variance to the rest, nothing happens and everything goes backwards. I wish Mr. Reid well. I hope it goes well for him. He will certainly receive the full support of everybody I know in the system because everybody wants to make it work.

The Minister promised to regionalise within the HSE, a step which is long awaited and greatly anticipated. I hope that is done in the very near future and that with it will come responsibility at regional level. Sadly, responsibility at that level has been missing since the abolition of the health boards many years ago. I did not get my wish back in the discourse that took at the time, nor did I get it at the Sláintecare committee, of which I was a member. Whatever reasons were behind the abolition of the health boards, people do not wish to go back to them. That may be a good thing or a bad thing. We may have to reconsider it in the not too distant future if the system does not work. I am not convinced by some of the excuses for not being able to go back to that regional system, such as that it did not work. Things happened more quickly under that system. If an issue was raised, it was dealt with quickly. If it was not, one knew what the problem was.

I wish to briefly refer to the issue of waiting lists. There is an ongoing requirement within the system. Whenever a waiting list occurs, two things must happen: one must remove some of the people from the waiting list - which is being done effectively and, I hope, efficiently - and one must deal with new people joining the waiting list. If that is not done, we will be forever beset by waiting lists. The problem is that we seem to accept that waiting lists are inevitable and go on forever almost everywhere. That is not the way to deliver services. It does not work that way.

The Chair thinks I should resort to a question. At this time in my life, I have the answers to most of the questions I have asked, and I am still waiting hopefully for answers to the others. The Chair will be glad to know that I will not go into that today. I do not wish to take up any more time. The Minister and the delegates will answer in due course. I stayed within the half an hour guideline.