Liam Twomey (Wexford, Fine Gael)

Fine Gael welcomes any reform of the health sector but fears that reform regarding two major issues in this Bill is in name only. One of these has regard to what the Bill sets out to accomplish, while other public health services to be provided for the public may also be in name only. Many of these changes were first highlighted three years ago in the health strategy. The Prospectus and Brennan reports of 2003 were part of this blueprint for change. However, with only four weeks to go before the implementation of the Health Service Executive, there is still a lack of clarity as to what will happen. This is a huge concern for patients, taxpayers and employees of the health services.

While many nice words have been spoken tonight, there is a considerable number of issues that should be cleared up. Everything is not perfect. The Minister is right on one point, that is, getting the legislation through the Houses of the Oireachtas will probably be one of the easier tasks in regard to this reform.

The first casualty of the Government's ineptitude in regard to reform of the health services was Professor Halligan. He must be thanking his lucky stars on this occasion because when one considers the behaviour of the Taoiseach towards the management of Aer Lingus last week, one can only imagine the scapegoating that will be due to the CEO of the HSE when the Government fails to implement the changes we expect in the health services. Perhaps incompetence is a strong word but we must look at what is happening with such a short length of time to go before 1 January 2005 when the HSE should be up and running. There is no permanent CEO for the HSE, although we knew this legislation was coming for the past 18 months. The permanent board of the HSE has yet to be announced. We are getting rid of 140 local authority members, 90 professional representatives, nine representatives of the voluntary services and 24 ministerial appointees, but as of now, we still do not know the identity of the 11 members of the new board.

This is a very important issue because we are getting rid of 263 people and replacing them with 11 individuals who will have responsibility for a total budget of €11 billion of taxpayers' money. To think that we do not know the calibre of the people who will make these huge decisions in a few weeks' time makes a mockery of many of the fine words spoken tonight. It is one thing to have lost the CEO but not to have a board to take over the new HSE is unbelievable, especially since the health boards, as we knew them, have already been dismissed. We are running the risk of having a banker's version of the ERHA taking over the health services. That lack of clarity and direction is far more worrying than much of what I have heard tonight.

We have been given three weeks to debate this issue in the Houses of the Oireachtas. In some respects, we are rushing through important legislation. We have seen this happen on a few occasions — for example, with the citizenship referendum and the amendments to the Freedom of Information Act. Both were vital and important Bills which were guillotined and rushed through this House to stifle debate and prevent people raising issues about which they had concerns. However, we will continue to raise these issues both inside and outside the House.

In regard to the long delay in bringing forward the legislation, all I can say is that the Taoiseach and the former Minister, Deputy Martin, must have had little or no interest in the health services. Both must have been more interested in saving their own aspirations for the future of Fianna Fáil. The Tánaiste, as leader of the Progressive Democrats, has been left to make up for seven years of bad Government. We hope this will happen more easily than what already appears to be the case.

The objectives of this legislation can be broken down into four major points. The executive will be responsible for managing the health services as a single entity and will protect the health and welfare of the population. The consolidation of service providers will reduce the fragmentation of services and make them more integrated and easier for patients to access. Those are the two vital points as far as patients are concerned. There will be established structures for public representatives and participation by service users — there are many faults in that regard — and there is provision for the transfer of staff to the executive from the ERHA, the health boards and other statutory organisations connected with health.

I have discovered that staff in the health services are not happy with the consultations so far. We cannot alienate workers in the health service when carrying out radical reforms. It does not matter whether they are doctors, nurses or administration staff, we cannot alienate these workers because their views are vital. In recent weeks I have been contacted by a number of employees of the health boards who said they were unhappy with the way the interim Health Service Executive has spoken to them. They feel the interim Health Service Executive is trying to force a corporate culture on health administration which is geared more towards the commercial world than the ethos of public service that exists in the health services at present. While I fully agree with the Minister in regard to efficiency, accountability and transparency, we must bring these people on board and not alienate them. The above four points apply not only to the people working in the health services but also to the Government. That is something that is not clear when one reads through the legislation.

IMPACT has threatened strike action because it is not happy with the way people working in the health services have been treated. These people believe they have been poorly informed and do not know what role they will play after 1 January 2005. The delegation about which the Minister spoke is not clear to anybody, not even the CEOs or assistant CEOs. They do not know what their function is or what the integration or the lines of responsibility about which the Minister spoke involves. They are simply unhappy with what is happening.

My concern is that as the deadline approaches, nobody seems to have a clear idea where the Government sees this executive in 12 months' time. Although section 3 allows for provisions of the Bill to be brought into operation at different times, if there is a lack of clarity beforehand, it will increase anxiety and increase the difficulties the Minister will face in trying to reform the administration side of the health services — he will face many difficulties unless it is clear to people what will happen.

In regard to complaints, it is important service users — patients, consumers or whatever one likes to call them — have an opportunity to make complaints about difficulties in the service. I do not want to see the HSE turn into an unaccountable statutory agency like the National Roads Authority, which appears to be happening. There may be less accountability to the people who use the service after 1 January 2005 than at present. We have had our fair share of complaints about health boards up to now but this could make matters much more difficult. There is nothing in this legislation which specifically shows the HSE is answerable to anybody other than itself. I am sure the Minister will take time to respond to these remarks, but that is how it looks to me.

The national health consultative forum and the four regional health fora have no powers and they could all end up as talking shops with no mandate. One could raise whatever issue one liked, but it would not have to be heeded by anybody, especially since the people who will now be on the board of the HSE will not be public or professional representatives but 11 people nominated by Government who can, more or less, decide to ignore or listen to what they like. The complaints procedure could be restrictive and could be anti-consumer. However, the health service belongs neither to the Minister nor to me but to all the people.

Section 55 states that a complaints officer may not, following investigation of a complaint, make a recommendation the implication of which would require or cause the executive to make a material amendment to the service plan. In other words, if the problem is not highlighted, the problem never existed. That is how I read that section. If there is no opportunity to state there is a problem and to make a recommendation, that is, more or less, saying the problem can be buried, put aside or forgotten about. It suggests that when the report is published at the end of the year, a complaint, no matter how important, can be ignored. The more important a complaint, the more likely it is not to be highlighted because the complaints officer would not be in a position to make a recommendation on it or could make only a lukewarm recommendation.

According to section 59, the annual report on complaints and reviews shall contain "such information as the Executive considers appropriate or the Minister may specify". This represents almost a second attack on those who wish to make complaints. The information contained in the annual report is that which the executive or the Minister decide. A blanket can be thrown over any major complaint against the Health Service Executive, HSE, in its annual report and some complaints may not even get that far. This is a similar situation to that regarding the restrictions introduced in terms of the freedom of information legislation two years ago.

Will the consolidation of service providers help to reduce waiting times and will integration make it easier for the public to access health services? This issue is very much an aspect of the administration of the health service and I stress that there are two elements which require reform. These are the delivery and the administration of health services and they run in tandem. We may get carried away with the notion that the proposed changes will change the situation dramatically. This will not be the case. The provision of radiotherapy services, for example, will not become available any faster for cancer patients. It is hoped the Tánaiste and Minister for Health and Children will address this issue before the Joint Committee on Health and Children soon. What about patients who face the prospect of waiting three years before they see a neurologist? This waiting time will not be reduced from January 2005.

This is another issue which must be taken on board when considering reform of the health service. Patients' conditions can deteriorate in six months, never mind over a period of three years. I mention neurology because it is another issue due for discussion with the Tánaiste in January. Patients in this area find that no matter how hard they try to contact the consultants, who are extremely facilitating when one tries to push urgent cases on behalf of constituents, it is impossible to secure an appointment. This is another issue about which the Government talks but does nothing.

There has been much talk of the national treatment purchase fund recently. Regional services are provided at the so-called regional level, including orthopaedics, dermatology, ophthalmology, ear, nose and throat services and so on. There is a hidden waiting list for such services with which the national treatment purchase fund does not deal. This involves the cases where a GP sends a letter to a hospital, after which the patient receives an outpatient appointment. This system will not become any faster under the reform of the administration. Hospitals generally do not send out appointments because it is at this point that patients may become eligible for services under the national treatment purchase fund. These hidden waiting lists are quite extensive. For orthopaedics, for instance, the waiting time can be as much as two to four years depending on the region. It is not much fun to wait four years for an orthopaedic review.

The Tánaiste may feel that I am inventing this information to create problems for her but the health boards have published lists detailing the waiting times for some of these specialist services. Waiting times for rheumatology services vary between two and three years while ENT services have waiting times of between two and four years. ENT services include, for example, the treatment of adenoids, provision of tonsillectomies and the use of grommets which have a dramatic effect on the development of a child's hearing. While a child may become eligible for treatment under the national treatment purchase fund within six months of receiving an appointment, most of the damage is done during a wait of two or three years. The administrative reforms will not speed up the delays that exist in securing outpatient appointments. As we have long maintained on this side of the House, we cannot effect a change in isolation. It must run in tandem with other reforms.

I have no issue with the 32 regional services because they are not being altered too much. My concern is with the HSE and the four regional services below it. These bodies have the potential to become merely another administrative nightmare for the patients who are trying to use the service. The Eastern Regional Health Authority was set up out of the Eastern Health Board for the purpose of improving the delivery of services to patients in the greater Dublin area. The ERHA was established to administer the service and three health boards were set up to function beneath it. The former Minister for Health and Children, Deputy Martin, established and also abolished this body. We should analyse the experience with the ERHA in the hope that we may discover the mistakes that were made. Of those who sit on the board, there is only one with any experience of the ERHA who might give pointers as to what pitfalls the HSE should avoid in the process of dissolving the health boards and the ERHA. The Tánaiste risks making the situation worse through the establishment of the HSE. Members on this side of the House have considered the matter and are unsure whether the correct approach is being taken. We are concerned about the accountability aspects for the patient. This aspect is not as strong as the Tánaiste has suggested.

Another problem evident in this legislation is that these health bodies will take on advisers and consultants and set up committees to do the work for them. Such an approach could see an expansion into the same old quangos into which we sometimes felt the health boards were descending. There is no indication in the legislation of the regulation that will operate in this regard. There is no concrete information about the regulation of the entire system. The Bill seems more concerned with setting up protocols and establishing chains of command. One can easily predict that many of these delegations and committees will include many of the same people about whom the Tánaiste has spoken of removing from the health service. She must make clearer her role in this regard.

Will managing the health service as a single entity make the significant difference that she has predicted? The health service is comprised of different branches. The primary care branch consists of general practice services and community care services such as home carers, nursing homes and public health nurses. There is the acute and non-acute hospital sector and I understand that the acute sector will be another pillar of the hospital service when it is properly established. Another branch is the mental health and disability services which have been grossly underfunded. In her estimates, the Tánaiste observed that some 1,000 staff will be recruited in this area. I hope this means the recruitment of 1,000 frontline staff, who will remain as frontline staff rather than move into another capacity after the first year or two. The administration aspect must also be considered. All these elements are important and should move in tandem with each other. This is not happening. The previous Minister, Deputy Martin, spent the past four years just spending money on the health service and did not seem to be quite sure what he was about.

This scattergun approach to health spending has left us with the current mess. The Tánaiste seems destined to repeat this approach in the context of the lack of clarity regarding investment in primary care and mental and disability services.

See this speech in context