Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

This Bill will not provide one extra bed in our hospital wards. It will not reduce by one hour the waiting time of a single patient in any of our chaotic accident and emergency units. It will not lead to the employment of a single extra nurse, doctor or paramedic. It will not extend radiotherapy services to the regions. It will not restore a single service that has been lost to local hospitals. Above all, it will not address the scandal whereby money can buy superior health care in this State and where public money subsidises the private health business while public patients suffer. The Bill diverts vital energy from the real delivery of services. I support the amendment tabled by Deputy McManus.

Before this Bill was even published the changeover process had descended into chaos. The duly appointed chief executive officer of the Health Service Executive, for which the Bill legislates, stepped down less than two months before he was due to officially take up his position. On the day this Bill was published, IMPACT which represents 25,000 workers in the health services, announced that its members had voted to stop co-operating with preparations for health service reforms until it gets safeguards about the continuity of health services, jobs and working conditions when the new health structures come into force on 1 January 2005. Its members have endorsed industrial action by a margin of 88% to 12% in a national ballot of staff directly employed by existing health boards, including nurses and other health professionals as well as clerical, administration and managerial staff. I do not believe these workers took that decision lightly. They feel they have been left in the dark and that they face an uncertain future.

I have also listened carefully to what has been said by organisations representing people with disabilities. They too are very concerned at the lack of clarity and information about how services on which they depend will be delivered under the new structures. This is surely yet another example of the disastrous mismanagement of the health services by the Government, which published its health strategy in 2001, the Prospectus report in 2003 and which is now presiding over a situation where those who deliver the services and those who avail of them are left in a state of uncertainty and agitation.

This Bill is based on the recommendations of the Prospectus report. When it was published I stated that it proposed not real reform of the health services but bureaucratic change. Everything that has happened since then, supports that contention. We see all around us the glaring need for real reform and real improvement in the delivery of services in our crisis ridden health system. Instead what do we have? We have this Bill that is the wrong remedy for the wrong illness. We have a Bill to establish an all-powerful quango appointed by the Minister for Health and Children and subject to no direct democratic accountability.

When the Prospectus report was published I stated that few would shed tears for the old health boards. They were too cumbersome and it was widely agreed that they would have to be replaced. The Minister's comments in her introductory speech were accurate in that respect. However, they had a degree of democratic accountability. There was representation of elected councillors and of bodies representing health service workers. That degree of accountability is now gone. The Government tries to cover up the democratic deficit by providing in the Bill for fora and powerful talking shops. They will be powerless talking shops. Decisions will be made even more remotely from the communities and individuals they will affect.

The people of my constituency know the consequences of that only too well. The day before he left office the Minister's predecessor, Deputy Martin, issued a public statement which appeared to provide for significant improvements at Monaghan General Hospital and to reverse some of the loss of services we suffered during his term of office. The promises have turned out to be a carefully woven fabric designed for public relations. That fabric has been unravelling ever since. Last week, it was confirmed that all surgical doctors are to be removed from Monaghan General Hospital, finally reducing our hospital to the status of a day clinic.

As a former member of the North Eastern Health Board, I know that colleagues of most political shades fought hard to retain services at Monaghan hospital. We were met time and again with deliberate efforts to deceive, confuse and conceal information. The executive of the health board, the Department of Health and Children in Dublin and the professional bodies, such as Comhairle na nOspidéal and the Royal College of Surgeons in Ireland, dictated from on high.

The Bill will make a bad situation even worse. Decision making will be even more remote from the citizen and the community. For at least all of next year, energy will be concentrated on this massive bureaucratic change instead of on real delivery for patients and real reform of the health services. It cannot be stressed enough that any so-called reform that does not challenge the grossly unfair two-tier public/private system will only maintain inequity and inefficiency. We should have a much fuller discussion on that issue. Such a debate would address the Government's policy of subsidising the private health industry.

The guillotining of this Bill will not allow such a debate, but I will make some points briefly. I ask the Minister to clarify the following issue in her concluding remarks. Spin doctors in the Department of Health and Children, or perhaps in the Progressive Democrats, recently told the media that the Minister wishes to increase private sector involvement in the health services. Lo and behold, a 43% increase in funding for the treatment purchase fund was signalled in last week's Book of Estimates. I have asked the Taoiseach how this tallies with his claim to hold socialist and republican principles but he has declined to answer. The increased privatisation of services can only lead to a reinforcement of the public private apartheid in our services, which is driven not by the need of patients but by the profit motive of the private health business. Money must be invested in our public health system.

We have yet to be given an explanation of why the Minister went on a visit to New York recently to look for ideas for our health services. I hope she has carefully examined the grossly unequal health system in the United States where an estimated 43 million people have no health cover whatsoever. Perhaps the Minister will also explain that trip to us in her closing remarks.

For years, the Government has been promising a separate health complaints Bill to provide a statutory framework for the handling of complaints within the health services. Then we were told statutory provision for health complaints would be included in this Bill. What have we got? We have little or nothing. It is left to the Health Service Executive to establish these procedures. There will be no independent complaints system. Section 52 sets out all kinds of limitations and restrictions on the type of complaints which can be made.

The Bill provides for the most far reaching change in the administration of the health services since the establishment of the health boards. It is a significant Bill for our health services, the foremost issue of public concern and a foremost responsibility of the Oireachtas. Yet, this long promised and long delayed legislation was only published late last Friday and we are being asked to debate and pass Second Stage of a major Bill of 82 sections in the space of three days. It is to be rammed through the Oireachtas by Christmas in a desperate effort to hide the shambles that is the so-called health policy of the Government. At the core of this issue is the ongoing erosion of our health services by the Government and its failure to grasp that fact.

Accordingly, I will be supporting the amendment tabled by Deputy McManus because the Bill is a mess and should be withdrawn and redrafted.

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