Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to contribute to the debate. I am pleased the Minister of State, Deputy Tim O'Malley, is present. I concur with the previous speaker's comments on health boards. The abolition of the health boards is unfortunate. I strongly support the notion of local representation and public representatives representing their constituents on key issues of concern to them. The Minister of State and I served on a health board and our experiences were positive. We made a contribution and held the Executive to account. I compliment the Minister of State on the work he did while a member of the Mid-Western Health Board during the many years he served there.

Deputy Noonan with others from all parties was on that board. We made our contribution in representing our people and in ensuring the executive and administrators were accountable and questioned them on issues of concern. While sometimes they were put under pressure, on all occasions they appreciated that they needed to account to the people of the mid-west region through their representatives in that forum. That forum has been removed and we now have a health executive whose accountability is very vague.

It is obvious that this is becoming the National Roads Authority of the health service. While we can get information on our national roads, all Members know how difficult it is to influence the decisions of such an authority in the interests of the people we represent. Even more significant and delicate is trying to influence an executive that makes decisions on one of the most basic issues that concerns everybody, the health of our people. While I am very dissatisfied with the response to representations at local level rather than at ministerial level, at least we had the opportunity to make those representations and to talk to people in the health boards. This area needs to be clarified.

Some people believe we should not make representations about issues of concern, such as people on waiting lists, people concerned at how they are dealt with in accident and emergency departments and similar issues. However, people with such concerns should have available to them the avenue of their public representatives to represent them. In a utopia that should not be necessary. Such complaints and difficulties should not exist and people should not need to contact us. People have concerns, however, and are sometimes upset about their dealings with the health services and we are the conduit to bring those concerns to the health board. Some people know how to go about these matters but there is a large number who do not know how to make contact or achieve access and who do not have the confidence to do so. Even when we advise them to take a certain route independently, they are often reluctant to do so. This might be nothing more than contacting the consultant dealing with the family member. I am surprised by the number of people who approach me in difficulty about a family member, often a parent or child, who are reluctant to talk to a consultant.

We act as advisers and mediators for those people. Will these functions of ours disappear? Currently we can carry out these functions and if we are dissatisfied, we can go to the deputy chief executive officers or the chief executive officer or table a parliamentary question and get a reply. Will all that assistance, representation and mediation still be available when the new executive is established on 1 January? For those of us who see assisting such people as part of our role, this is important work and I would appreciate it if the Minister for Health and Children would clarify the position.

In general, I can only compliment the people in the various Departments who respond to our requests and assist in every way they can by informing us of issues of concern to our constituents. I find it difficult, however, to get the same level of response from the Mid-Western Health Board. Perhaps the Minister of State has experienced this or maybe it is a personal thing against me. I do not know and I have not discussed it with my colleagues. I have, however, discussed it with the chief executive officer of the health board.

A year ago, a person came to me in pain late at night. She asked me if I could obtain information about the results of a CAT scan for which she had been waiting for some time to assist in obtaining relief from the pain and advice on what was happening. She felt the delay in getting the results inhibited the treatment of her condition. I contacted the Mid-Western Health Board and was told it would be a breach of hospital confidentiality policy if it kept me informed at every stage of a patient's condition once she has been seen by the hospital consultant. I simply asked when the patient would be seen. The reply to my inquiry stated that this practice would be in breach of patient clinical confidentiality as well as being time-consuming, and the health board would not respond. It continued that recent representations bordered on malpractice and I was asked to cease immediately.

I tabled a parliamentary question on this which was responded to by the assistant chief executive officer who informed me that the consultant physician requested a CAT scan on 6 June, which was later discussed at a case conference with the radiologist where it was decided that it was not appropriate to have a CAT scan for this patient. However, a chest X-ray was carried out on 24 September 2003 and the results were made known to her, the consultant and her GP. That is the information I wanted on the first day but instead I was told that I was to stop making inquiries.

I have other examples of such behaviour. On 3 August I spoke with extreme concern about a distressed patient and said that there was a danger to the person's life. I was told by an officer of the Mid-Western Health Board that I was very rude to say that and I should not do so. I have a letter about another person on a waiting list that states that the patient will be informed of the prognosis and treatment and there is no need to continue to make representations because the person was in the system and the correct course of action would be decided by the medical team. This person had been on a waiting list for a long time and he just wanted to know when he would be called.

I expressed my concerns on this issue to the chief executive officer of the Mid-Western Health Board on 5 April. He said he would look into it but I am still awaiting a reply from him so I have given up. The Minister of State is from my area and I appreciate his professionalism but I am concerned about this because I have never experienced anything like it in any Department.

People take politicians into their confidence and in all my experience of public representatives, those confidences have always been respected. I cannot remember a person coming to me to express concern about a political colleague using information given in confidence. Every interview in a clinic is confidential and will only be dealt with by relevant people who can give the information to assist the person in their query. We do this work even though the perfectionists would say that we should not, that we should only legislate. I totally disagree. We have a role in legislation but we also have a role in representation and that role exists for politicians in all countries. In Britain, MPs who live in London spend more than 50% of their time dealing with queries from their constituents. I make no excuses for doing the same. We would like the Minister of State to respond to our concerns on representation.

Complaints may be made under the Bill if a patient feels he or she has not been treated in accordance with fair and sound administrative practice. We often, however, have queries about other areas, sometimes of a clinical nature. Will such complaints be excluded? Why should someone not complain about clinical aspects of his or her treatment?

In the area of mental health, especially, which the Minister of State deals with extensively, as I do because of my responsibilities as party spokesman, I am conscious that we may differ on certain aspects, because of our different roles. Deputy Tim O'Malley is a Minister of State and I am an Opposition spokesman. I am not being personal, but I deal with this area on an ongoing basis and I get many complaints. Last week there were two suicidal patients, one of whom would not go back to 5B in the regional hospital because of his clinical treatment there. I understand this complaint would not be allowed under the proposed legislation on the grounds that it is only an administrative issue. It is not an administrative issue, but a clinical problem. Are clinicians eliminated from the Bill? As the Minister of State is well aware, the report on the death and suicide of Ms Anne O'Rahilly from Adare in 2002, certainly raised many clinical problems and queries about clinical issues and decisions which were vital to the quality and credibility of that excellent report. It queried the clinicians on several occasions. In this legislation, can such a report be compiled under the complaints procedure? If it is just a question of administration and the limitation of clinical queries, then it is extremely limited. It now seems that certain clinicians and clinical decisions are above questioning. Most people who query clinicians just want information or assurance and sometimes have definite complaints to make. Many of these can be satisfied locally through a complaints procedure, but if it is being asserted that any of these issues cannot be queried, the likelihood is that the Minister will end up in the courts. People in such circumstances do not want to go to court, they just need to have their complaints responded to under the system. The Minister of State is aware of the many issues that I raise in that area, and I will not repeat them on this occasion. However, this is an area that should be covered and to which the Minister for Health and Children, Deputy Harney, might respond when she comes to debate the Bill.

Under section 21, the CEO will be required to appear before the Oireachtas committees when requested by them to account for the performance of the executive. The Minister for Health and Children of the day is responsible to this House directly and we can hold him or her responsible. We cannot hold the CEO responsible. However, last March the Joint Committee on Health and Children wrote to the then Minister for Health and Children, Deputy Martin, and invited him to attend a meeting on three issues about which members were extremely concerned. He was due to meet us before the end of May, but could not make that meeting. He was due to meet us before the House rose for the summer recess and that did not happen. We were anticipating a Cabinet reshuffle and he did not want to come anyway. There was a change of Minister and we invited the new incumbent, who now tells us that she must read into her brief. That is perhaps fair enough, but I reckon that if a Minister attends the committee to respond to those queries, the process will have taken approximately 12 months. This is the Joint Oireachtas Committee on Health and Children, where the Minister is directly responsible to this House. What chance is there of getting a CEO to a meeting of the committee, who is not responsible to it, apart from section 21 specifying that he or she may appear before the Oireachtas? The Minister for Health and Children is directly responsible to the Oireachtas and it takes 12 months to get him or her to meet the committee to discuss issues of concern.

Finally, I would like to deal with one of the Minister of State's own areas of responsibility, since he is in the House. We were extremely concerned that yesterday's Estimates showed that the contribution to the mental health services as a percentage of the overall budget has dropped again, to 6.15% from 6.69%. The relative contribution has dropped for every year since 1997 when the Fianna Fáil-Progressive Democrats Administration began. The Minister of State has spoken about €15 million being contributed. However, one of the key recommendations in the report is for a dedicated isolation service or a special care unit for people who are suicidal in 5B. The cost of that is €10 million and it is being promised as "imminent" in that report. However, there is only €15 million extra for the whole country, so where is the rest of the expenditure that is needed to come from? I was hoping and expecting a response for the needs of our own area, and we then see a total of just €15 million for all the areas of need, which are our responsibility as well. This puts the entire issue into context and the Minister of State will understand our concern. I believe he deserves a better response from the people who decide how the budget is allocated within the Department as regards mental health services.

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