John McGuinness (Carlow-Kilkenny, Fianna Fail)

I welcome the Bill. Before dealing with some of its aspects, like many other Members and indeed those in public life in general, I have been critical of the bureaucracy surrounding the health services and the manner in which replies are delivered to us, whether in the context of a parliamentary question or by way of correspondence to the CEOs of health boards. The previous speaker has outlined his experience in a way that ties in with the matter I want to address. A serious inadequacy exists in terms of the health boards and the information they give. Likewise, there is inadequacy in terms of the accountability of the health service to this House. In the course of this Bill, while public representation is mentioned as well as the public being represented in other fora, there is a strong need to ensure there is clear responsibility to the Members of this House in the context of the questions we ask of the service, or in individual cases, while recognising the confidentiality that must exist between the health service and its client. There is no excuse for the virtual non-accountability that exists at present.

I welcomed the abolition of the health boards as a step towards reducing the bureaucracy in the system. I also welcomed the appointment of Deputy Harney as Minister for Health and Children. I wish her well, because like many others, I believe she is the right person in the right place at this time to do the business in the context of delivering an efficient health service by removing vested interests from it and the top heavy bureaucracy we have seen. All one has to do is look at the increase in the number of employees in the health service, when it is obvious that it is primarily accounted for by bureaucracy rather than people in the front line, with the administrative square footage substantially greater than the area reserved for centres of care.

I have tabled umpteen parliamentary questions and have got unsatisfactory answers. I have been critical of our local health board. We are at a point where the Bill is being introduced and the system is being radically modernised. There is a need for a common sense approach across parties, as mentioned by the Minister. There should almost be a Tallaght strategy because it is the health of the country we are talking about which involves a budget of €11 billion per year. To continue to haggle over the health policy would not be helpful. There is no sense to the Labour Party position on medical cards and its comments generally on the medical services. Some of the comments do not facilitate constructive debate. The terminology "yellow pack" used in regard to medical cards is a disgrace and the Labour Party should refrain from that type of language in the context of this debate. I appeal to all parties to work towards a political consensus, to urge constructive debate and to take the emotions and political positions out of the debate in order that we can come to some resolution on an overall package for the heath service.

During the course of the debate leading up to the launch of the Bill, I saw St. Luke's Hospital in Kilkenny being transformed. I will use it as a model given that a number of backbenchers from all parties have visited the hospital. The Fine Gael spokesperson has visited it and I commend him for doing so as it is not part of his constituency. He is showing an overall national interest. I commend the Minister of State, Deputy Tim O'Malley, who also visited St. Luke's Hospital. During a visit to Kilkenny, the Minister, Deputy Harney, visited the hospital. I extend a personal invitation to her, without any political bells ringing, to come and walk through the hospital with the consultants and those who run and manage that hospital because it is a model for the rest of the country.

Thirty years ago Carlow hospital closed. There were beds in the corridors in every part of St. Luke's Hospital in Kilkenny. The consultants and the managers at the hospital, separate from the health boards, saw there was a crisis and that something had to be done, and worked together. Today there are no beds in the corridors. Some 17,000 in-patients and 40,000 out-patients are seen. For that service there are only five rooms and three cubicles, plasterboard separating them. It is not a modern facility.

There is no surgical waiting list. All of this has been achieved with 317 beds. It is possible to radically overhaul the service and deliver care directly to the patient where it is required. They have pioneered these initiatives. They have dealt with paediatrics and geriatrics. The hospital also has a stroke unit. The plan was supported by the investment of millions of euro in that hospital by the former Minister for Health and Children, Deputy Martin. The hospital can act as a model for the rest of the country against the backdrop of the Mater and St. Vincent's hospitals, each of which has 14,000 in-patients beds. The figures are generally the same.

The Hanly report is condemned throughout the country and politically one should not speak about it. There is a sentence in it that refers to the general hospitals. I suggest the activities of St. Luke's, as of today, fit into its description of a general hospital. That service should proceed under the Hanly description of a general hospital and be funded and expanded accordingly. It does not take that much money. St. Luke's Hospital is considering an out-patients facility which would cost €3 million, which is in addition to the work it has done. The staff are excellent and one gets the best of care. If it succeeds in getting the out-patients facility it can use the building to improve the accident and emergency unit. It has moved from the provision of services, the whittling away of the waiting list, dealing with thousands of people across the services to endeavouring to improve the quality of service being delivered. The cost of that improved quality is €3 million. It is seeking a Dexascanning system to define how brittle or otherwise are the bones of the elderly and get them the appropriate treatment. It is seeking accommodation for step-down facilities. It has the initial facility for analysing patients on the way in. There are those who will vacate the acute beds and end up in the care facility before going home. That has all been achieved on a shoestring budget. It is the finest campus in the country staffed by the best people. I urge the Minister to look at not only what has been achieved but at its short shopping list to put the hospital at the cutting edge of the development of the health service without waiting lists or people being delayed for a considerable period in the accident and emergency unit. If the system in that hospital is replicated we will have a system based on that model which will relieve hospitals throughout the country. There is a need for sensible debate and accountability.

As one who promoted the notion of abolishing the health boards and reducing bureaucracy, I say there is a need to speed up that process. I hope the Bill has a speedy passage through the House. I hope too that the debate is constructive, and if sensible amendments are proposed on Committee Stage they will be accepted.

I have no doubt, given the long political career of the Minister, Deputy Harney, we will have that type of approach in trying to reach agreement across parties to resolve the many problems in the health service. We can strive towards the working model where we do not have waiting lists and services are available immediately. I consider the health portfolio to be a work in progress. There will always be new problems, new services coming on stream and demands of one kind or another but we can deal with those.

An issue that annoys me greatly in St. Luke's Hospital is that the scanning system is not available out of hours, it is available from 9 a.m. to 5 p.m. Monday to Friday. When patients have to be scanned outside of those hours they have to be sent either to Waterford or Beaumont hospitals. There was a case some time ago where the proper care and attention was not given to a patient and the journey to Dublin was simply too much and the patient died. That was one death too many. We have to resolve the staffing issues in regard to that problem, ensure the mechanism for a resolution is found immediately and that the service is delivered not only to Kilkenny but to the region it serves.

Last but not least, care of the elderly must come first. A unit is being completed at St. Canice's Hospital in Kilkenny, which will make available a separate unit that the Minister of State has seen. I urge the Minister of State to ensure that unit is delivered on time and within budget and that the next phase is funded immediately in order that care can be extended to the elderly and pressure can be taken from the beds in Castlecomer and Thomastown.

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