Tommy Broughan (Dublin North East, Labour)

He realised his mistake and left the outfit. Historically, he was on the left and he ended his days in the Labour Party. The Government has never had the bottle or the resourcefulness to take on the key vested interests in medicine. The Economist ranks Ireland close to being number one in the world in terms of gross national product and the magazine states Ireland is number one with regard to quality of life. However, we know from bitter experience that does not apply to the health service. When one visits France, Spain, Germany or any of our other European partners, their health care systems are definitively superior to ours. That is an appalling failure of will by Fianna Fáil in particular.

I commend the Tánaiste for having the courage to take charge of the Department of Health and Children. Her own party played a full role in the savage cutbacks of the late 1980s, which the Ceann Comhairle will recall since he was Minister at that time. Those cutbacks had a disastrous and ferocious impact on the people I represent. The Progressive Democrats have been the ideological driving force in health administration since 1997, together with Mr. Charlie McCreevy, the leading PD, so to speak, a member of Fianna Fail who has now departed for Brussels. The party has also been the force behind the cynical and brutal failure to deliver on the promises of the 2002 election.

Seven and a half years after the summer of 1997, the Minister for Justice, Equality and Law Reform, Deputy McDowell, seems to be preparing an exit strategy from the Government. Despite the Taoiseach's intentions, we may not reach the early summer of 2007. Deputy McDowell is enamoured with the evolution of Irish politics along the lines suggested by Mr. Frank Flannery, where those of a democratic persuasion, including the Progressive Democrats, will be on one side and Fianna Fáil and other parties will be the other. The Tánaiste may not have two and a half years to deliver any kind of change under this Bill.

In 2001, before the last general election, the then Minister for Health and Children, Deputy Martin, issued the health strategy entitled, Quality and Fairness — A Health System for You. We are now halfway through the development of that strategy, which accompanied developments in the Prospectus and Brennan reports. The key elements of the strategy were better health for everyone, fair access, appropriate care in the appropriate setting and a high-performance system. The Bill before us seeks to develop a high-performance system on the basis of organisation. However, while I commend Deputy Martin for introducing the smoking ban, the other three elements of the strategy have not been delivered. We still do not have fair access; we have the opposite. We still do not have appropriate care in the appropriate setting. The amount of funding set aside by Deputy Martin for primary care was derisory, as stated by general practitioners who visited me in Dáil Éireann and made representations to other Deputies.

With the exception of yesterday's excellent news regarding smoking statistics, we are still waiting for better health for everybody. In terms of a general approach, the health strategy had some merit with regard to a framework for change of primary care, acute hospital services, funding, human resources, organisational change and information. However, apart from this Bill on organisational change, three and a half years later we are still waiting for the development of the strategy.

One can contrast this with the programme put before the electorate by the Labour Party in 2002. Its fundamental driving force was to achieve an integrated health system for everybody which did not depend on a person's wealth. People would not have to go to their GP and enter into the long waiting system, where one waits to get an appointment to wait for another appointment. The Minister, myself and other Deputies have to put up this virago of nonsense week in, week out as we try to encourage and assist people to seek appropriate medical care.

The fundamental problem which remains is the gross inequality of our health system. This was well-illustrated a few months ago in a report by the Public Health Alliance of Ireland entitled, An Unequal State. The report showed quite dramatically that in terms of cardiovascular disease, cancer and infant mortality, those who are unemployed or have a manual job or are on the borderline of family income are far more likely to die prematurely than those working in professional fields. That is based on information we have. The Bill does not advance public information with regard to health statistics. Ireland is a decade behind the British in terms of the provision of a proper data bank of health statistics. However, the Public Health Alliance of Ireland report bluntly showed how unequal our society is with regard to health provision.

There are currently 70,000 to 80,000 medical cards in the system. The Public Health Alliance of Ireland's report pointed out that if a person is unemployed, working for the minimum wage or on borderline income, they will not get a medical card from this Government. The report indicated, across a range of indices, that we are still a grossly unequal society in terms of health provision.

In an article the Professor of General Practice at Trinity College Dublin, Dr. Tom O'Dowd, demonstrated, across the range of primary care provision, how people on low income and senior citizens are also left in a vulnerable situation.

The key problem in this is the conservative alliance in this House which has prevented the creation of an egalitarian and fair health system. The ongoing cynicism of the Government in regard to the health strategy and the promise of 3,000 additional beds, an end to waiting lists in two years and 200,000 medical cards is breathtakingly unbelievable and will have to be severely punished in 2006 when we will probably go to the polls.

Apart from the political problem, the other major problem is that of the controllers of the political process, represented especially by the consultant class. The best recent example is in regard to orthodontic treatment. Members have spent much time in the past decade making repeated representations to health boards, the Minister for Health and Children and various interests in the medical profession to try to deal with the spectacular waiting list for orthodontic treatment. Some months ago, some 21,000 children were waiting for treatment, with 11,500 further children on a treatment waiting list.

During the past three years, I received repeated replies from the former Minister for Health and Children, Deputy Martin, with regard to his plans. A report he presented to me in January 2004 is typical of many such reports in regard to orthodontics. The Minister's report refers to the establishment of a grade of specialist in orthodontics in the health board orthodontic services. At that time, there were 13 trainees for the public orthodontic service in addition to six dentists who commenced their training in 2001, making a total of 19 trainees. However, this came years after another former Minister, Deputy Noonan, had set in train a similar development for the training of consultants.

The former Minister, Deputy Martin, ignored the advice of a number of orthodontic professionals. I think in particular of Dr. Ted McNamara, who presented many Members of the House with an unbelievable story of how collusion between the Department of Health and Children and vested interests in the dentistry profession had prevented the creation of a public orthodontic service. Not alone did they do this but they basically smashed a service which already existed and was working well in the Mid-Western Health Board and Western Health Board regions, to such an extent that distinguished public servants resigned from the board of the Dublin Dental Hospital in protest at this disgraceful behaviour. The reports of Dr. McNamara and other professionals in orthodontics represent a shameful story and one to which I hope we will not have to return in the context of a tribunal of inquiry or an investigation by the Garda bureau of criminal investigation, given that it is alleged that serious damage was done to the teeth of the children and teenagers of Ireland due to collusion between the Department of Health and Children and vested interests in the orthodontics profession.

The net result is that anguished parents are still asking Members to assist with teenagers who have waited up to eight years on the A or B list but have been moved to the third list, which seems no longer to exist, and who have received a tough lesson in the provision of health services in this country. The Minister should reconsider this area because it seems a spectacular and clear case of vested interests, allied to incompetence and lethargy in the Department of Health and Children and the political conservatism of Fianna Fáil and the other conservative parties in the House, preventing the development of a modern health service.

The Bill is welcome. It is interesting that it is being taken at this time as we read yesterday of the collapse of a crazy and narrow decentralisation, or non-decentralisation, programme. Like you, a Cheann Comhairle, I believe profoundly in local and regional development. I believe Cork people are the most suited to run Cork, Munster people the most suited to run Munster, Connacht people the most suited to run Connacht and, in the same way, Dublin people are most suited to run Dublin. One of the Dublin's problems is that most of the time Dublin people have not run Dublin. Despite the Taoiseach putting on a blue shirt on occasion, on many matters he has let down badly those he makes out to be his own people, nowhere more so than in regard to the crazy decentralisation programme outlined by the former Minister for Finance, Deputy McCreevy.

For example, instead of locating the Department of Communications, Marine and Natural Resources in Rossaveal or-——

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