Dan Boyle (Cork South Central, Green Party)

The Tánaiste when introducing the Bill talked of it as historic legislation and of the original Health Act 1970 as ineffective. As the 1970 Act was introduced by a Fianna Fáil Government, I wonder what her colleagues in Government thought of this. Perhaps the Tánaiste was saying that changed times and circumstances mean we must reconsider the administration of the health services, a fact about which there is little argument in the House. However, the Tánaiste in surprisingly choosing to accept the position of Minister for Health and Children, which is seen as having the potential for political success, could also be looked upon as acting with some degree of political arrogance. She seems to think her particular brand of economic theory can work upon every type of social problem. The experience on this side of the House and of many others outside the Chamber is that the policies to which the Tánaiste refers often cause further inequality and divisiveness.

We therefore need to look critically at what is being proposed and why. The Tánaiste is wrong to accept from the previous Minister for Health and Children an emphasis solely on administration. If we are concerned about health care we must go back to first principles. We have to talk about greater degrees of health education, improving the lifestyles of our people, engaging in preventative and primary health care, and then talk of the investment needed in secondary, tertiary and other types of health care. Unfortunately the balance is all askew and that creates many of the current inequities in the health system.

The curious element of the Tanáiste's approach to the ongoing health crisis is that her proposals seem to suggest that the problems of what we recognise as being a two-tier health service can be solved by turning it into a four-tier health service. We will now have categories of people who rely totally on health insurance, others who rely neither on health insurance nor access to medical cards, another category which will have medical cards entitling them to doctor-only service but not to medicines or hospital care. We will also have people entitled to the full medical card service. That is the nature of the health care service proposed by the Tánaiste. She is choosing this particular administrative model to implement this in a manner which will worsen rather than improve public access to, and confidence in, our health care system.

The issues of accountability are paramount in this area. Most of the areas of health care I have listed from a health hierarchy point of view can and should be best dealt with at a local level. This Bill proposes a top-down approach to health care services. That is necessary only for the largest type of capital expenditure and the broadest type of policy initiatives. The Government is choosing to travel the big bang road towards dealing with our health crisis. Unfortunately it is not willing to back that up with resources. In per capita terms we still rate lower than most European countries and the problems in our health service are about access, not necessarily about administration.

The most disturbing aspect of this Bill is that not only is the chief executive of the Health Services Executive wholly reliant on the political will of whoever the Minister for Health and Children is at a given time, but the parliamentary role of this Chamber in making that person accountable is being undermined in terms of how this person can and should be give evidence to Oireachtas committees. This is of particular concern with regard to the Committee of Public Accounts, of which I am a member, which has powers of compellability. The Comptroller and Auditor General has concerns as to how this Bill is currently worded in terms of the compellability to give all the necessary information on how public money is to be used by this new agency. That might be compromised unless changes are made. I look forward to seeing the Government critically examine the Bill to ensure that the tiny level of accountability in this Bill can be made more real by the time it comes to Report Stage.

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