Finian McGrath (Dublin North Central, Independent)

I thank the Ceann Comhairle for the opportunity to speak on this new and important legislation. I welcome the debate on the urgent need to reform our health service and I enter the debate with an open mind. I recognise the need for change, reform and investment. If this Bill means reform plus investment, I am interested in being positive and constructive in the interests of patients, staff and the taxpayer. I am not merely going to use our health service as a political football or an issue to score points if I have a serious input into changing and improving the service. That is my bottom line — change, improvement and investment.

I hope that the health service can deliver more effectively and I am not one of those who say that we can do nothing about the hospitals, our accident and emergency units, our elderly, those with disabilities, and other issues related to the health services. It is a question of choices and priorities. Are we serious about making health a top priority and are we prepared to make tough decisions to fund the health service? These are not easy decisions and may not be popular, but if anyone comes up with constructive proposals or ideas to deal with these important matters, I am open to their views, and this debate can thus be very positive.

I cannot accept that after seven years in power, and massive wealth in our society, people should have to wait in trolleys and chairs in accident and emergency units. An immediate problem is the shortage of 300 beds. That is why I welcome the decision in the Estimates to provide an extra 300 acute hospital beds and to free up of another 100 beds. That is a start but the momentum needs to be continued. I also welcome the extra €20 million to be spent on reducing hospital waiting lists. We all support those ideas, but can the Minister deliver on the promises? That is the test, and a marker for the new Health Services Executive. These improvements should take place within about three months; if not, this Bill means nothing. People are fed up with excuses and with waiting. Our citizens are fed up with all the talk and debate on the issue.

Looking at the details of the Bill, it provides for the reform of the health service management structures. This is a welcome development and something that needs to be done. Out-dated practices must change. Two days ago a number of my constituents receiving speech therapy services in the Drumcondra area received letters from the Northern Area Health Board informing them that those services would be suspended on 30 November. They were horrified and shocked by this treatment because of a row about premises. When I raised this matter in the Dáil yesterday under Standing Order No. 31, and issued a statement, the health board climbed down within a few hours and has now guaranteed the service, which will continue in Whitehall and in another venue. The handling of this issue by the management of the Northern Area Health Board and the threatened suspension of the speech and language services at the Drumcondra location were disgraceful. It is good that the families involved received individual letters at their homes this morning and that the board apologised for the inconvenience caused. I raise this matter because it is relevant to the reform of our health service and the formation of the Health Services Executive.

Looking at the broader issues, when Imelda Marcos was the first lady of the Philippines she had a dream. She wanted to turn her country into the world capital for heart transplant operations, an admirable aspiration. The problem was that to achieve her ambition she proposed to divert almost all of her country's health budget to finance the state-of-the-art facilities. As a result the budget for primary health care for the entire population would have been on a par with Imelda Marcos's personal shoe budget. Her grandiose plan had to be shelved on foot of the tidal wave of outrage generated by her proposal. It was almost universally accepted that treatment for the privileged few should not be at the expense of the impoverished many.

There is an ongoing tension in the health care system between the right decisions from an economy viewpoint and those from an ethical viewpoint. Successive Ministers for Health and Children boast about the amount of money spent on our health service. Although most civilised societies espouse the concept of equality for all, this ideal rarely corresponds with the reality. Issues in the allocation of resources for and within health care are arguably the most difficult issues facing us today. As a former teacher I am acutely aware that we also have major allocation decisions to make in education if we are to ensure that our education system is to be an instrument of equality. In health care and in education, situations present themselves in which decisions must be taken and alternatives selected which will bring advantage to some and may leave others disadvantaged. A political ideal or a constitutional right might assert that every person has an equal claim to health and education but this aspiration is not always realised in Ireland. Choices must be made about which patients and treatments are to be given priority, and which students will go to university. In a situation where there seems to be a contradiction in making certain choices, then in order that fair treatment may be given to all it is essential that we consider, however tentatively, the ethical grounds on which to make such choices. There is both an economic and an ethical dimension to the problem of allocation. This Bill has the potential for change. There are many aspects of it that can be developed to improve the services but the bottom line is, there is no point establishing a Health Service Executive if we do not introduce change along with investment. Trying to introduce change in the health service without any investment will do nothing for the patients on trolleys and chairs.

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