Seán Ardagh (Dublin South Central, Fianna Fail)

I am pleased to be able to speak on the Health Bill 2004. We must transform our health system through investment and reform and deliver lasting progress. We must put in place the best medical practice available. The Hanly report has set out the type of medical practice needed in Ireland.

Our first task is to consider the provision of a medical service which is provided by consultants rather than led by them. Too many of my constituents tell me they have spent time in hospital and have been very well looked after, but by non-consultant hospital doctors who are working extraordinary hours while trying to keep up to date with modern developments in medicine. Consultants are not sufficient in number to provide a service to all members of the public. The public not only demand but deserve consultant provided service.

In order to ensure the provision of such a service we need more consultants in the health service. If this is to be achieved consultants must be given a contract which will give them a reasonable return for the time they have spent in education, learning and developing their skills. The return should not be exorbitant, as is sometimes the case at present. Public service and the hippocratic oath are foremost in the minds of many hospital consultants, who think only about the care of their patients. Other consultants derive huge incomes, and increasing those incomes is a greater priority for them than looking after all their patients on an equal footing. That issue must be dealt with. I hope the Minister will do so in the not too distant future.

It is also important to achieve critical mass. There is no point in a consultant in a small rural hospital dealing with ten patients with a particular illness per year while the same consultant, in a larger location, might deal with 250 patients with the same illness and, thereby, gain greater knowledge of the best clinical and pharmacological programme for that disease. Such critical mass would allow consultants to gain vital experience from dealing with a large number of patients. It is vitally important that each region has an acute hospital in a single location so that sufficient patients will be treated there to allow consultants to gain experience and so that equipment, resources and knowledge are adequate to give the very best leading edge clinical treatment to patients.

To achieve the best possible medical service it is essential that the Bill be enacted. The plethora of independent health boards does not help to bring that service about. When the Bill is enacted the managerial responsibility for the health service will rest with a single executive which can establish the necessary structure to put in place the best leading edge medical practice. Political responsibility will, of course, remain with the Minister for Health and Children.

The board of the new Health Service Executive will be made up of 11 persons. These board members will carry an enormous responsibility, more onerous than that of a member of Government. A Cabinet Minister can accept a proposal made by another Cabinet member and pass it on the nod. The Government is not liable to judicial review for any actions it might take. On the other hand, every member of the Health Service Executive will need to familiarise himself or herself with today's report on the MRSA bug, for example, so that its decisions on how to deal with MRSA are beyond reproach. Any board member who is not completely up to speed on such an issue could find him or herself subject to judicial review and liable to be charged with dereliction of duty. All board members are obliged to be fully informed of all facts relating to any decision taken by the board. Most of these board members will act from a sense of duty to public service. They will feel it is incumbent upon them to do so because they have achieved so much in other fields. All these duties are becoming so onerous that it will be increasingly difficult to find competent people who are prepared to take on that type of responsibility in future. Mr. Kevin Kelly who was the chairman of the HSE and may still hold that post——

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