Martin Ferris (Kerry North, Sinn Fein)

The main flaw in the Bill is its proposal to increase the centralisation of overall administration and key services in the health sector. This will further the agenda laid down in the Hanly report whereby decisions will be made with no input from democratically elected representatives. While the Bill attempts to gloss over this matter by proposing to establish a national health consultative forum with fora at regional level, these will have no practical role and will merely provide a thin democratic veneer over the reality of centralised dictates.

Sinn Féin had criticisms of the old health boards, which we proposed ought to be reformed in a number of ways to increase their accountability and effectiveness. However, the Bill does not achieve that end. Instead it ensures that decisions with wide-ranging and possibly detrimental effects on local areas can be taken without any local input. The effect of the philosophy underlying the Hanly report and the Bill can already be seen in the withdrawal of services from regional hospitals. In my constituency severe hardship is being imposed on people who must travel to Cork for radiotherapy treatment. With the confining of this service to Cork, Dublin and Galway many other people will have to travel unacceptably long distances to receive treatment. The level of anger over this issue is huge in many areas with Waterford witnessing its largest public protest for decades in support of the demand for a radiotherapy clinic in the regional hospital there.

With the diminishing of local input into decisions made, many regional hospitals are being denied facilities and improvements that have already been promised. While Tralee General Hospital has been promised a new accident and emergency unit and a new maternity wing, neither of these has been delivered. It also needs a breast check unit with the current service being totally inadequate to cope with the demand. This week a neighbour of mine underwent a breast check in Tralee General Hospital. All that is available is one room for one hour on Monday and Friday mornings, which is totally inadequate and disgraceful.

Instead of throwing the old health board baby out with the bath water, the Government ought to establish methods to reform them in such a manner as would have retained and expanded their democratic accountability and eliminated the red tape and misuses which reduced their effectiveness. It might also have eradicated those elements within the boards, which were a result of certain political parties trying to run them as rewards for party loyalists and to ensure political control.

Further evidence of the concern over the health services has been signalled by IMPACT whose 25,000 members have voted to withdraw co-operation with proposed reforms within the service unless its members are given guarantees of no cutbacks in services, no redundancies and no diminishing of working conditions as part of the changes to come into effect from January. The concerns voiced by IMPACT have been echoed by other professionals within the health services. It is a poor sign when any Government service loses the confidence of those responsible for its day-to-day running and that lack of confidence will not be eased by the proposals in the Bill. The Department needs to listen more to those who work at the coal face within the health services and involve them directly in any proposed reforms rather than farming it out to consultants who appear to have a rather narrow definition of the verb "to consult".

The implications of the decision made by IMPACT may be serious as the union now has an overwhelming mandate to authorise industrial action. This must act as a red light to the Department to pause before going ahead with its proposals until it has fully explained the implications of the changes and inserted the necessary democratic mechanisms to ensure the concerns of those who work in the sector and of those who utilise these services are fully addressed.

The alienation of health service workers is another consequence of centralisation and the withdrawal of local accountability. At least the old health boards had some mechanism whereby workers representatives had an input into the decision-making process and many problems could be addressed at local level with the direct involvement of those concerned. Removing this increases the level of suspicion and potential conflict that can, as we have already seen, lead to issues quickly escalating into large-scale disputes, which might otherwise have been resolved. The consultative fora proposed in the Bill are a poor substitute for genuine involvement and consultation. For these reasons and others, I with the other Sinn Féin Deputies oppose the Bill.

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