Jerry Cowley (Mayo, Independent)

On my first day in the Dáil, I outlined my support for the abolition of the health boards because of the lack of co-ordination and co-operation between them and the way in which they compete with each other. They applied health schemes and interpreted vaccination policy differently, used incompatible software and duplicated administrative functions. The situation, however, has gone full circle and there is now a major democratic deficit. Reform is a good idea but it is only one aspect of the equation. Funding is fundamental and the Tánaiste's statement that there is no black hole in the health services is a good starting point.

This Bill, however, must be amended to allow for democracy. People expect and demand value for money, but there should also be a proper health service. Health apartheid in the service is a severe problem.

This Bill sidelines the Department of Health and Children from the day-to-day running of the health services, which is not a bad thing. We already know about decisions made by the Department, the health boards and other bodies which create a two tier system, such as giving BreastCheck to only half the country in 2000 and leaving the other half to wait until 2007. A breast screening programme has been in place in Northern Ireland since 1993 and death rates have been reduced by 20%. There is no reason to delay a service until 2007 when 65 people in the south west are dying from breast cancer every year.

Today in Mayo a woman will appeal on the radio for someone to take her father's place because he is unable to go to Galway for dialysis treatment. He cannot get into a state-of-the-art dialysis unit in his own town as a result of bad planning. Only half those who need dialysis receive it. The national average for dialysis requirement is 600 to 800 people per million but only 256 people per million can get dialysis in Mayo, a situation that has an impact on every one of those people.

The health service has been starved of resources. The new legislation will make the Minister for Health and Children the kingpin. As the song says, "one is the loneliest number", and the Minister will be lonely, as will the chief executive officer of the new health executive. It is no wonder Professor Aidan Halligan thought twice about it. The Minister for Health and Children, however, is granted major powers in this Bill and, if amendments are accepted to it and she receives the necessary funding, mechanisms to address the problems in the health service will be put in place.

The power in the Bill is surprising. The Minister's bidding will be done through corporate plans that she can send back if she does not like them. Under section 21, neither she nor the chief executive officer of the Health Service Executive may be questioned by an Oireachtas committee. The CEO and the Minister should watch their heads or they will end up like those in the French Revolution who lost theirs. The Eastern Regional Health Authority crumbled because there was a need to put something between the people and the Minister but the people did not support it.

This agenda suits centralisation and the rail-roading through of new plans and policies. The Minister will select the 11 board members. Where are the medics? These people are all accountants and this is another quango, as I said on the Health (Amendment) Bill 2004. Just as it is difficult to get information from or influence in any way the NRA, the Minister will inform the House that she has no function and the Department will say the same. Who will have any input to ensure the people's bidding is done? Who will force the people's agenda?

This is a cynical Bill which is about money and implementing reports and cutbacks. In the new Bill, the Minister for Finance will decide who will be hired and who will be fired. Where will this end? I hope there will be an end to the current system of health apartheid and I wish the Minister for Health and Children well but she must listen to the people and address the democratic deficit in the Bill.

See this speech in context