John Moloney (Laois-Offaly, Fianna Fail)

I wish the Tánaiste every success in her new portfolio. Health is clearly one of the most serious issues facing the Government and we all look forward to the successful tackling of the issues. I have every confidence that the Tánaiste will achieve that.

This Bill contains much that we could spend days analysing. Most of the issues that create difficulties for health board members are addressed in this Bill. Many speakers have referred to the boards competing with each other and anyone who has served on a health board knows the problems that causes. Boards compete with each other when the Estimates are published to reach the premier league by implementing policies that cause difficulties in adjoining health board areas.

County councillors feel they are being ignored in this legislation but I take heart from the fact that the HSE will manage and deliver health services on a national basis as a single unified system replacing the health board structure. That is where I part company from people who have criticised the Bill on the grounds that it has not taken local public representatives into account. This Bill will go a long way to help deliver localised and regionalised services. I remember the difficulties of many health board members over the years who were mandated by their own local county structures to support health facilities on a county basis rather than take into account the need for regional services that will provide a far better level of service, attract medical experts and deal with more patients.

The independent advice given to the National Cancer Forum by Professor Fennelly was often ignored as a result of political pressure from local interest groups to ensure the county flag was flown. My health board area had to park essential cancer services for four years when funding was provided by the Minister but members of the board felt they were letting down their county and challenged the independent medical advice, thereby delaying the process. In the meantime people were attending Dublin clinics, often travelling there in unsuitable transport and enduring long delays while we waited for a High Court judgment.

I welcome this legislation because it transfers decision making to the HSE and makes it responsible for service delivery. If we recognise the major contribution this could make in a short time with adequate funding and services put in place in the regions, we will see tremendous improvements in essential services. I appeal to former health board members to recognise that their contribution can be considered in the regional structures. It is time to put health ahead of politics and realise if the funding is in place, we should grasp the opportunities it presents.

The Tánaiste stated that there is no black hole in the health service, as Deputy Cowley mentioned.

I experience some concern, however, when asked where all the money has gone, as if this were a spending spree without a definite commitment or endgame in prospect. People are often bored by statistics, especially when a few points are clarified. As I reflect on the 1980s when health boards were trying to put budgets together to provide essential frontline services, nobody can challenge the fact that those days are gone. Health boards have not had difficulty in securing adequate day-to-day finance from the Department of Health and Children over recent years. However, when one examines where the money has gone, quite clearly it has paid for the hiring of 8,200 nurses since this Administration came into being in 1997, 438 new consultants, 661 occupational therapists, 456 physiotherapists and 200 speech and language therapists. That is the reality of where the money has gone. To appreciate specifically where the money has gone, it must be recognised as well that local, general or regional hospitals cannot cope without those services.

Money has also gone to the largest hospital modernisation programme in the history of the State as well as to the dramatic increase in care places for people with disabilities. I congratulate the former Minister for Health and Children, Deputy Cowen, who is from my constituency and who recognised early in his time in that Department the need to ring-fence specific funding for the disability sector. That is another prominent and welcome feature of the health budget.

We must recognise, however, where problems exist. We have seen significant investment in areas that have contributed to early death. I refer specifically to cancer treatment. As we embrace and recognise the potential in this Bill, we must concede that mistakes have been made over the years. The greatest mistake was relying on and expecting a 30 year old system created in 1973 or 1974 to deliver in present-day conditions when there has been an increase in demand for specific specialties within hospitals. I recall that the demands on my local general hospital in Portlaoise years ago were relatively limited in scale compared with the level of services now being delivered there. I see this Bill as an attempt to manage and deliver these services on a national basis, while containing the responsibility for this initiative within one structure.

Many people have asserted that public representatives will have no direct input, but I do not agree. If we are expected to deliver First World services that are second to none, we cannot be handcuffed into believing that one must deliver for one's own county first and, by failing to do so——

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