Bernard Durkan (Kildare North, Fine Gael)

I disagree with the concept and structure of the Bill. I disagree strongly with the views expressed by those who believe, rightly as far as they are concerned, that this Bill is the panacea to the health problems. I do not agree with the notion that the abolition of the health boards was the answer to the maiden's prayer. It was the issue the Minister seized upon to extricate himself from a difficult position before the local elections. It was the Barabas handed to the multitudes before the elections and sacrificed and was a populist course of action but it served no useful purpose whatsoever. What I strongly disagree with is that there is absolutely no accountability so far as the House is concerned. Power is totally vested in Government. The Government or the Minister no longer have to account to anybody. They do not have to account to the House under any circumstances. Having listened to some of the speakers on the Government side, they appear to think it is a good thing, but I do not agree.

Let us look at what has happened in many areas in recent years. The partnership agreements have essentially moved Opposition and Parliament away completely from the whole area of collective bargaining. The result is that the Executive deals with the various agencies that report to it, but Ministers and the Government do not report to anybody. People can speak about these issues outside the House anytime they wish but they can never speak about them in the House or raise questions about them on the Order of Business. With each passing day less and less democracy is vested in the House and that is sad.

The issue speakers on the other side should have addressed is how did it happen that 35,000 extra staff were employed in the health services in the past four or five years and yet it delivered only 50% of the services delivered heretofore. The answer is in the way it was done. There was a theme called, delivering better Government and delivering better health services and delivering better local government and therein lies the flaw. The Government and the relevant Ministers failed to deliver and did not appear to understand it was the public, the consumer, the patient in this case, who deserved delivery in the first instance. It is the patient who has been left waiting, who has been left on a trolley and who is full of anxiety while awaiting the result of tests. In all areas it was the patient who was left waiting. The service was operated as if it was an employment agency. That is not what the health service is about.

I do not agree with Deputy Cowley who said big is beautiful and that the massive multi-storey hospitals are the answer. They are not and they have not been able to deliver all services. There was a time when the notion of two hospitals on the northside of the city and two hospitals on the southside would deliver all services was current, but it did not work that way. What has been forgotten is that approximately 5,000 beds are missing from the system compared to ten or 11 years ago. What in Heaven's name was the Minister thinking? Where was she going to provide the services previously provided by these 5,000 or 7,000 beds? What thinking was behind the notion that somebody supposed it would be possible to provide them elsewhere?

I was a member of a health board for a long time. A genuine notion arose of deploying patients in psychiatric institutions into the community. This requires money, attention and supervision. In many cases, people who were institutionalised found themselves out on the streets sleeping in the open air, barely subsisting simply because there was no follow-up and because that part of the plan was never put in place. It still has not been followed-up and there are still people sleeping on the streets. As I was driving along the quays in this city this morning, I looked up one particular side-street and saw two people sleeping in the open air, even though this is November and Christmas is approaching.

Let there be no doubt that the original plan was correct. It fell down because it was not followed through. This is also the case in respect of the general health services. The primary care system should be such that we can identify and deal with problems at an early stage and deliver services at a local level, thereby eliminating waiting lists.

The health services have been appraised more than space in the past five to ten years. We have had a series of rescue plans, a one year plan and a three year plan. When the former Minister for Health and Children, Deputy Martin, saw an election looming, he said it would be better to have a ten year plan. This plan was trotted out but did not really draw all the fire away and therefore a number of reports were commissioned, the most recent of which is the Hanly report. There have been more reports on the health service that there have been on the moon. I am not blaming the Minister of State, Deputy Tim O'Malley, but he should note that it is time that somebody called a meeting of all the relevant health specialists and the Minister. They should acknowledge that whatever they have been doing to date has been wrong and that the services have not been delivered. It is a farce.

The idea behind the controversial Hanly report is to shut down services in smaller hospitals and deliver them through a major, centralised delivery service, a conveyor belt system in which a group of highly specialised surgeons will be taking patients off trolleys. This does not work either. Can we not return to the old-fashioned system of dealing with patients' requirements before the other issues? We should consider what happens when a patient is referred from a GP to subsequent stages in the system and how long this takes. This will allow us to redress the problems that exist.

What in Heaven's name can anyone make of the recent resignation of the chief executive of Aer Lingus, Willie Walsh, and his colleagues? This is very serious from the Government's point of view. The company had been turned around from a loss-making to a profit-making position. Mr. Walsh and his colleagues made the unfortunate error of suggesting that there might be a management buyout. As far as I am aware, management buyouts have been encouraged in many other institutions around the country, but Mr. Walsh's suggestion must have been a bridge too far for the Government. It must not have merged properly with the socialism of the Taoiseach, a concept which he has embraced with both arms.

See this speech in context