Liam Twomey (Wexford, Fine Gael)

I was delighted to be in the House tonight to see the Ministers who were present scratch around for something to say to save their miserable reputations in their Departments. After they uttered their few measly words, they all scurried out of the Chamber rather than stay and listen to what we have to say about them.

In regard to the health service on which I wish to comment, it is amazing that the Tánaiste, who brought a few of her Progressive Democrats colleagues to support her, can come into the House to talk about the Health Service Executive as if it will dramatically change something. The Health Service Executive and its management is made up of the former health boards and their staff and nothing has really changed in that respect. The idea of a changed management structure means nothing more than the positions such staff held have changed. As the Tánaiste raised this issue, I do not see any problem in commenting on it.

There was an able administrator in the Southern Health Board who was put in charge of the information and communications technology unit of the Health Service Executive, the same person who oversaw this PPAR system. One of the findings that might emerge from this debate is the level of expertise this gentleman had in running a complex information technology system for the health service. The Tánaiste pointed out the complexity of this system and referred to the 900 forms of payments. This issue is the Tánaiste's responsibility. That is the reason there is a senior Minister and three Ministers of State in the Department of Health and Children. They are supposed to give direction via the Department of Health and Children to what is happening in the HSE. If there is something seriously wrong with the HSE, it is the Tánaiste's responsibility. That is one point I wish to make.

I also point out to the Tánaiste that in other jurisdictions, such as in America, there are health management agencies which cater for 30 million to 40 million patients rather than numbers such as the 4 million population here. They can use information technology to connect to general practitioners' surgeries, hospitals, laboratories and radiology departments, yet we cannot even pay 100,000 people working in our health service. There is serious problem and it starts at the top with the Tánaiste and the Government because they have allowed this mess to develop. They do not have to go far to find solutions. The Tánaiste needs to do the job properly and not treat taxpayers' money as if it were the Government's slush fund to look after its cronies and party people. That is part of the problem.

It will be nice to hear what the HSE has to say tomorrow. It is bringing in a recommendation of the Hanly report, the dealing with which will take up the time of many of the Fianna Fáil backbenchers over the weekend. This issue is probably far more important to them in terms of trying to save their seats because the Government is not doing anything to help them.

The national treatment purchase fund is the only aspect of the health service that arose in the Comptroller and Auditor General's report, which is surprising considering the mess in accident and emergency departments. As we debate this motion, 250 patients are on trolleys in hospitals throughout the country. Some 30,000 people are anxiously waiting for medical cards and 200,000 are waiting for doctor-only medical cards that were promised last January. The MRSA and many other bugs are rampant in our hospitals, yet the Tánaiste's response to this problem is to issue guidelines that were last issued in 1996. The best she can do is re-issue a set of guidelines.

On the issue of the illegal nursing home charges, we discovered during a debate in the Oireachtas Joint Committee on Health and Children that nobody was responsible for that and that it just happened. Now €150 million of taxpayers' money has gone down the drain on PPARS. It does not matter what excuses the Taoiseach made in that regard. Perhaps it is difficult for him because he was not quite sure whether it was an information technology project, but he changed his mind, read his brief and realised it was an information technology project. At least there is some hope that matters will move on from there. However, what is happening at Government level has a considerable bearing on the misery inflicted on many children and vulnerable communities in our country. It is a disgrace.

I wish to deal with the national treatment purchase fund. Of the 23,000 patients who were treated under that fund, and no doubt they were delighted to have been treated, half of them will not have noticed that they were treated under it because they will have been treated in public hospitals while one third will have been treated in the hospital where their names were on the waiting list. It is possible that they will have been treated by the same consultant under whose name they were.

This report exposes one of the first lies about the national treatment purchase fund. In 2002, medical advice to the fund stated that there can be nothing more frustrating for a group of consultants than to see a contraction in the public hospital service and money being diverted to the private system. In the past three years that has reached a double contradiction because the public health service is still starved of money and other resources, while the same hospitals and, in many cases, the same consultants are doing between one third and half of all procedures under national treatment purchase fund. There is something wrong about that. This report poses two questions which should be answered, namely, how a hospital with a long waiting list for operations can have the spare capacity to do private work and whether these hospitals, if funded properly, could do the same work. Is the national treatment purchase fund nothing more than a photo opportunity for Ministers? This is a serious question.

I will use general practice as an example to explain what is happening under the national treatment purchase fund because people might understand it better. Imagine if GPs approached the Government and said they were finding it difficult to see their medical card patients and the Government responded by indicating it would set up a medical card treatment purchase fund under which the patients they could not get to see would be seen by a private doctor. Three years later someone suggests that the system be examined. They find a third of those patients are being treated by the doctor being paid for their medical card capitation. Half of all those patients are being treated by doctors who look after the medical card patients. That is an outright scandal and that is how stupid it looks when put in terms that people can understand.

I also want to know what is going on as regards orthopaedic surgery. Some 83% of the cases for hip replacement under the national treatment purchase fund were carried out in public hospitals. Some 45% of them were carried out in the hospitals where the patients were on waiting lists for orthopaedic surgery. There is something seriously wrong when my patients are waiting for anywhere between three and five years to get to the outpatient clinic of the same consultant. These are the types of anomalies Deputy Curran was very worried about earlier, concerned as he was that this report was being debated before it goes to the committee. It is far more important that he should investigate why such anomalies exist within the system.

The national treatment purchase fund is another lie. A lie is a deliberate deception. That is the issue as regards the three months waiting time.

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