Liz McManus (Wicklow, Labour)

Here we are on the second day of the new Dáil session and it is already groundhog day. Nothing has been learned by this Government. Despite PPARS, the leaking tunnel, dodgy Luas tracks and electronic voting, nothing has changed and here we are, yet again, dealing with money that has been misspent and waste and incompetence that could only lie at the door of the Government.

It is clear the Government has known for some weeks that this money has been mismanaged, to put it kindly, within the HSE but we are only hearing about it now. This is the Tánaiste who made the great claim to be outspoken, to tell it as it is and when it happens. However, these attributes seem to disappear the longer she stays in her brief. Even though the Tánaiste is responsible, it was the Minister for Finance who sneaked in here yesterday, told his sorry tale and sneaked out again. The Government has been trying to spin and obfuscate its way out of this matter ever since, as it has done in the past.

The facts are plain. It is clear that the Tánaiste and Minister for Health and Children is floundering. Far from being in charge, she is flailing around and trying to spread a bit of the blame for the latest debacle in a chaotic health system, a chaos that is largely her own responsibility. Even with her latest speech she is unable to answer legitimate questions asked about her stewardship of the health service.

Let us examine the record since she has been in that office. She failed to deal with the accident and emergency crisis despite her grand promises. Her medical card scheme has fallen apart and the scheme for repayments to the elderly is still on ice, yet this is the Minister who insisted on forcing through the establishment of the new regime, the HSE, last January despite the advice of civil servants and the urging of people like myself. She insisted on pushing through legislation and making the Accounting Officer of the HSE the CEO of the administration. At the time, there was no CEO on the horizon, there was only the sight of Professor Halligan scampering away as quickly as he could. The Minister forced through the legislation without debate, leading to a new regime that did not have the preparation and planning necessary for such a major regime change.

In Britain, when changes of that type occur, much more time was given to preparing the transition from one system to another. We are now reaping the whirlwind of a health service managed by two systems, the old and the new. This has led to much bewilderment from people operating the system. I recall the assistant CEO stating that since the establishment of the HSE he had six different job titles. One cannot manage a health service in a professional way when there is such administrative chaos.

The incoherence in the system was not eliminated but exacerbated by the Minister's actions. She overlaid an old system with a new, unfamiliar one. Millions of euro have been lost or unspent as a result. Before we get too tangled up in issues of financial management, let us recall that elderly patients are lying on trolleys in accident and emergency units, hospital wards are filthy and cancer patients have difficulty accessing desperately needed treatment.

The clear message that comes back is that we must build capacity. The pressures on our health service are so great that capacity building is crucial yet €56 million that could have provided new beds, built accident and emergency units or increased capacity in operating theatres remains unspent. The Minister must explain why it was unspent. Why does Professor Drumm point out that the capital programme was not agreed until July? I believe the Minister bears responsibility for delays in delivering the capital programme in 2005. Had there been political leadership to drive the capital programme, no money would have been left in the kitty.

From year to year the capital programme is not spent and this suits the Government as it appears more money is put in each year. Money remains unspent on the most important project in the health service, namely, building capacity. Our population, the elderly population, and our health needs are all growing fast but the element that is not growing fast is capacity. This debacle is further evidence of this lack of growth and this is deeply disturbing to people dependent on the health services.

The Taoiseach has no perception of how deep is the crisis in the health service. He speaks of people being unintelligent if they ask why a relative is lying on a trolley in an accident and emergency unit. This reflects his understanding of the seriousness of the situation.

The simple rules of good governance should be ones this Minister would espouse and understand. The HSE was warned by the Department of Finance last June about the issue of transferring money from capital to current spending. Why did it not heed this warning? What must the Minister tell the HSE so that it understands what is happening? What are the pressures on the HSE that lead to it paying bills for day-to-day spending, even though the Minister cannot tell us which bills these are?

The central point is that a high price has been paid, going back as far as the establishment of the HSE, for the pig-headed approach of the Minister, who drove this project without thought, preparation, foresight or understanding of the implications of bad management. One year later, a little humility would not go astray even if, during the Minister's watch, some €56 million has gone astray.

The Tánaiste promised efficiency, accountability and value for money when she became Minister for Health and Children. The Minister cannot tell us how much the HSE has spent, where the money is gone, how many people are employed in the health service and how much this costs, even though €160 million has been spent on a computer system to find this out.

She has been successful at apportioning responsibility and blame. The Secretary General of the Department is gone and the previous Minster is responsible for so much. This latest incident has happened during her watch and reflects a lack of understanding of how the health system works. We all accept that a change was required in terms of streamlining the system.

The HSE was established without a CEO, which does not make sense at the most basic level. One does not have to be senior management to realise that this creates difficulty. The director of finance vanished very early in the life of the HSE. The disappearance of the director of the hospital authority received much publicity but we do not know why the director of finance left. What are the difficulties in the management of finances in the HSE? I regret we do not have more time as this subject requires much more attention and detailed investigation. I hope the Minister will accept the invitation of the Joint Committee on Health and Children to attend a meeting to address this in more detail.

See this speech in context