Barry Andrews (Dún Laoghaire, Fianna Fail)

That is inevitable and is part and parcel of the work we do. Clinical decisions are made by hospital staff, not by councillors on health boards, as the Deputy knows. I make the point that the HSE in its present organisation will inevitably take time to reform. During that period of reform, during which it is difficult to have patience, it will take time to iron out anomalies. We may suffer a political fall-out as a result but that is not as important as whether patients are properly treated.

On the question of industrial relations, the IMO is always blamed by the politicians for all the problems that exist in the health service, which is to take a simplistic view. Let us focus on the facts. The IMO advises its members not to co-operate with the setting up of primary care teams — one of the points being made concerns the development of out-of-hours services. While the Government has invested €60 million, Opposition Deputies and Senators tell it to provide primary care services and ask why it has not been done as it was part of the health care strategy of 2001. I am not suggesting the IMO is to blame. This is a democracy and it is entitled to oppose such policies, but the IMO is a factor in this problem, and a symptom of the problem is the situation in accident and emergency units.

The number of doctor-only medical cards was increased last October by 20%, and 30% in other cases, but the IMO objected to that increase at the Labour Relations Commission. It also objected to discussion on the consultant contract, which is the sine qua non for real reform within the health service. It even refused to take part in talks and, while I stand open to correction, my impression is that it refused to allow Professor Drumm to address its conference. The IMO objected to the introduction of cervical screening at primary care level.

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