Liz McManus (Wicklow, Labour)

I wish to share time with Deputy Burton.

I welcome this important debate. The work of the Comptroller and Auditor General is vital for ensuring good governance as it provides a reality check, particularly for a Government whose hallmark is profligacy and waste. It also shows the gulf that can open between ministerial rhetoric and ministerial practice and nowhere is that gulf more evident than in the area of health.

When the Minister, Deputy Harney, took office she insisted inexplicably on rushing legislation through the House to establish the Health Service Executive by 1 January 2005. There was no proper planning, preparation or even a chief executive officer in place. However, the Minister blithely promised this new structure would provide "better outcomes for patients and better value for taxpayers' money". We have seen neither. We were promised:

The lines of responsibility and accountability are clear in this legislation, the clearest they will ever have been in health administration in this country. That will make a real difference to the quality of health services provided for our people.

Two years on, the Minister for Health and Children cannot even tell us how many people are employed in the health service. What we have is bad value for money and almost zero accountability. The Minister presided over a messy, inarticulate transformation of our most important public service. Any regional local accountability which existed prior to the establishment of the HSE has disappeared. Media access is limited and local decision making has been greatly eroded. Parliamentary questions are now diverted from the Minister to the Health Service Executive. An answer eventually makes its way back to a Deputy's office in the form of a private letter and there is no public record ensuring a further lack of accountability. I have waited for as long as four months for a response to a question and other Deputies have waited even longer.

Were it not for the annual Comptroller and Auditor General's reports, the full extent of the waste and disregard for providing taxpayers with value for money may never be exposed. Mr. Purcell said he feels his annual report needs to be brought to public attention "in the interests of transparency and accountability". His oversight role is particularly important in a health service which is so deficient in these safeguards.

The saga of the HSE computer system, PPARS, which does not work despite having more than €150 million spent on it is just the latest but also perhaps the most stark example of the extraordinarily cavalier approach of this Government to taxpayers' money. In the past week we have discovered that the Minister and the Health Service Executive are commissioning yet another review of PPARS. The previous review was carried out when Professor Drumm called a halt to its development in November 2005. We have now been told that a further review is required which will conveniently extend beyond the date of the next general election. I smell a rat. We do not know who will carry out this review and how much it will cost but we know that in terms of the timeframe, it will let this Government off the hook. I call on the Minister for Health and Children to prove me wrong by ensuring this review is carried out within three instead of nine months, although frankly at the rate skeletons are tumbling out of the cupboard, we do not have a guarantee the Government will last three months.

In regard to the nursing home repayments, had the previous Minister for Health and Children, Deputy Martin, been doing his job properly and reading the brief, this problem would have been identified much earlier and taxpayers would not now be faced with such a massive repayments bill.

In terms of medical cards for people aged over 70, if there had been any kind of cost benefit analysis, any kind of constructive negotiations with the doctors or an actual study of the number of recipients, perhaps the cost would not have jumped from an estimated €19 million to an estimated additional annual cost of €51 million.

This year, the Comptroller and Auditor General's report highlights further issues surrounding the way public funds are spent in health. There is an overspend with regard to discretionary medical cards. These are medical cards that are given to individuals that are over the income guidelines for a medical card but who, by reason of illness, may face large medical bills. The main problem with the discretionary medical card is that they are not being administered in a uniform way across the country, thereby creating further geographical inequalities.

The definition of a discretionary medical card has never been agreed. A lack of clarity around these cards means that the total figures from the HSE and the Department of Health and Children vary significantly, resulting in doctors being paid in excess of what they are due. This has been highlighted in the current report, which states:

The remuneration of doctors for medical cards assumes the existence of 75,000 discretionary cards. The figures provided by the HSE regions suggest the real figure may be far lower, perhaps as low as 45,600. The figure recorded on the Primary Care Reimbursement Service (PCRS) database is lower still at 36,000. The Accounting Officer has indicated that the ongoing validation exercise in all HSE regions is likely to reveal that the figure is between 65,000 and 68,000.

Despite the expenditure of €10.046 million in 2005 in respect of 75,000 cards, it now emerges that the number of actual cards is much lower. It is worth remembering that this Government promised 200,000 medical cards but did not deliver them. Then there was a new promise of 200,000 GP-only cards and less that 30,000 have materialised. I suppose this is one way that the Government makes up its losses. It wastes money in one area and saves money by reneging on promises made to low income families who cannot afford to go to their family doctor.

The record on the publication of reports by the Minister for Health and Children is also a matter of concern. For example, the post mortem inquiry into the removal and retention of organs from children who died began in 2000 and continued until December 2005. The cost was originally estimated to be in the order of €1.9 million. The final cost of the inquiry and report came to almost €14 million. That is approximately seven times over budget and ultimately the report did not satisfy those who were most directly concerned.

I have asked the Minister for Health and Children many times about the following issue but the replies have not been satisfactory. A report into alleged abuse at the Brothers of Charity home in Kilcornan, County Galway, that first commenced in 1999 remains unpublished. We are now in the extraordinary position that seven years later we are waiting for a review of the original inquiry. The individuals concerned are people with intellectual disability — the most vulnerable in society who are entitled to see justice but have been blocked from getting it. Likewise, the Leas Cross report has not been published even though we have made it very clear to the Minister that she has the power to do so.

Ministers are custodians of taxpayers' money. When reports are commissioned, it should not be unusual that they are produced on time and on budget. This Government has failed to meet this test among others, as has been exposed by the Comptroller and Auditor General. I do not believe the Government is capable of doing any better. It is not capable of reforming itself. What is required is a fresh start and that can only come by way of a general election.

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