John McGuinness (Carlow-Kilkenny, Fianna Fail)

I am sure the Minister will be somewhat relieved that the discussion has come back to this side of the House. The debate so far has centred on a number of negative aspects of the HSE and of this legislation, but I commend the Minister for bringing the Bill before the House. As I have done publicly on many occasions, I also commend her for taking on the position of Minister for Health and Children. She has approached the role proactively with a willingness to take on the challenge required to turn around a health service that, without a shadow of doubt, is ailing. It requires increased and ongoing funding. As far as her job is concerned, the Minister is determined to try to change the culture, structure, direction and focus of an old administrative system for health. At the same time, she is trying to improve front-line services and make available the necessary capital funding throughout the country to ensure buildings can house the increased number of services. In addition to ensuring the necessary expertise is available, the patient must be central to everything that is done by way of legislative change in the health sector.

While I am sure we will not find common ground on all health service areas, there are some where the Opposition could engage with the Minister to ensure a Tallaght-type strategy. As long as there are political divisions over health, there will always be a risk that it will be more difficult for the policies of the Minister, the Government or the HSE to succeed. It becomes even more difficult to change the existing culture when political differences are factored into the overall changes that are required. I encourage the Opposition not just to roll out the different cases, as I could do from this side of the House. We all have our case load and understand what is going wrong within the HSE and the Department of Health and Children. However, to stand up to speak without having a tangible, workable solution to some of the issues embedded in the system that need to be changed is a clear indication the Opposition is without a policy. I do not deny changes are needed but I believe we have a Minister who will ensure the finance is made available and who has the ability to apply that finance through the HSE to ensure real delivery for the patient at the end of the line.

There has been a change with regard to how the health services are administered from the time of the old health boards to the new HSE. Some Members of the House — we have heard them already — will harp back to the days of the old health board system and suggest it was almost better than the current HSE system, although it has not been in place long enough to allow it to develop to the extent it should. The old health board system simply did not work. The members of the boards did not fix the system or come up with imaginative policies at regional level to change the speed of delivery in the context of services to the patient. They failed and that is why we had the debate about the changes that were necessary, which led to the establishment of the HSE.

It is an easy way out for the Opposition to point the finger at every turn and claim the Minister is at fault. The example given earlier by Deputy Twomey was that the Bill does not tackle MRSA. It will take more than legislation to tackle the issue of MRSA or of providing an efficient health service. It is not achieved that easily. To make it sound simple is to miss the point of assessing the HSE under Professor Brendan Drumm and contributing to its success.

This is not to suggest there is no need for an ongoing debate and ongoing change, and perhaps some of the decisions taken by the HSE were wrong or fell short of the mark in some way. However, in this debate the HSE is seen as being on one side with the Department and the role of the Minister on the other. One can define the role of the Minister as one who oversees the health service and as the person with whom the buck stops. One can point the finger at every turn but that would be wrong because, below the Minister, there is a very well paid group of managers in the HSE's management system. If there has been an error or bad judgment, it is their judgment and professionalism which should be called into question. This is not to defend the Minister or leave her position to one side. It is about identifying where the system went wrong, identifying responsibility and making a manager who is well paid admit he or she made a mistake, as Dr. Gary Courtney and St. Luke's Hospital, Kilkenny, did in regard to Rosie's case, which was a positive development.

Like Opposition speakers who referred to Rosie, I too feel sorry for her and would like to have seen her case turn out otherwise, as would all of us. What should we do? I do not blame the Minister. I examine the system and ask what happened and how we can improve it. The improvement in that system has been identified by Dr. Courtney and a project is currently under construction on the St. Luke's Hospital campus. I accept that more needs to be done and that finance is needed for the project that is being undertaken to improve that aspect of the service.

The HSE is inefficient in delivering funding to hospitals such as St. Luke's. It is paying lip service when it suggests it will reward excellence. Rewarding excellence means putting one's money where one's mouth is. It means directing funding specifically to a hospital that is innovative in its approach to the various complex health care problems and openly supporting those who support change within the HSE. If we do not do this, the group of staff who are not rewarded will not be encouraged to introduce change, ensure it is patient focused and cost effective, and deliver either an old service in a new way or a new service in new surroundings. That is what the HSE needs to do in this regard.

Holding up St. Luke's Hospital in Kilkenny as a model that works efficiently, and as one that should be rewarded, is not good enough unless the required funding is invested in the hospital. A current project at the hospital, which aims to correct a particular problem, will cost €500,000. If I was to ask anything of the Minister, it is that this money be found and immediately directed to that problem, thereby providing the infrastructure to deliver the service and remove a problem within a hospital that is functioning properly.

The question of communication with the HSE is a major issue in the House. During the debate on the HSE and its structure, I raised this issue in the context of many other Bills that have passed through the House. Members of the House seem to believe that placing an organisation an arm's length away will in some way ensure it will not become contaminated by the political system.

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