Seán Crowe (Dublin South West, Sinn Fein)

The Minister for Health and Children, Deputy Harney, talked tough in her statement when she published the Bill last month. She said we were getting tough on standards and on enforcing standards and that an independent organisation with teeth was being created.

As someone who meets every week people who have experienced the unfairness and the lack of proper resources in our health services, I find this kind of hype from the Minister hard to stomach. Fianna Fáil and the Progressive Democrats have been in Government for the past nine and a half years and have had almost a decade to comprehensively reform the health service and ensure that people receive the health care they need. Instead, three Ministers for Health and Children in succession have presided over a system that has failed the people.

This is not a criticism of the great work being done within the system by health care workers who have to provide care in the context of a fundamentally flawed system that fails to give all patients equal access on the basis of need. In April 2006, the latest date for which figures are available, a quarter of patients waiting for surgical procedures in the State had been waiting for more than a year and more than one third had been waiting for between six and 12 months. These patients are predominantly public patients. Those who can afford private health care have fast-track access to surgery. We have two waiting lists, public and private, which is an obscenity. Under our system, the lives of some patients are valued more highly than others. Wealth buys health here. Otherwise, patients are left on a waiting list or on a chair or trolley in accident and emergency units. The Bill will not change any of this. The Health Information and Quality Authority can set standards and monitor implementation, but it cannot challenge the two-tier system that gives better access to services to people in the private health care sector. This is not rights-based legislation.

None of these issues was addressed by the Minister in her opening speech. She concentrated almost totally on the part of the Bill dealing with the chief inspector of social services and on the role of the office in regulating residential services, including nursing homes. However, the Health Information and Quality Authority is tasked in the Bill with setting standards and monitoring compliance with standards for all services provided by the Health Service Executive or on its behalf. How this will be done is unclear.

The Leas Cross scandal exposed how many vulnerable older people suffered as a result of not implementing existing legislation and because of the lack of stronger and tougher legislation. Unfortunately, the latest nursing home inspection reports, published by the HSE, show that the Leas Cross scandal was not an isolated incident. They contain a litany of failures that put the health and safety of residents of nursing homes in danger. These include staff being aggressive with patients and compelling them to take medication; a night nurse left alone with responsibility for 41 patients, most of whom were classified as maximum dependency; used incontinence pads left in open bins; a reception area used to treat a maximum dependency patient; a lone nurse caring for 46 patients overnight; inadequate and improper use of prescriptions and medicines; and dirty and badly maintained premises. The reports also give and account of some homes' front doors being left wide open and report concerns with regard to patients' access to clean water.

The HSE should have published 430 reports on nursing homes by end-December 2006, but only 230 have been published so far. We must wait anxiously to discover to what other horrors some of our older citizens are subjected. Will the Bill address these problems? I doubt it because it is not rights-based legislation and it is unclear how the inspectorate and the authority will relate to individual patients. How will the authority relate to acute hospital and primary care services? Many people justifiably suspect that what is being set up in the Bill is another layer of bureaucracy. It was highlighted recently that the HSE has 3,000 administrative staff, yet it pays millions to outside consultancy firms to advise it on its finances. This is farcical.

Some speakers have mentioned that the Government's cancer strategy is in disarray. It is a mess brought about by neglect and mismanagement on the part of successive Governments and Ministers. The same can be said with regard to the debacle of the proposed national children's hospital. On that issue there has been a total lack of clarity and proper planning, and repeated delays in providing the care and facilities that children so desperately need. Tallaght Hospital incorporates a children's hospital now in limbo. We do not know what services will be left in Tallaght or what will happen with Crumlin. There is a lack of satellite services, but we do not know which will remain. What are parents to do regarding their children? We currently have three accident and emergency departments in Dublin but do not know where they will go in future.

Sinn Féin takes a rights-based approach to health. We believe fundamentally that health care is a right and also that social and economic equality, and therefore the elimination of poverty, the achievement of full employment on fair terms and equal access to essential public services, is a necessary precondition for the vindication of equal rights in the area. This Bill is not in the same ball park regarding health care rights, and that is simply not good enough.

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