John Gormley (Dublin South East, Green Party)

As someone who subscribes to a belief in less state interference and smaller bureaucracies, the Minister has managed to massively increase the amount of bureaucracy in the health service. As a result of the establishment of the Health Service Executive, bureaucracy in the health service has increased and the level of information available has reduced.

As regards health information, ostensibly the subject of this debate, Deputies receive less information in response to parliamentary questions than they received prior to the establishment of the HSE. The Minister may recall that during the Second and Committee Stage debates on the legislation establishing the HSE, I repeatedly stated it would lead to less accountability. My position has been vindicated and I could give countless examples of the problem. For instance, it is extraordinary that I have been waiting for two months for replies to parliamentary questions which I tabled on medical card entitlements and costings.

Having contacted staff in the parliamentary division of the Health Service Executive, all of whom have been co-operative and polite, I do not point a finger at particular HSE employees or officials in the Department but I must point a finger at the Minister because she bears ultimate responsibility. I hope she agrees that it is not acceptable that Members must wait for months for information. When we contact the parliamentary division of the HSE, we are referred to the Department. The mantra in the Minister's replies to parliamentary questions is that the matter raised by a Deputy has been referred to the Health Service Executive. Deputies who then contact the HSE with simple questions on issues such as hospital food do not receive replies and must spend considerable time trying to track down the relevant information. The bureaucracy becomes farcical when one is told by the Department that it must refer the matter to the HSE for a final time in order that it can be clarified. Does the Minister accept that this is terribly frustrating for Deputies, perhaps deliberately so? As I indicated in earlier debates, perhaps the reason for establishing the HSE was to have it act as the Minister's mudguard. Many people in the HSE are probably getting somewhat annoyed, if we consider the leak from the HSE concerning the cancer strategy. As far as they are concerned the cancer strategy is simply not deliverable on time. The Minister said subsequently that the information was historic and needed to be updated but that is not the impression given by the leaked memo. Looking at the facts, it seems the Minister's cancer strategy was not properly costed. According to the statistics, cancer rates will increase by 90% in 15 years. How can the Minister deal with that given the budget deficit attached to the cancer strategy? We are coming up to an election and the Minister wants to say it is deliverable, but clearly it is not.

Previous speakers have referred to the accident and emergency situation. I get the clear impression, mostly from anecdotal evidence but from fairly reliable sources also, that everything is now being done to ensure people are not on trolleys. This is not being done by increasing capacity, however, but by cancelling elective surgery. In addition, older people are inappropriately being pushed out of hospital into a step-down facility. They may then have to be re-admitted to hospital because they were prematurely discharged. Those are the sorts of stories I am hearing. Neither the Minister nor Professor Brendan Drumm are prepared to deal with the main issue, which is the capacity problem. They are quite prepared instead to allow the private sector to provide the solution by giving generous tax breaks but, thus far, that sector has not done so. In previous incarnations, people currently in the private health sector may have been beef barons or car salesmen. They are now looking to make a quick buck in the health sector. They are not from the caring professions. We ought to have learned from the experience of those who cared for older people in our community. We should see how the elderly were treated by people from the business sector who wanted to make money. They treated older people as a commodity. We can now see that health provision itself is being treated as a commodity. This ties in with the Minister's own neo-liberal PD philosophy, which treats practically everything in life as a commodity. Health cannot be treated in this way, however. The Minister ought to have learned from the failure of trying to introduce competition into the health insurance market. Even the Minister must admit that it has been a fiasco. Risk equalisation, which the Minister wanted to introduce, has not worked and was rejected by BUPA. How will we proceed with this matter? I did not hear any complaints about how the VHI operated as a stand alone company. It seemed that people could obtain insurance and gain access to a hospital at the time. Deputy Ó Caoláin stated previously that people purchase private health insurance because they want to skip hospital queues since our public health services have been allowed to run down.

The Minister should adopt a simple approach and deal with the capacity problem, but she is not prepared to do that. The capacity problem is a central issue in dealing with the McKinsey report and the critique of the location for the new national children's hospital. It is interesting that everything I raised in a previous priority question to the Minister has turned out to be true. At the time, I said the paediatric experts had not been consulted, while the Minister said on the floor of the Chamber that they had been consulted.

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