Gay Mitchell (Dublin South Central, Fine Gael)

I wish to say a few words about accountability and transparency. I wish to speak first about occupational therapy assessments for older people who need not be institutionalised and could well be at home and have a comfortable life there if simple fittings, such as stair rails and bath rails, were installed. However, many people cannot get assistance to have these fittings installed, at least in Dublin, because of the three-year waiting list to see an occupational therapist. This is crazy. Something has to be done to clear that arrears list.

General practitioners should be allowed certify that such fittings are necessary and urgent and should be installed or there should be some process whereby one can purchase privately an occupational therapists' report, or some such method. This Stalinist economic control system cannot continue.

I am aware occupational therapists do not like me raising this issue and they think I am a terrible man for doing so. One occupational therapist manager wrote to me recently saying nothing could be done on a case that needed special and urgent attention because everybody had to be dealt with in order. That is not what happens in local authorities. Where there is a particular urgency, the services of an occupational therapist is brought in to allow something urgent to be done outside of the norm. What the person who wrote to me does not know is that I know her name is on the list for the local authority and that she does the nixer for the local authority. Yet she has told me that those in the Health Service Executive have to wait on the list and that this is an important principle. The principle is that while we continue to operate this system old people are falling down stairs.

A lady in Inchicore fell down the stairs and ended up in hospital. She is in need of a wheelchair because she had to wait for assessment for occupational therapy to have a few rails installed. This is not all about institutional issues. There are ways and means of keeping people out of institutions if we put our minds to it. It is time we looked at these lists. A three-year waiting list for assessment for occupational therapy is not acceptable. Neither is it acceptable that occupational therapists should be the people in charge of assessing whether this is a fair and reasonable system.

I have heard much about representations made by Deputies. We live in a democracy. Nobody has any money to spend on public services aside from what this House takes from the people's pockets, under the authority they have given us and which we in turn entrust to Government authorities and agencies. Like the Minister, I vote in this House annually to take that money from the people and to provide it for these services.

I speak on behalf of the shareholder or the owner of these organisations and I am entitled to question a three year waiting list for occupational therapy. Why is it that when there is an exceptional case there is no compassionate system for dealing with it? Why must it all end up in some sort of institutional arrangement and huge waiting lists? That is unacceptable. What is wrong is that there is no accountability. This would not be accepted in the private sector. This system is not operated in local authorities because there is compassion and interaction between public representatives and officials, who can arrive at real solutions to immediate problems. It is true that some people are left to wait, but they are the people who are capable of waiting. If somebody turns up with an urgent problem, that urgency should be addressed.

The Minister and I, as public representatives, know there are always exceptional cases. Over the years I have found that any rigid rules we made always left hard cases on the wrong side of the line. When I asked people why such things happened they would reply: "Deputy or councillor, you made the rules." It was better to have some discretion left to public officials, even if it was open to abuse, than to have people suffering injustice as a result of being left on the wrong side of the line. I urge the Minister to take this issue on board and to examine why people are waiting so long for occupational therapy and why there is an absence of accountability and transparency.

The Bill seeks to address this in certain ways. However, I can give another example of the absence of accountability and transparency. It is the issue of the location of the new children's hospital. I represent a constituency that includes the Crumlin area and I am a former member of the committee of management of the board of the hospital. Of course, I want the hospital to remain where it is. I have an emotional attachment to it, like everybody else in the locality. However, I took the remit of the task force seriously. I consulted people, went to look at possible sites and met with members of the task force. I do not know if any other Deputy from Dublin South-Central did that; I doubt it.

When I met the task force my first direct question was whether the decision had already been made to locate the hospital at the Mater Hospital site. The reply was that this was certainly not the case, that the task force had an open mind and that it could be sited at any hospital in Dublin that applied. There were certain issues involved with regard to locating it with an adult teaching hospital. On that basis, I spoke to the task force about the project. I said I would like the hospital to remain on the Crumlin site but I also said something that probably no other Deputy had said, that I was prepared to see a hospital in my constituency moved if it was in the interests of children. However, if the task force was considering moving the hospital, I asked it to explain why it would be moved away from the M50.

Let us examine the site of Our Lady's Hospital for Sick Children in Crumlin. An application for planning permission was made by senior consultants, including from the Mater Hospital, to locate a private consultancy facility on that site. The reason is that it is so easy to access from the M50. It could be accessed from any part of Dublin and any part of the country. They wanted to locate this facility beside the children's hospital. The only reason it did not go ahead was that the planning application was unsuccessful.

Down the road are two hospitals which are also accessible from the M50, St. James's Hospital and the Coombe Hospital. The Coombe Hospital is adjacent to St. Teresa's Gardens, which is about to be knocked down, and the old Player Wills site which is due to be redeveloped. This was a golden opportunity to redevelop the children's hospital near a women's hospital, as had occurred with two facilities in Canada according to the preliminary report. Would that not be an ideal location for a children's hospital?

What about across the road in St. James's Hospital, which is joined at the hip, so to speak, to the Coombe Hospital? St. James's Hospital is on an enormous site; I believe it is approximately 24 hectares. The site at the Mater Hospital is approximately six hectares. I am not definite about the figures but they are of that order. The Luas line runs through St. James's Hospital. The hospital is a five minute walk from the Coombe Hospital. The Luas line goes to Heuston Station and Connolly Station and, therefore, connects with the DART. This hospital is connected to the DART, Connolly Station and Heuston Station and is near the M50. It is a teaching hospital on a huge site.

According to the task force the choice came down to the Mater Hospital and St. James's Hospital. The task force never said that the Mater was the better site but that the hospital would probably be built quicker there. After the event, Dr. Drumm said that the metro would go to the Mater Hospital. However, the decision on the metro was not made until after the decision on the hospital. On the day that an editorial appeared in The Irish Times stating that the decision had been made and we should proceed with it, I rang the editor's office. I had never done this previously. I told the office that the editorial was a load of nonsense and that the newspaper should be examining how this decision was made. I did that on the day of the women's marathon; I am not sure what date it was.

I do not easily ring up the editor's office in The Irish Times. I have a great deal of time for the editor and for the newspaper's general policy of openness. Now, however, I believe investigative journalism is this country has gone to sleep with regard to this decision making process. How did we arrive at deciding on the Mater Hospital site for a national children's hospital? If there was an international, independent review of this decision and it arrived at the conclusion that the Mater Hospital is the correct site, I would shut up and say nothing more about it. However, I do not believe this was the best decision in the interests of children. I cannot understand how the Mater Hospital site was selected in a choice between it and St. James's Hospital.

One of the reasons given is that the hospital can be built quickly. What is the hurry? Why must it be built quickly? This hospital will supposedly be in existence for a couple of hundred years. Is it necessary to build a hospital that is not the best simply to have it built a few months earlier? Is that the right thing to do? I do not believe so.

I also rang "Morning Ireland" on the morning the decision was announced. A doctor from Temple Street Hospital was on the programme. I told the programme makers that the decision did not stand up. RTE returned to the issue on the "News at One" but this time the bold Dr. Drumm was on the radio to explain why it was such a wonderful decision. I am sure Dr. Drumm is a very good paediatrician and I hope he is a good chief executive, but he is not a politician. The late Judge Sean O'Leary criticised his colleagues in the Judiciary for intruding into the area of politics. I must also criticise Dr. Drumm; I believe he has crossed the line and entered the political arena.

The person who should explain this issue is the Minister for Health and Children. That is what she is elected, appointed and paid to do, not to put a doctor forward to explain it. No paediatrician was involved in the decision to locate this hospital. It is an extraordinary lapse. Furthermore, my colleague, Senator Brian Hayes, discovered from an Adjournment debate in the Seanad that no point scoring system was used to assess this decision, as was used for other projects. How was this decision arrived at? Where is the accountability and transparency if such decisions cannot be explained to the House?

We simply have the Minister for Health and Children stating that the decision is made. She wants to be seen to be the hard woman backing the Taoiseach, saying the PDs will not let Fianna Fáil down, and having done a deal for Government will stick by it. That is not what this is about. This about the health of children. It is not about politicians or votes or doctors. It is about children. What is the problem with taking a couple of months to have somebody examine this case and saying to everybody beforehand that whatever the outcome of the independent assessment that will be the basis on which the decision will be made, regardless of what politicians or doctors say, and that it will be accepted? If it is confirmed that the Mater Hospital site should be used, let us get on with it and have no further delay. In the interests of transparency, the decision should be reviewed internationally.

It may be a coincidence that the Taoiseach is a former employee of the Mater Hospital. It may be a coincidence that, as one doctor stated, he is invited to the Mater Hospital to unveil every pane of glass that is put in. It may be a coincidence that the hospital is in the Taoiseach's constituency. Perhaps I am being unfair to him in raising this. However, in the interests of children and in the interests of the people who elected me to this House, it is reasonable for me to raise it. The Taoiseach, described by the late Taoiseach, Charles Haughey, as the most cunning, the most devious of them all, will not leave his fingerprints on this.

Let us put all suspicions to one side. Let the Minister for Health and Children, Deputy Harney, who told us the PDs were in Government to guard against the excesses of Fianna Fáil, stand back from this and say this is not a case of local pleading but a case where people's genuine concerns need to be addressed and that this can be done in a short time. I have no interest in getting involved in medical politics. I repeat that if the children's hospital is to move from the Crumlin site to a better site in the interests of children I am prepared to accept that as well. However, I do not accept that I should be patted on the head by a task force and a chief executive of a HSE who have made the decision because they believe they know best. I have been elected every 23 months for 26 years. I have been a member of local authorities. I have been a Member of this House and of the European Parliament. I know a bit about how public services work and I accept that the public service running our Health Service Executive and the Department of Health and Children is open, accountable and transparent. However, I believe the way this decision was made leaves much to be desired.

It is time Members of this House stood up for their right and duty to make their views known. That is why we were sent here. People who have not been elected to this House should not involve themselves in politics or act as a mouthpiece for the Minister. I suspect, and I say this with some sadness, that the reason some people do not want an independent review is that if it is found the Mater Hospital is not the right location their position will become untenable because they have put themselves out on a limb, and that is not the right place for public servants to be. Ministers are elected to be accountable, to go on radio and television and to appear in this House to answer questions. Ministers should take that responsibility. That is part of the whole business of accountability and transparency.

As spokesman on health I regularly raised with the then Minister, Deputy Martin, issues related to the number of committees, groups, inquiries, task forces and so on created by the Department. I asked by way of parliamentary question how many there were. There were so many that an answer could not be given immediately. It took some weeks to compile a list of approximately 160 different groups. In all of those groups there are administrators, doctors, unions, nurses and, in some cases, patients, but they are only one among many. All of these are dividing up the cake and what is left goes to patients. If the Government doubled the amount of spending on health tomorrow the system would gobble it up. Somebody needs to take a step back and put the patient back at the top of the list. The patient should be first. I published a Private Members' Bill, the aim of which was to create the office of surgeon general, not another quango to report to the Government but somebody to report directly to Dáil Éireann through the Committee on Health and Children. The role of surgeon general would be similar to the role played by the Comptroller and Auditor General in the area of general public expenditure. The strength of the Comptroller and Auditor General is that he is totally independent and reports directly to Dáil Éireann, working with the Dáil through the Committee of Public Accounts. Until we have a powerful advocate, with the title of surgeon general or some other title, who reports to Dáil Éireann, Members of the Dáil who provide all the money for the health services will be throwing good money after bad because the system is not being reformed or changed in any way.

How can anybody deal on radio or television with the emotive language of doctors, nurses or parents who have sick children, who want to praise what exists and not disturb it? We need to disturb it. The system cannot continue as it is. We need to appoint somebody to become a powerful advocate for patients, who will cut through all the self interest that exists in the health service and who will report directly to the Dáil. I would give that person the title of surgeon general. Even if the office were abolished after five years it would help. That person appointed would work directly with the Dáil through the Committee on Health and Children and would put the patient first, which is not happening in the health service at the moment.

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