Bernard Durkan (Kildare North, Fine Gael)

We knew precisely what was going on, including some things we were not supposed to know. The abolition of the health boards was promised before the last general election as a panacea that would save huge amounts of money. That was absolute rubbish because it had the opposite effect. It brought to an end the supervision of the health service by the blue-suited, brown-shoed, hard-nosed, red-necked politicians who used to watch what was going on. We often made ourselves unpopular by asking hard questions. We were removed from the arena because we were a nuisance to Ministers. It was tough, but that was the way it was.

There have been a number of scandals over recent years in areas like the political arena, financial services, banking, the environmental sector and the churches. It is good that members of all professions have been investigated and scandals have been uncovered. It indicates that the public has become more perceptive and demanding. I have no problem with it because it should lead to higher standards. This process applies to the medical and health sectors as much as it does to the sectors I have mentioned. I cannot understand why there is a need to provide in this Bill for a more rapid investigative system. Such a system would not be needed if the current systems were operating properly, as they were intended.

We are familiar with a number of instances of highly questionable medical practices in respect of which no action was taken for some unknown reason. Some such cases have been mentioned during this debate by other Members of the House. It is not sufficient to argue that the necessary procedures were not in place. If the normal procedures in any business, including the medical profession, had been followed and the normal comparisons had been made, alarm bells would surely have started to ring in all directions. I cannot understand why people did not ask what in heaven's name was going on. I recall the exacting performances which were demanded when politicians sat on health boards. Hard questions were asked of medical practitioners at health board meetings and in public. We may have been resented for asking such questions, but we asked them nevertheless. Some patients have tragically died after failing to be admitted to hospital, to be treated or to be referred to the right place at the right time. Is it good enough to investigate such cases? Will that bring such people back? Will it ease the tragedy or the hurt and loss for the immediate families? I do not think so.

Deputy Ó Fearghaíl spoke about the need for a vocational commitment in modern professions, which is important in the political arena and in every other sector in which services are delivered to the public. Those who have a genuine vocational commitment have an aptitude for what they are doing and a willingness and desire to serve the greater good. While such a spirit might seem anathema to some modern thinkers, it continues to exist, although it is disappearing. This quality, which is important because it adds significantly to the quality of service that is delivered to the public, seems to have been forgotten in this debate. I was not in favour of the introduction of degree courses for nurses, for example, because I thought it would lead to division within the system. I said at the time that young people who want to get involved in patient care would be excluded. They can work as nurses' assistants, etc, but that is not the same thing. The degree courses have excluded many people. The point made by Deputies Ó Fearghaíl and Fitzpatrick in this regard is correct. One can get 800 or 900 points in the leaving certificate, but it does not prove one has the ability or the aptitude to serve well in this area.

I have the greatest admiration for many medical practitioners, including local general practitioners and consultants, throughout the country. They work extremely long hours — above and beyond the call of duty — day in, day out. They have very little regard for their own health and personal circumstances. However, they do not all behave in such a manner, sadly.

The decision that patient focus groups are needed to deal with fitness to practise problems, etc, is part of the depoliticisation of what used to be a very political area. There was a time when there was an instant uproar if somebody did or said something wrong. Before the issue came into the public domain, questions were asked within the system and therefore the tendency for something to go wrong was averted. The circumstances were questioned. The emphasis now is on treating the issue after the event. We are putting the cart before the horse.

Modern technology could be utilised more effectively. It is possible with the use of modern technology to have video case conferences on a regular basis and to link hospitals. This would ensure standardisation of all aspects of the delivery of the services, whether it be at consultant, doctor or nursing level. This should be a simple task but it is not happening. It is common-place all over the world but for some unknown reason it cannot happen here. It is relatively inexpensive and there should be no difficulty with it. These matters require the attention of the Minister, the Minister of State and the Government.

Other speakers have referred to pay and conditions in the health service. The Government will say that pay and conditions in the health service absorb significant resources and this is especially true because of the way the system is managed. Reference has been made to an administrator from Northern Ireland who highlighted the issues.

I was a member of a health board at one time and I remember a visit to an institution. I will not name the institution but I spoke about it on another occasion in the House. The conditions applicable within that institution were appalling and shocking. An internal dispute was the reason for the conditions but it was the patients who suffered. This situation was uncovered during the course of an inspection by the visiting committee and within 12 hours the issue was addressed in full, otherwise the institution would have been closed down. If the standards and rules do not apply it is quite in order to close an institution.

I have been advised by some people that MRSA is very difficult to control. I disagree and remind the House that simple procedures of hygiene which are enforced around the clock will control it. However, there is no longer an emphasis on hygiene procedures because nobody wants to get involved as it is not an area of expertise.

Deputy Twomey has referred to the work practices expected of junior hospital doctors. I agree that operating theatres should be used on a 24-hour basis but I hope it is not suggested that the same consultant or surgeon should spend the whole day operating in the theatre. I hope it is recognised that the theatres will need to be staffed. No consultant can work from 7 a.m. until 12 midnight as the quality of work would suffer. The same applies to their attendance in wards and theatres all over the country. There are simple issues which could be attended to if practices are put in place. This might have helped to avoid some of the recent problems.

Public servants have a tendency to be defensive when their work is questioned and this is understandable. However, this may not be desirable in the case of life or death situations or in the delivery of health services. I recently telephoned a hospital about a patient who had attended there. I am bound to pass on information that had been brought to my attention because I would be to blame if I did not do so and something happened. I explained my interest in the case and I presume the matter was dealt with but I will revisit the matter if needs be.

In the past five years I have had occasion to bring a situation to the attention of the Minister of State's colleague by way of parliamentary question. This concerned the family of a patient and I decided it was necessary to explain what had happened. However, six or seven months went by with no reply to either the parliamentary question or the letter. It was the new system of answering parliamentary questions whereby a reply is issued a year later if one is lucky. Nothing happened until I insisted, with a series of parliamentary questions, that the matter be taken further. It should be sufficient to write one parliamentary question and receive an immediate response. That is the way it used to be when I was first elected but sadly, things have changed everywhere and not always for the better. In matters of that nature it does not necessarily mean that a public representative has a hidden agenda or is looking for publicity; it may mean that a genuine issue needs to be addressed. It should not automatically follow that every possible means is found to make excuses for not providing the information.

This Bill may be beneficial in protecting patients and patients expect to receive a service from the health system. They are supposed to receive an efficient, fast and effective service. Those providing the service are also supposed to be treated fairly and to be paid. Reference was made by other speakers to the fact that almost 70% of Irish-trained nurses leave the service. This must be addressed as a matter of urgency. They go to agencies and come back to work within the service with the result that the agency is the main beneficiary. Something crazy is happening. That is why Mr. Robinson was able to identify measures that were counterproductive. I would love to have more time to speak on this subject, in which I have taken an interest for many years. I hope I will be around for a few more in order to continue to take more than a passing interest in it.

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