Damien English (Meath, Fine Gael)

I welcome the opportunity to make some comments on the Bill which is welcome. I welcome the initiative behind the Bill and I welcome discussion on the area, but there are some problems. I will not go through the debate on Navan hospital again as we had that debate yesterday. There has been much talk about the Medical Practitioners Bill prior to its arrival in the House and there has been significant correspondence on it. I am glad we finally have the opportunity to debate it.

As the Minister stated, the main concern of the Bill is trust. We live in an era where trust is absent. It is absent not just in the medical profession, but in various organisations, the church, politics, etc. People have doubts, often with good reason. Life experience and reports of what takes place in hospitals have created fear and people no longer believe and trust in our systems, not just the medical system.

It is our duty to try to restore confidence, faith and trust in the systems for which we are responsible, whether social welfare, health, justice or whatever. We must all face that challenge over the coming years and try to give people a belief in what we do in this House and in Government. We do not always do a great job in this regard, yet we expect and demand other organisations to reform and take new initiatives.

I spoke about this with regard to justice. We have had many Bills in the House on the issue of reform of the Garda, etc., yet we have never had a proper debate about reforming ourselves or the House and how it works. We demand and expect every other organisation to reform and change the way they do business, but we have not done it here. This issue is separate to the Bill under discussion, but it is something we must face up to at some stage. We must modernise the way we do business and be accountable to Government, the Opposition and the public. I believe the House does not represent a real democracy in the way it works. If I, as a Deputy, say that, what does the public think? The issue of trust arises across the board and is all about restoring faith in our systems.

With regard to the medical profession, we have a major role in restoring belief in the service to the people. It is not all about money and hours of work but about providing a service. The desire to serve is an essential requirement for those who want to work in the public health service. Those working in the service are meant to be there for the good of patients and must believe they are there to serve. Politicians also serve.

The country seems to have lost belief in the idea that we are here to serve. This leads to abuses in the system, for example, the abuse of power, patients not getting the treatment they deserve or proper recognition, or patients' rights being abused. Many of our public servants no longer believe in public service. We have a role in trying to restore belief in the service. We can have all the rules, guidelines and councils we want, but if the people working in the system do not believe in what they are doing or do not do it for the right reasons, they will find a way to abuse the system, breach rules or break guidelines. There are bad eggs everywhere.

We must put legislation like this in place to monitor and control, but we must also work at restoring the desire to serve the community and patients and to deliver on results. It is not all about personal agendas. When we succeed in restoring this desire, it will help restore faith because people will get a different reaction from frontline staff. This aspiration is not just for the medical profession. We must deliver on service in this House and set a good example.

Many of the abuses in the medical and other professions are a result of the practice of deference and submission to authority. People bowed to authority and thought they did not have the right to question or be informed. I welcome the new initiative to ensure people are better informed and are not afraid to ask questions. Legislation such as this gives people confidence to ask questions and to know they have a say and are important.

There are, however, many people of various ages and with various levels of education who feel they cannot ask questions or who are afraid to ask them. We often meet these people because they come to us for advice or to ask us to ask questions on their behalf. We are not doctors and do not work full-time in the Department of Health and Children, but we try to give them advice and let them know they can push for information and ask questions. They must do so. Often, a sick hospital patient depends on a relative to push his or her case because he or she does not have the energy to do it or is afraid to offend the doctor.

We must let the word out that people can ask questions and seek information. They can demand and expect that. It is important to make a person available in all hospitals to link with the public and to tell patients in their own language exactly what is going on. They must be let know they have the right to push and expect more from their doctors.

Some people are still afraid to ask doctors a question, to challenge them or to advise them of what a second doctor has told them. I know of many experiences where people told doctors about advice or opinions received from somebody else and the attitude was how dare one offer an opinion, as if the opinion of the doctor in question was the only one that counted. We have seen, from the experience in Our Lady of Lourdes Hospital and other hospitals, that to accept just one person's opinion is a dangerous route to take. There should be greater openness in this regard.

The Bill removes self-regulation from the profession, which is a help. It is wrong for any profession to have the members of that profession responsible for regulation. I welcome any initiative to try to give Joe Soap a real say in a council such as this. There were many submissions in this regard and I am glad the Minister took them on board. I would still share my colleague's concerns that the Minister might have too much power in it. It is all about perception. We are supposed to believe this is a new way forward, safe from political interference. When one is explaining one is losing. The Minister went to great lengths today to explain that there would be no political interference in this system and that it was straightforward, but the fact that she had to say so proves to me that there is room for interference on this. We are supposed to close that door off so that interference is not possible.

One of the reasons there is a need for the Bill is what happened in the past, especially following publication of the Our Lady of Lourdes Hospital inquiry and other reports. We are fortunate to have good reports which document the hurt, trauma and abuse that went on in some of these hospitals. Our Lady of Lourdes Hospital inquiry is one with which I regularly have dealings and the hurt of the parents involved is very real. They are still suffering, yet the State did not act for a long time. The systems failed those people and it was only eventually — the same old story of a just-in-time policy — that the Government did anything to ease that pain, get information, get answers and punish those involved.

Sadly, there are other scandals still left unaddressed. What the Parents for Justice campaign is going through in the organ retention scandal is appalling. We are debating a Bill to restore faith, trust and justice in the system when they are still looking for information and answers. Those parents are going through absolute hell every day and the Minister is not doing enough to get the answers the families need to bring closure to their cases. The families are bitter about that and we really must go further to help them.

I went with parents to a hospital when they were to receive their child's organs and it was one of the most traumatic experiences I have ever had. Although I am young, I have witnessed a great deal but that certainly was one experience that went right to the heart. Their child, in their eyes, arrived out in one small white box. Their baby's organs were a set of slab slides, the size of microchips, out of the science laboratory. What they got back, in three or four different boxes in packages, was their child's organs. It was extremely traumatic.

They sat there that day and I sat with them. During the meeting of approximately an hour the parents asked questions of the relevant doctor. He could not give any answers or he could not give opinion, or there were legal reasons he could not give it. They did not get the answers they needed. They did not get all the parts of their child back. This occurred years later, following a cover-up. The parents thought they had buried their child's remains only to discover they had not, and they are still looking for parts of their child. That is an absolute disgrace and we have not done enough to get the answers.

I feel strongly about debating this Bill and speaking of the future when we have not done enough to correct the problems of the past. As Minister for Health and Children, Deputy Harney has a major role in getting those answers and bringing closure. What those parents are going through is appalling. By the grace of God, most of us here will never have that experience, especially because of change in legislation. However, we must correct what has happened in the past and end this saga once and for all.

The Bill is also about patients believing that doctors are adhering to best practice, that they have access to proper follow-up and that they can investigate the system. We are told that patients deserve best practice, but they need to know what best practice is. It is not clearly explained to everybody. While I accept best practice amounts to adherence to international standards, it seems to change quite a bit to suit the argument and it is not enough to merely use the words. One sees "best practice" referred to in health reports. Often it seems an excuse to bring about changes that will save money or to rearrange services. The perception among the general public is that best practice means the best system to suit the everyday lives of the doctors and the consultants, including golfing requirements, and that needs to be changed.

There has been talk for years of a new regional hospital in the north east to replace existing hospitals. After the HSE was formed, one of the new officials who was given the task to wrap up the matters in the north east, close as many hospitals as possible and get a new one opened explained to us that a catchment of 250,000 people was needed for a top-class regional hospital to give best service. We were told that was best practice according to international standards and that was the buzz line approximately two years ago. Then, seven or eight months ago, when the Teamwork document was published, another group of consultants brought in so-called experts from the UK to produce a report on the future needs of the north east and, lo and behold, we are told that the magic figure according to international best practice is now 350,000. It has changed by 100,000 in a year. I would say the main reason that figure changed is that the population in the north east has increased to over 350,000, heading towards 400,000 plus. The magical figure of best practice suits the new argument for one new hospital for the north east. In fact, if that Teamwork document is to be believed and if 350,000 is the new figure, we should be looking at building two regional hospitals in the north east, especially as that document is a plan for the next 20 or 30 years. The population of County Meath alone is over 170,000 and heading for 200,000 within the next couple of years. The population of County Louth is 150,000 plus. The populations of counties Cavan and Monaghan are both between 60,000 and 70,000. If the population of the north east is well above that magical figure of 350,000 and heading rapidly towards a second 350,000, should we not be discussing two regional hospitals for the area?

While the Minister is present I take this opportunity to raise another matter which is slightly outside the scope of this Bill, but it all comes back to patients' safety and patients' service. Recently on "Question and Answers" the Minister stated that in the future we will build this new regional hospital, a project we all support. In the meantime, however, we must retain services to the highest standard in our hospitals, but we in Navan are being told that the emergency surgery service is to be withdrawn — in fact, it is nearly gone. We are told this is best for patients.

The Minister stated that there must be investment in certain hospitals, even during this ten-year period until the new hospital is built, and she mentioned Our Lady of Lourdes Hospital and Cavan General Hospital in that regard. She did not mention any investment in the hospitals of Navan, Louth or Monaghan. While I accept she cannot put money into them all, the Navan case is worth looking at because its population has nearly trebled in the past couple of years. The population of Meath has increased by over 50%. The journey from the further parts of Meath such as Enfield, Ballivor and Oldcastle to Our Lady of Lourdes Hospital in Drogheda takes well over an hour, yet we are being told that it is best for the people of Meath to withdraw emergency surgery facilities, which has a knock-on effect in reducing the service provided by casualty and accident and emergency. We are being told to accept that in the next couple of months, yet the completion of a new regional hospital could be ten years away at best, if not 15 or 20 years.

I have asked Professor Drumm about this. He has been on radio telling us all that we should accept this, he knows his stuff and he will challenge any of us to debate it with him. Nobody has come down to explain to the people how it is best for them to remove this service. I accept, as we all do, that the emergency surgery service in the hospital is not ideal, but that is because of a failure of Governments over the years which did not provide the hospital with the resources and staff to keep functioning to a high standard.

Navan hospital provides a great service but we are told, by a crowd from the UK who wrote Teamwork, that it is best to withdraw that service now before anything better is provided. It is hard to accept. In my humble opinion, and in the opinion of the average Joe Soap, it would be best to keep the service where the people can get to it in time after a serious accident. Would it not make sense to improve the service? We are trying to operate a surgical department which should have at least three consultant surgeons with one and a half whole-time equivalents and expect them to perform miracles, and yet the Bill is about ensuring best practice is adhered to. It is not best practice to have half the number of staff necessary running a surgical department. It is certainly not best practice to withdraw the service. Best practice would be to put additional staff in place to ensure a top-class service.

When the new hospital is built we will accept the withdrawal of services in Navan hospital and in other hospitals. When the new hospital is large enough to cater for all the patients and the population concerned that would make sense, but at present we are being shoved into Our Lady of Lourdes Hospital which cannot cope. It has not increased in size in the past ten to 15 years, yet the population in its own county has increased dramatically, never mind all the Meath patients. Lumping a catchment area of 170,000 on top of an existing hospital does not make sense, has not been explained properly and certainly could not mean best practice.

The Bill is about ensuring people can trust and believe in the system but it is hard to envisage this happening in the current environment. It is to put people first and give patients greater influence. They must also be respected by health service staff. That is not always the case. The Minister cannot wave a magic wand to solve the problem, but she must try to instil a sense of respect into all medical staff, both at the front line and in offices. Patients do not deserve to be treated like nobodies and should be given complete information. They should not be kept in the dark and fed like mushrooms, which often happens.

Doctors are working in a much more demanding environment than heretofore because of population trends, new initiatives, best practice guidelines and modern advice. They require new guidelines and watchdogs to keep an eye on them, but we still expect them to work savage hours. Some junior doctors are working unbelievable hours. There is no point saying life is bad and that they are under pressure. Government decisions resulting in the failure to provide enough doctors and resources are putting them under undue pressure in the first place. In this regard, I have already mentioned the surgical department in Navan hospital but it applies in other hospitals as well.

I welcome the idea behind the Bill, especially the view that the public interest must come first. However, the public does not believe it. The Bill is a step in this direction although it requires amendment. I want to believe the public and patients come first, yet I deal closely with people who say they do not.

Reports such as the Teamwork report recommend changes that do not make sense and appear to have been drawn up to suit the HSE's plans, the Government's agenda and resources rather than to implement what is best for the patient. I have said to consultants, Professor Drumm and others that they should explain to the people why the reports' recommendations are best for them, but nobody is doing this. Decisions are made and services are withdrawn without consultation and people are left in limbo, with longer journeys to make if they need to go to a properly staffed accident and emergency unit. This is certainly not good enough.

Consultants were paid taxpayers' money to produce the Teamwork report. When they arrived in Buswells Hotel to present it to all the Deputies from the north east, we listened and accepted the need for change. However, when I went to Navan hospital, where I was told services would be withdrawn, and asked the chief member of staff if he knew there was a mine employing over 700 people under the hospital, he could not answer my question. He and the staff around him had a look on their faces that confirmed to me that they did not realise it. The mine has an ambulance on its premises, not for fun but because it is quite possible that a serious accident could happen at any given time in which many persons, even 50 or 60, could require emergency treatment. Although it is very important that a top-class accident and emergency unit be retained at Navan hospital, the consultants reporting on its future did not realise and were probably not even told about the mine. Will the Minister check this out? If I am wrong, so be it, but I do not believe I am. If I am correct, the report must be fundamentally flawed and will have serious consequences for many people.

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