Michael D Higgins (Galway West, Labour)

Without seeking to make a party political point, when I raised this issue at the last such meeting during the previous Dáil most Deputies agreed that the meetings were nonsense. It is also nonsense to suggest that the issue at stake is anything more than the presentation of the HSE's image to elected representatives.

It is important to establish principles of policy provision which will be accountable in the Oireachtas. To give an example, universality of access is a principle on which we, as politicians, can differ. There are those who argue, in a dangerous manner, that one can provide for health based on market principles and that the ethos of competition will deliver a service for something as basic as health. I profoundly disagree with this view. Health policy must be structured in accordance with the theory and practice of citizenship. This requires building a model not on notions of co-location, which we have discussed elsewhere, but on principles of universality, namely, that which is required to meet need.

It is interesting that the Taoiseach uses aggregate sums when replying to questions on this matter. The Government amendment lists gross figures for expenditure, which does not answer a single question. It is unhelpful to provide units of cost rather than need because planning in health must entail planning in accordance with need and performance must be measured in terms of how need is addressed.

I have no difficulty in acknowledging the performance of medical practitioners in difficult circumstances. In 2005, I spent a number of weeks in Merlin Park Hospital having been operated on by an excellent team working in a building constructed in 1951. Although it was possible and necessary to modify this building, I later learned that the Health Service Executive failed to spend its full capital budget when it could have enhanced the capacity of health service staff to perform to an excellent standard.

The motion notes that a 24-bed specialist unit for elderly people — unit 4 — at Merlin Park Hospital faces closure. Unit 4 has a small gymnasium and patients are provided services in a single, compact space. Staff are trained in the use of certain types of equipment, assisting people in ambience and so forth. The unit's services and staff will now be scattered across the entire hospital. The public relations people tell us that a new, specialist unit will emerge by 2012. It does not make sense that a body which failed to spend its capital budget can close down a service that is meeting immediate needs on the basis of a nebulous commitment to provide a replacement service at some point in the future.

With regard to the guff about the national treatment purchase fund, performance in this area is uneven. Certain consultants, as their receptionists have informed me, have waiting lists of three and four years which act as a barrier to access to the NTPF. That is a health policy matter. Unfortunately, Deputies no longer receive replies in the House when they ask questions on any health policy issue. Their parliamentary questions are fobbed off to the HSE's parliamentary affairs division. I no longer bother about names and titles because staff and their titles frequently change. When we gather at 8.30 a.m. meetings we are told that the problem lies with Members, that we, the elected representatives, are obtuse and that a new public relations initiative is needed to convince us that the HSE's performance is good rather than poor.

Capital expenditure has proceeded in some areas even though approval for staffing the facilities in question has been withheld. In Indreabhán i gContae na Gaillimhe, beidh eolas ag an Aire Stáit faoin gcaoi go bhfuil an t-airgead ar fáil ach níor tugadh cead na daoine a fhostú. It is interesting to note how we have arrived at the current position of the HSE being told it must live within its budget. It would be useful to examine how the current overrun in the executive's budget occurred. Although the cap on the public service side was instituted, those in charge would freely admit that they have been able to exceed budgets and overspend on privatised services. For example, with regard to the 80 or 120 home care packages in Galway city and county — the figure depends on how the calculation is made — it was possible to exceed the budget if one purchased these services from private providers. Across the entire system of the HSE, privatisation by stealth generated the current overspend. However, in responding to the current circumstances, no attempt is made at analysing how the overspend occurred. The people paying the price for the overspend are those who need the services, those who should be appointed and those who undertook training to meet skill shortages. Be it in respect of home help, home care packages and so on, we must analyse the reason for so much unscrutinised spending in the privatised section.

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