Fergus O'Dowd (Louth, Fine Gael)

It is difficult to follow Deputy Ring. I agree with most of his comments and, while I would put them differently, he has put them well. Like him when he discussed the democratic deficit in the health service, I wish to refer to the section of the report that addresses the reconfiguration of hospital services. I also wish the two Ministers of State across the floor well, but I hope their time on the opposite benches will be short. It is my job to get rid of them.

There is a serious democratic deficit in the health service and people are losing trust in the HSE. It has lost that trust and credibility because there is no public accountability, fora or public representative involvement. In analysing the problems in the health services, while I accept the old health board system had its critics, people could go to a board meeting at least once per month and ask officials to account for themselves and their reports. Were there a meeting tomorrow, one could ask the officials to account for the appalling scandal regarding X-rays in Drogheda and Navan in which 4,700 people must wait for up to eight weeks for the issue of whether they have serious health problems to be resolved.

The report puts the case well when, on page 273, it states, "The reconfiguration reform project is not a resource issue". It also states:

A key challenge within the reform programme is communicating this prerogative to a population that has high expectations of service delivery, but feels that the government is just trying to save money by closing hospitals; they do not trust the government to provide the relevant services at primary care level in the short-to-medium term. Faith in the government and in the Health Service Executive to provide an appropriate level of service and to deliver on reforms has been exacerbated by a number of health care scandals.

Due to a lack of communication, no one believes the HSE or the Government when it comes to the reconfiguration of the health service. Trust in particular has broken down.

A heading in the report's recommendations on page 290 reads: "Take account of demographic needs using international trends". A key controversy in the north east has been the attempt to reconfigure five hospitals into two. According to recent HSE research, these hospitals will become one eventually. The report on which the decision is based is informed by a United Kingdom model and took account of the opinions of the Royal College of Surgeons of England, which claims that a catchment area for a general hospital should be between 450,000 and 500,000 people. However, it is worth noting that, within other OECD countries, there is a range of possibilities. For example, the catchment size for a general hospital of 500 beds in France and Germany is three times less, namely, one hospital for every 150,000 inhabitants. It is important to ensure the model used in the north-east region is the most appropriate. The HSE and the Government must carry out a broader consideration of international systems, including those that are similar in terms of needs. The Government could examine different patterns of hospital requirements.

These recommendations are at odds with HSE policy. According to the OECD, the outcome of an international review that includes the European experience could be the same, but it could be different. The north east needs two hospitals, which would meet the region's needs. The British model of reconfiguring five hospitals into one will not work and is not what the people want. I do not know why we should slavishly follow the Royal College of Surgeons of England and ignore the obvious experience in France and Germany. Will the Ministers of State bring this part of the report to the attention of the Minister for Health and Children and make it clear that five into two is the way to go in the north east? People want at least two hospitals, as the infrastructure will not allow for just one.

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