Barry Andrews (Dún Laoghaire, Fianna Fail)

I welcome the opportunity to contribute to this timely debate which anticipates what will happen in the next several weeks.

Child protection services, provided by the Health Service Executive, are sometimes forgotten and considered a poor relation in these debates. They only seem to arise in debates on a crisis, not allowing for calm and rational debate.

According to the 2008 Euro Health Consumer Index, Ireland has moved from a position in 2006 of 25th to 15th out of 26 countries. This is a dramatic improvement with Ireland being the highest mover in the two years. The reason given by the index for this dramatic change was that the creation of the Health Service Executive had been a much-needed reform. It also acknowledged this new position may be an underestimation of Ireland's position. For example, one indicator used by the index is the number of cataract operations per 100,000 of a country's population. It is a rather crude indicator, putting countries with young populations at a disadvantage. Ireland has one of the youngest populations in the EU which would have a much lesser need for cataract operations.

It is not just the formation of the Health Service Executive which has made these improvements. The Euro Health Consumer Index commented that recognition of patients' organisations and legislation supporting patient welfare have also contributed to Ireland's improved placement. Several years ago the type of issues dominating the health debate in this Chamber, and elsewhere, mainly concerned primary care, cancer care, hospital waiting lists and consultants' contracts. From an honest analysis, it would be fair to say substantial progress has been made under each of these headings.

There has never been a time when health has not been a contentious issue, nor has there been a time when it has not given rise to, in some instances, properly emotive debate. There will probably never be a time when health does not give rise to serious and interesting debate in the House. It will always be a matter of great public concern. We must, therefore, reflect on the substantial improvements that have been made. In that context, we must consider the number of primary care teams already in place, and the further such teams will be put in place this year, and the benefits to which these teams give rise.

We must also examine the position regarding day or ambulatory care, the cornerstone of HSE reform and what Professor Drumm is trying to achieve. There has been a 40% increase in the level of ambulatory care. The knock-on effect of this increase is obvious, namely, that fewer people are lying in our hospitals, that there is a much greater volume of operations and procedures and that there are better outcomes for patients. Everyone says that once one enters the health system, the care provided is first class. We are all aware of the problems that exist with regard to getting into the system.

Reference has been made to the spirit of the age and the fact that we must begin to talk up what we do in this country. There is no doubt that real progress has been made. For example, the level of MRSA in hospitals has decreased by 25%. A major debate took place a number of years ago regarding hospital-acquired infections and substantial progress has been made in respect of combating these infections. However, not enough is said with regard to such progress.

The National Treatment Purchase Fund has delivered procedures for 140,000 people who would otherwise have been obliged to wait for such procedures. As the Minister stated earlier, there has been a huge take-up in respect of the consultant contract. I accept that the contract is not perfect. However, that fact should not — as was often the case in the past — be used as an excuse to do nothing. People should not wait for everything to be perfect before serious and radical reforms become the norm, not the exception, and before vested interests are faced down.

The improvements to which I refer have been made and should be recognised. It is clear that the HSE faces challenges with regard to the delivery of services. To its credit, the HSE balanced its budget in 2008. I am confident that in the difficult months ahead it will do the same within the new parameters set down for it.

As Members are aware, the problems and difficulties to which I refer are not exclusive to Ireland. We must acknowledge that issues arise, in an international context, with regard to the cost of health care services. Dr. Michael Barry has provided information in respect of drug use and we must face the challenge in this regard as strongly and honestly as possible.

I have responsibility for child protection services. Such services are delivered by the HSE through various local health offices. As with so many health services, a legacy issue arises as a result of the changeover from the former health boards to the HSE. Again, however, I am of the view that substantial progress is being made in this area.

As stated at the outset, the services provided by the HSE are often considered to be exclusively geared towards medical needs. We must reflect, however, on the vital nature of the child protection services it provides. A child who is damaged by way of abuse or neglect will carry a psychological scar throughout his or her life. Medical problems can often be resolved without there being any undue legacy for the child or patient. Child protection should, therefore, always be one of the most important services and should always be at the forefront of the debates in which we engage with regard to the HSE. Let us be honest. The debate on this issue has been ongoing for an hour and no one previously referred to child protection. I am of the view that it should always be central to debates of this nature.

We want to move forward in the context of standardising the business processes that obtain within the HSE. In certain instances to date, performance has been patchy with regard to the way in which waiting lists are calculated and referrals to social work services are assessed. We cannot, therefore, truly compare the delivery of child protection services throughout the country in a contemporaneous way. As a result, the process must be standardised. We have made substantial progress in this regard and I met representatives of the HSE earlier today in order to discuss the nature of that progress. Cases such as that which arose in Roscommon underline the absolute importance of delivering a first-class, standardised HSE service.

The HSE is also responsible for the delivery of social services. The services provided by social workers are too often denigrated. In my view, social workers must deal with incredible challenges. For example, they must decide whether to leave children with their families or remove them. Such decisions can affect children for the remainder of their lives. We must support social workers and talk up the work they do. Morale is crucial to the delivery of good social services and we have an extremely important role to play in that regard.

I hope that in the coming months — if it can be agreed among those responsible for delivering the relevant services — we will be in a position to place in the public domain the information relating to some of the progress we have made. By European standards rather than any subjective analysis, the HSE has made substantial progress. We must remember the crucial and central role to be played by those charged with delivering child protection services and social workers in the overall area of health service delivery.

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