James Bannon (Longford-Westmeath, Fine Gael)

We have heard fine contributions from Deputies O'Reilly and Jan O'Sullivan. Either of them would make a wonderful Minister for Health and Children. I have no doubt the country would benefit greatly if either of them were in charge of the health portfolio in this House. That would greatly benefit the nation as we move forward.

The integration of 15 health agencies as part of an efficiency drive was announced in budget 2009. However, when one takes into consideration the fact that no staff reduction will be effected, it makes a mockery of the efficiency element of the so-called drive to create a more efficient health service. The reality is more likely to be that areas such as those concerning the elderly will lose their focus and the Government will continue its assault on the vulnerable, as they will be without specific representation, leaving them unable to stand up for themselves. I compliment our elderly citizens, the grey vote, as they are called, on the way they protested outside the House when the budget was announced. They were rightly angry. Some back-tracking did take place. The Government should keep its hands off the elderly and the most vulnerable next week.

We have seen centralisation followed by decentralisation, in an ever continuing attempt by the Government to bring rationalisation to the health service. That is evident all over the country. The end result is that important health areas fall victim to cutbacks, while a top heavy executive continues to blunder its way from initiative to initiative, and report to report. I referred to the 140 reports that are gathering dust on shelves within the offices of the Health Service Executive. I note that an expert group has been set up to examine how money is spent in the health system and to come up with innovative ways to reform the system, in order to make money follow the patient, as Deputy Jan O'Sullivan outlined. While that is welcome in principle, it will be interesting to see whether the group's report gathers the usual dust that covers the ever mounting pile of reports within the HSE.

There are many calls for a return of the health board structure in some form as it had the benefit of local accountability. When I served on a health board people contacted me regularly in advance of the monthly meetings to bring to my attention issues of concern. Currently, there is nothing to compare to the local political involvement they provided. We were at the coalface and we knew what was happening. We had a say and we improved systems for the betterment of patients. I do not see the benefit from the change to the HSE. Waiting lists have grown longer and there is more discontent with health services across the board since the HSE was set up. I have heard Deputies from the Government side complain about and criticise the HSE. Some of them are like me; they have their ear to the ground and they know exactly what is happening. That raises the spectre of the disastrous decentralisation initiative which, literally, like an Irish reel saw Departments moving in and out of Dublin with the massive costs involved in such manoeuvres.

The health service in this country can be best visualised as a vast, clumsy overweight dinosaur, burdened with thousands of people clinging to its back, whom it refuses to shake off no matter how superfluous or draining to its economic well-being. That is evident all over the country. When the HSE was established, recommendation R3.3 stated there should be no net increase in staffing levels within the health service. The reality, which is to the detriment of funding for basic patient care, is that between 2005 and 2008 there was a 14% increase in its administrative staff. Following the appointment of Professor Drumm and what could not in hindsight be referred to as "best practice", vast centralised services were divided into "pillars" with national directors, an abundance of assistant national directors and local health officers. Last year that error of judgment was somewhat alleviated by the recognition that there was scope for several thousand managerial and clerical staff to leave the HSE voluntarily. The executive accepted that its structure was overly-bureaucratic. There is evidence of that everywhere one turns. Nobody can deny it.

What has happened in terms of the implementation of such cutbacks? Precisely nothing. The Minister of State, Deputy Hoctor, is sitting sombrely across from me but she has done nothing to deal with the issue. According to the HSE's office of human resources and the national employment monitoring unit of the executive, no redundancies have been implemented. In what can be only compared to the waste of millions of euro on prefabs for schools, the HSE is now prepared to carry dead weight to avoid paying redundancies, which it claims it cannot afford. Even in the current economic climate, it would make sense to offer some redundancies, as this would save money in the long run. The HSE has proposed cutting 10,000 staff from its 111,000-strong workforce, with 1,000 jobs expected to be cut this year. It was hoped that up to 4,000 staff would take voluntary redundancy in the long term. The HSE has an annual wage bill of €7.5 billion and could make a saving of €67 million a year for every 1,000 redundancies. This situation is a farce. When we think of the speed with which the axe falls on essential local and national health services, on provision for the elderly, the young and the disabled, this is a massive indictment of the priorities of the Minister and her Department.

I wish the Minister had gone out to the gates of Leinster House today to listen to the people gathered there. They started to gather there at 9.30 a.m. because of their serious concern about what is happening with community services throughout the length and breadth of the country. I have an autism society badge in my lapel. I support its grievances and those of carers, the cystic fibrosis organisation and others who gathered at the gates. I went out to speak to them. I have a humane approach to their problems. I spoke to them and wished them well with their campaigns. They need all the support they can get in the current climate.

Despite the failure to curtail staff numbers in the administrative and managerial areas of the HSE, I was shocked to hear that staff at Longford-Westmeath Regional Hospital, in my constituency, were informed yesterday that all contract personnel would be let go on 27 April. These contract workers are front line staff who are delivering services at the coal face to people in the midland region. People are dying daily due to health cutbacks. It is a sobering thought that lives are being lost due to lack of funding for essential services, while the massive cost of the public sector payroll and the huge expansion of managerial grades across the HSE eat into health funding. As a result we have a badly configured hospital system, underdeveloped primary care and an unfair allocation of services that favours private health patients and penalises the elderly, with certain treatments being refused to older people.

I learnt of a sad case in my constituency yesterday. A 78 year old woman was crying on the phone to me. She has a serious eyesight problem and her doctor has advised her to go for treatment to a hospital in Dublin. If she does not, she will be completely blind by July of this year. That poor woman is on a medical card and is pleading for help and assistance towards the cost of transport. If she is to take a taxi from the constituency to Dublin, it will cost approximately €170 per visit. She needs to make two visits per month for her eye treatment. It is a shame that such a poor old woman must delve into the savings she has made for her burial to pay these transport costs. This is scandalous in this day and age. The Minister must have no heart if she allows this sort of thing happen to elderly human beings who have given life service to their communities. It is these people who are being affected by the Minister's behaviour and her failure to provide essential services for the elderly.

The OECD has recognised that the majority of State agencies were created since the start of the Celtic tiger era — an era that seems an illusion now — with approximately 200 non-commercial agencies operating at national level, some 34 of which are in the health sector. Therein lies the answer to where at least a portion of the wealth of the boom years went. At the same time, necessary retrenchment brings the great fear that voices will go unheard and the most vulnerable will be left further out in the cold, like the poor old crathur in my constituency who was left in a state of panic yesterday. She is only one of many in society in that boat.

I take this opportunity to raise the ongoing position with regard to phase 2B of Longford-Westmeath Regional Hospital, which is a long and ongoing saga of Government neglect. I hoped Deputy O'Rourke would wait and give me the courtesy of listening to me. She talks out of both sides of her mouth when she is in the constituency. It is regrettable she is not here.

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