Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

Cuirim fáilte roimh an Aire Stáit. This is not the Health Bill we should have before us in the Dáil today. On 1 April the Minister for Health and Children, Deputy Mary Harney announced the establishment of an expert group on resource allocation and financing the health sector. It is not due to report until April 2010. I have no doubt the deliberations of the new group will be used to further delay the publication of the Eligibility for Health and Personal Social Services Bill, which has been promised for years. Why the delay? The answer is obvious. The last thing the and the Government want to discuss is the question of rights and entitlements to health services. They have presided over and reinforced a system where wealth can buy better health care and the private for-profit health business is allowed to act as a parasite on the public health system.

As the public health system reels under the cuts imposed since 2007 and braces itself for even worse to come, the Minister, Deputy Harney ploughs on with the building of private for-profit hospitals on public hospitals sites, subsidised by the hard-pressed taxpayer. The Minister, Deputy Harney and the Government imposed a so-called public service pension levy on nurses and have sanctioned the non-renewal of contracts for up to 14,000 workers in the public health service. At the same time the Minister, Deputy Harney gave a gold-plated guarantee to the hospital consultants that their €250,000 per annum contract will not be touched. This is for a 33-hour week in the public system, and they can still work up to 25% of the time in private practice. Even at that, the hours are not properly monitored, providing another lucrative let-off for whatever number - it is not everyone - is happy to abuse their privileged position.

This is what the Minister, Deputy Harney and the Department of Health and Children preside over in crumbling Hawkins House which, a view not unique to me, is the ugliest building in this city. At times it has struck me as a very appropriate symbol of this Government's health policy.

What is the role of the Legislature in all of this? We are excluded from any role, except for the rubber-stamp type of legislation we have before us today, the Health (Miscellaneous Provisions) Bill 2009. The Minister, Deputy Harney has made herself unaccountable through the establishment of the HSE, while major policy decisions with major implications for the health service are not put before the Oireachtas. For example, the Government never put one sentence of substantive legislation before us regarding its co-location proposals.

This Bill gives more functions to the HSE and the Department, something I would be reluctant to do. Earlier this month in my constituency, two prominent general practitioners resigned from the HSE GP unit, citing in an open letter to Professor Brendan Drumm the arrogance of HSE management and its complete disregard for the views of general practitioners. In February this year, 41 GPs in Cavan and Monaghan signed another open letter opposing, on patient safety grounds, the removal of acute medical services from Monaghan General Hospital.

We have no choice but to address this Bill within its limited scope and to accept in good faith the assurances we have been given that the functions of the various bodies now to be subsumed into the Department and the HSE will be properly fulfilled. However, we must also be assured, and this is the assurance I am seeking today, that the work will be properly monitored and that the Minister, Deputy Harney, and the HSE will be fully accountable for these functions.

The Bill dissolves the National Council on Ageing and Older People and transfers its employees, assets and liabilities to the Department of Health and Children. It establishes the office for older people to support the Minister of State at the Department of Health and Children with special responsibility for older people, Deputy Barry Andrews The programme for Government has a commitment to frame and publish a national positive ageing strategy and the Department has informed me that this will now be its function.

A cross-departmental group has been set up to prepare the strategy and the former Minister of State, Deputy Hoctor, has said it is intended to facilitate the participation of older people in the process of preparing the it. These include an invitation to make written submissions and the conduct of consultation meetings around the country. I urge that this work proceed without delay. I also urge that the Government reverse its recent decision and proceed with the publication of the national carers' strategy, a matter of vital concern to older people. The production and implementation of these strategies will be the real test as to whether the office of older people will work.

With regard to the dissolution of the National Council on Ageing and Older People, the Women's Health Council, the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency, concern has been expressed about whether their functions will be safeguarded within the Department and the HSE. I wish to refer here to the relevant questions posed by the National Women's Council of Ireland and I ask the Minister of State, Deputy Andrews to respond in detail. As the Bill does not provide for any review mechanism to monitor or measure this change of policy direction against outcomes how will Government and the Oireachtas know if the functions of the agencies are being carried out by the Department of Health and Children? I ask the Minister of State, Deputy Andrews, to note the specific question, as well as a number of others I wish to pose, and to ensure they will be responded to fully in his closing contribution to this Second Stage debate. What is the estimated cost of dissolving these bodies and what are the projected savings, which we are told there will be? What is being done to safeguard the knowledge or institutional memory built up by these agencies since their inception? The staff in question have much knowledge and experience which should not be lost to the public service. What commitments have been made to ensure that the Department and the HSE will continue to work in partnership with civil society and other relevant sectors?

These questions are especially relevant to the Crisis Pregnancy Agency. Its establishment in 2001 was a recognition of the need to address crisis pregnancy in a comprehensive and effective way. It has made progress and helped to improve support for women facing crisis pregnancy. Since the inception of the agency, counselling services for women in this area have expanded significantly. The agency has also played a role in helping to prevent vulnerable women from ending up in the hands of rogue pregnancy agencies. However, the need for the work of the agency is as great as ever. Crisis pregnancy is still, and will always be, a major problem. What has changed to warrant dissolving the agency? This question goes to the kernel of the Bill. Is it really about enhancing efficiency and co-ordination or is it simply a money-saving exercise? We need clarity; we need the bare facts laid before us. Whatever answers we are given, time will tell, but we also need to know what mechanisms are in place to monitor the effectiveness of the work formerly carried out by these agencies and now to be carried out by the Department and the HSE. I have made this point already and I re-emphasise it.

I welcome the amendment of the Hepatitis C compensation scheme to remove age limits for travel insurance. The National Cancer Screening Service Board is also to be dissolved and its functions subsumed within the HSE, becoming part of the HSE's cancer control programme. The Bill provides for the National Cancer Registry Board to be appointed by the Minister, yet it is also to be subsumed into the cancer control programme in 2010. Will this be an interim board pending the change in 2010? If so, what will its functions be over that period? I hope the Minister of State will address the questions I have raised during the course of this contribution.

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