Éamon Ó Cuív (Galway West, Fianna Fail)

I listened with interest to Deputy Mathews's contribution. This is an issue which has been ongoing for a long time. We must work with the Minister in a rational and reasonable way to ensure the junior doctors crisis which has arisen this year and in other years is finally resolved. If the truth be told, we should all get behind the Minister's efforts because I know he has given a commitment to try to resolve the very issue to which Deputy Mathews has referred. For my part, I believe the greater good of society is served by us working together and not making a political football out of this issue.

There are a number of issues to be considered. I refer to the issue of the training of doctors and the entrance requirements for medical school. Deputy Mathews alluded to the issue of how to attract our young qualified doctors to stay in this country. The third and most complex issue is also the issue that has failed to be dealt with over many years by many governments, namely, the grip which consultants have over the system. The danger is that consultants have the system in a certain way that suits them and this is not friendly to the young, aspiring, up and coming person within the system. In my view, if the Minister is genuinely working to resolve that issue, if he is prepared to do the slow, patient work rather than becoming the tool of vested interests who are trying to preserve the status quo, then the Opposition will support him in bringing about the radical change needed.

I refer to the genesis of the mother and child scheme dispute and the 1947 Fianna Fáil Bill that was eventually enacted by Fianna Fáil in 1951. Unfortunately, Dr. Noel Browne failed to have the scheme established and it was the cause of the collapse of a government. That scheme was more about consultants' interests than it was anything to do with the Catholic Church. The more one reads about it, the scheme was a football among the vested interests. In my view, where there is common cause, we should not play politics with it. Unfortunately, however, the record of this present Government when it was in Opposition was exactly as Deputy McHugh said. It was harnessing the anger and making promises it knew could not be delivered once it walked into government. Promises relating to Roscommon hospital were made as late as March of this year. I hope the Minister will give the House an assurance today that this issue of the shortage of junior hospital doctors will not be used on the so-called health and safety grounds to start closing accident and emergency units in smaller hospitals permanently. Sometimes what the system loves is an emergency in which to introduce measures for a temporary period but which are then made permanent. It is fair to say that income tax was first introduced in Britain to pay for the Napoleonic wars. That emergency measure has lasted a long time.

The Minister has clearly identified that the smaller hospitals will be the losers in this regard. I refer to a statement he made when he said that we may very well end up with some accident and emergency department that cannot be safely manned. He assured us it would not be any of the major hospitals but rather that it would be the small, rural hospitals where there would be a real difficulty. If this is caused purely by a temporary difficulty, I hope the Minister gives an undertaking that once that temporary difficulty is resolved, we will then revert to the status quo.

As regards the smaller hospitals, I have never believed that the status quo can go on forever. I have never been unrealistic. I know people criticise me on various issues for being, what I would call, analytical and realistic and not playing to the gallery. I have never joined the queues of people who say we are going to abolish special areas of conservation, SACs, for example, or that everything in the small hospitals will stay as they were. I defended and I will continue to defend the basic thesis of the cancer strategy. If there was an appreciably better chance, we would go a lot further than Galway or Dublin to get a diagnosis or operation.

I do not believe that we have examined enough the work that could be done to decentralise that which is currently done centrally but does not need to be. We could provide services on a much more local basis. If something is high-tech or very specialised and people's chances are better over a short duration, they are willing to travel. I know people who have gone to England and America to get what they thought was a better chance of life in an extreme situation.

People want continuous treatments which can be provided locally to be provided at local level. They could start in one's own home and involve things like tele-medicine. They could also include GP clinics, and primary care centres that should be able to provide more services than they currently do should obviate the necessity of travelling to major hospitals for treatment. The system can work up to smaller hospitals. Very good work practices have been developed in Galway and Portiunucla where outreach services are being provided and doctors go to hospitals because a high level of technology is not involved.

What should be the preserve of the big hospitals are expensive and specialised treatments which need critical numbers. Therefore, the process does not need to be a continuous one of drawing into the centre. As is the case with chemical reactions, the system could go in two directions at once. Lots of things that were traditionally done in the centre could be moved away from it to the most local level possible. Certain specialties that require ever greater levels of technology and specialisation should be centralised because they tend to involve short-term procedures such as operations and diagnosis.

We often get the impression that this is a one-way street and things can only be moved into the centre. I am not a doctor; the Minister is. If there is a problem with MRSA in hospitals, the more people who are brought in unnecessarily to huge conglomerations of people, the greater the risk of infection. Therefore, limiting the time people spend and need for them to come into large centres would be a rational approach. It is also convenient to provide services locally, in terms of reducing queues and so on. There is a lot we can do.

There is a great temptation to play the game that was played with us on the Government. There was cynicism in recent years in terms of promises made which were known could never be fulfilled. In the anxiety to get into Government, any promise could be made. The programme for Government is littered with promises that will never be fulfilled. The temptation is to respond in kind but we would be wrong. The Government was wrong in Opposition and we will not do it because it plays to the gallery.

I was amused to hear the comments of Deputy McHugh. Fine Gael Deputies have short memories. He was correct. When we know in our hearts and souls that change is inevitable, we should work to make change for the better and not pretend that the status quo is a perfect solution and no change will happen. I have always argued that if people set their faces against any change, it will take place without any influence or input. If one recognises that we are in a radically changing world with radically new technologies and try to direct the change to give the best output, even though it is not half as spectacular as trying to stop the flood, one will have a much greater chance of influencing change for the better and ensuring it is rational.

As I said on the Order of Business, we are anxious to facilitate this Bill. We accept it is an emergency Bill and it is important that we work with the Minister to ensure this type of emergency legislation is not needed in the future. We should resolve this issue and stop robbing the Third World of people it has trained at great expense and bringing them here because we have a flawed system. It is morally reprehensible that we have to do it. It is mainly a result of vested interests in the medical profession.

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