Bernard Durkan (Kildare North, Fine Gael)

I am glad to have the opportunity to speak on this Bill. It is unfortunate we have to introduce it in the first place. I recognise the difficult position in which many Members of the House have been placed in recent times and no doubt will be in the future. One has to ask why we have to introduce this Bill at the current time. Sadly, the reason is because of the lack of procedures in place to ensure we did not arrive at our current junction.

The Bill is intended to assist urgently in the addressing of current difficulties relating to non-consultant hospital doctor vacancies. Forward planning in all institutions is supposed to be able to identify and plan for something long before the need arises and becomes urgent. I mean no disrespect to the main Opposition party. Sadly, it has to bear a huge amount of responsibility for the situation in which we find ourselves. For the past five or six years I have been listening to how the Minister has been doing a great job in the Department of Health. I am afraid if the Minister did a great job and this is the end result, I do not agree with that and did not at the time.

Needless to say, I did not agree with the setting up of the HSE. I was totally opposed to it when it was set up, as were a number of other people in the House. It created a duplication of services that already existed. The Houses of the Oireachtas and Government handed over to an independent autocratic body full policy-making responsibilities for which the House, its Members and Government became responsible. Decisions are taken by people who are not elected to public office or Ministers. They have taken over and now dictate to the Government and Parliament where we should be going in the future.

The thinking that has led to our current situation is out of date. We have listened to the mantra about centres of excellence. We have heard how they will be the answer to all our prayers and that we will have delivery of services all over the place in a way which was never seen before. It is rubbish. It was the theory in the UK ten or 15 years ago. It had to change its thinking and policy when it found out that big was not beautiful, did not deliver, was too bureaucratic and sprawling and access could not be gained to services in the manner in which the public wanted. Services are provided for the public and patients and should involve ease of access for them rather than internal administrators, consultants and those working in the system.

A great deal of the responsibility for the debacle we have seen in recent times must rest with those who had authority and presided over the situation over the past ten years. I will separate Sinn Féin from my comments on the Opposition because it did not have responsibility for health. I hope the Opposition recognises that it was a disaster and we have seen the results. The sad part is that we have a growing population with a growing demand for services but less access to them. More people are telling us how we should deal with the issue when the simple fact of the matter is that the solution was obvious to all and sundry.

I listened to Deputy Twomey with interest. He gave a very interesting account of the way the system works from the inside. Those of us, including the Minister, who were once members of health boards know full well that what he said was true. In the thrust for forward thinking, the amorphous mass said we must close down services throughout the country and asked what to do to achieve that.

We disrupt services and fail to address the issues before, or as and when, they arise. We refuse to have proper forward planning, so we have dysfunctional institutions. The sad part of it is that, one by one, in the various smaller hospitals around the country means and reasons will be found to remove some part of those services, leaving them incapable to standing alone and providing the services to which people are entitled.

That responsibility rests with the main Opposition party whether or not it wants to accept responsibility for it. I am not suggesting the Members sitting across the floor of the House were responsible. However, we heard all the time about how the previous Minister was doing a great job. I know that Minister was not a member of Fianna Fáil but that party had core responsibility, to use a commonly used phase. It was readily said that the Minister was doing a great job. I could not understand where they were getting their information from but now I know because the information was wrong. It was provided by spin-doctors to tell people they were feeling well. Even though some people might be dying, they were still being told by spin-doctors they should be feeling better. They were told services were in place and access was available. They were asked what the problem was with travelling 50 or 100 miles, if they were in danger of dying in the next the minutes.

What in God's name are we talking about as we move into the 21st century? How often have we seen situations in the recent past, in every branch of society, where modern science and technology cannot do a better or quicker job? Why are we going the other way? We are incapable of responding to people's needs when they arise, although it should be simple to do so. We could get simple things done years ago, but not now.

Not so long ago, matters such as we have discussed over the last 24 hours were raised at health board meetings. We were told, however, that health boards were bad but, ironically, the issues raised there received attention and were addressed. That was because the health board membership comprised medical professionals, such as doctors and nurses, as well as politicians and administrators. They foresaw what was happening in advance and could predict what was likely to happen next year, so we did not arrive at a crisis.

The Minister of the day - I will not say who he was, but he is still an Opposition Member - came forward with this brilliant idea to abolish the health boards. First of all, he said they were not working, so he increased their number from eight to 11, but that did not work. He then decided to abolish them altogether, which was a bright thing to do. He said he would hand them over to what effectively was a private organisation. It was a privatisation of the health service. He handed it over but we now have no service at all.

We have what appears to be a public and private health service but in fact we have two private health services. Therefore when the unfortunate public need access to health services, which would ordinarily be available to them through the public health service, they must now join waiting lists. If they want a hospital bed they will be told that no beds are available. If they wish to be seen by a consultant, they may find the consultant is in another hospital, or could be in two places in the one day - one public and one private clinic. It will depend how urgent a person's case is as to whether they are seen. Meanwhile, the patient's physical condition will not have changed at all, so I do not know how the urgency of a case can change as regards access between the public and private systems.

I understand the need for this legislation, but its provisions were required four or five years ago. That was obvious to all and sundry. In recent years, many of us tabled questions as to why provision was not made to meet such requirements long before it became a necessity. The Department of Health failed to exert its authority over the HSE. How many times were we told when in Opposition that the Minister had no responsibility to the House and that it was a matter for the HSE? What is the HSE and what does it do? Who elected or appointed its members?

The HSE has devolved responsibilities and this, without a shadow of a doubt, is the biggest single enemy of democracy in this country at present. It is the biggest single obstacle to the delivery of health services. As elected public representatives we are expected to deliver to the public, either through Parliament or Government, but we cannot do so. The public have a right to comment on us, but it is within our hands to change the system. I hope this is the last time we will have to take this kind of retrospective action as a result of the negligence of previous incumbents of various offices to do the job they were elected to do.

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