Liam Twomey (Wexford, Fine Gael)

Deputy Ó Caoláin and I were in this House prior to the 2007 election, when the Medical Practitioners Bill went through, and I am surprised to be back so soon with amending legislation as a result of a crisis involving the junior doctors in our hospital service. At the same time it is to be expected because of the way we run the health service. There is a crisis in the daily running of our service and in the manner in which we plan and look to reform it. People have seen what happened outside the gate last night and Deputy Ó Caoláin and I have experienced the haphazard changes to the way health services are delivered. One would be surprised at how far back is the genesis of this crisis.

The last Government received praise for changes to cancer services and the cancer treatment reform programme it initiated. The baseline of that change to the delivery of cancer services goes back to 1994 when Deputy Michael Noonan, then Minister responsible for health, published a cancer strategy. It took over ten years for that strategy to have an impact on health services. When we ask why we are here and how quickly we can change the issue, we must realise who is responsible for making changes in the health services and how their decisions can have an impact for such a long time. We must be radical in our thinking if we are to achieve solutions for the current crisis.

Manpower planning in the health services goes back to the Hanly report published in 2003. It was not concerned with closing small hospitals but rather the planning of manpower, and it is still being used by the HSE and the Department of Health to this day. Changes implemented over the past ten years have to some degree contributed to our current position.

The last Government failed to take on board the problems in our public health care system. The former Minister for Health and Children, Mary Harney, abandoned any sort of change within the health system and tried to find a political solution in the co-location project, which was built on the idea that the Celtic tiger would never die. That is another Government policy lying in tatters while still affecting how health services are delivered.

There are many good individuals within the health services but the administration is chaotic, with no grand strategy concerning what we want from the services. Percolating through the system to hospital and regional management, there are many problems which are not being dealt with by people we are paying well to do so. There is a need for us as politicians to highlight such matters and discuss them in an open, frank and transparent manner in order to deal with the issue.

There is another group within the health service, the hospital consultants, that must take some of the blame for our current position. I spoke about the cancer care policy document published by Deputy Michael Noonan in 1994, the same year I became a senior house officer in Mallow General Hospital. I went through a large number of hospitals in Munster before I went into general practice, and I earnestly believe the same carry-on in training is happening today. There has been little or no change and the group of people responsible is hospital consultants. It would be generous of me to say my training was only haphazard. I can honestly say disaster was averted not because of excellent training or my expertise but because I was lucky and I had a good nurse beside me. That is not the way to train junior doctors.

I am also concerned about supervision within our health services. We must place responsibility not just with some faceless bureaucrats within the HSE who can then hang out a junior doctor when a mistake is made. We must make the people who are delivering the health services responsible for what is happening. We should also wake up and consider what changes can be made. As far back as the late 1990s a programme was being run in Donegal where heart attack patients received thrombolysis in the back of an ambulance under the supervision of trained emergency medical technicians and the local GP. That programme disappeared. In Paris and many parts of France there are now ambulances being driven around with fully trained doctors and cardiologists who can deal with heart attacks and strokes in the back of the vehicle. We have not implemented such radical proposals within our health services.

Innovative pilot projects have been run on a piecemeal basis across the health service in the past 15 years, with some showing potential to work in primary and emergency care, but they have not been progressed or implemented. We are not thinking radically enough about the solutions to the problems.

This legislation is a sticking plaster and it is a bad policy for a country, after 25 years, to rely on 80% to 90% of junior doctors in non-teaching hospitals coming from countries like Pakistan and India. That is the case in this country and we have essentially been relying on countries which need doctors as much as we do, taking their qualified doctors and putting them into our health system. Our doctors are leaving our health care system to go to America, England, France and Germany because the quality of the training in those countries is better, as is the experience they will garner. Some of the doctors will return but many do not. We are acting as a parasite on Third World countries in order to shore up our health service.

As other Members have stated, this policy is ingrained in our health services and we see it as normal that up to 90% of junior doctors are from outside the jurisdiction, which is wrong. There should be opportunities for people from outside the country, such as Pakistan or India, to come to the country for extra training and to improve their skills before returning home. That is not what is happening and we are using these doctors just to shore up our services. Many of those doctors must be just lucky like I was in order to avoid crises in the health service. We have not drilled down into how we train junior doctors within our health services or taken the issue seriously.

I commend the Minister, Deputy James Reilly, as he understands these issues perfectly. His problem is we are dealing with an economic and not just a policy mess. That is having a massive impact on how we deal with the policy disasters in our health service now. I wish the Minister for Health the best of luck in trying to work through these issues.

We should submit our own solutions while being realistic about what can be achieved. Deputy Ó Caoláin and I have seen all this happen very close to home, and we know some issues could have been averted. Radical solutions could have been used but were not. As I noted, pilot projects were promoted but left to fall apart. The health service is chaotic by its nature and includes emergency services, such as Dublin fire brigades, ambulances in Connemara, the emergency care nurse in a small hospital or a junior doctor with limited experience. Nevertheless, we must ensure to maintain the proper standards, protocols and procedures to limit the damage done to patients we are expected to care for within the emergency services.

We must focus on patient safety as it is only through luck that there have not been more disasters in the health service over the past number of years.

We need to make sure there is good training and expertise. Proper procedures, rather than luck, will ensure people get good outcomes from our health services.

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