Dara Murphy (Cork North Central, Fine Gael)

First, I welcome the Bill, and particularly the co-operation of the Opposition in facilitating its speedy passage through the House. Some reference has been made to the fact there is an element of emergency in this and a strong element of rush. I suppose that has been a factor across a broad range of Departments over the past number of months. However, the Bill must be welcomed and the Minister must be commended in bringing forward the Bill so quickly.

The Minister has gone through the main elements of the Bill but there are a couple of areas on which I want to touch. The first is the important area of confidence. There are measures in the Bill that give confidence to the people of the country, particularly in the area of the assessment, supervision and the potential for censure or removal, if required.

Yesterday, by coincidence, the Indian ambassador visited the Oireachtas Joint Committee on Foreign Affairs and Trade. He was supportive of, and indeed engaged with, the forthcoming arrival of doctors from his country. However, he made the observation - he stated he had met the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Gilmore - that we need to engage more with the universities in securing more students to come to study medicine in the country and follow through as part of their training, rather than come here for a couple of years as a stop-gap measure. He pointed out there are only 1,000 Indian students in this country as compared to 80,000 studying across a broad range of subjects in our neighbours in the United Kingdom and he suggested that some work should continue to be done - he stated he had met the presidents of the universities - to try to encourage an increase in that. From speaking to the president of my university in Cork, no doubt there would be a significant degree of welcome in bringing more international students because of the revenue they can deliver for the universities.

While this is a European-wide problem as has been discussed - the spokesperson for Fianna Fáil, who is not now in the Chamber, made some reference to not being political and then proceeded to be quite political in his remarks - like so many other elements of this first number of months in government, such as our economic problem which is a world-wide problem, somehow we find ourselves with problems that are more serious than those being encountered anywhere else. It must be restated that the reason for that in terms of the health service has been the mismanagement of many areas of those services in this country for the past 14 years. It is unfortunate that a large element of work done by all Ministers in the first number of months has been to put out the fires but when these have been extinguished, one will see a proper structure that will deliver services, as was suggested, through universal care and other areas.

I support Deputy Calleary, who was much more constructive in his remarks, on the importance of using the existing structures. I note the two previous speakers for Fine Gael, including the Minister and Deputy Twomey, are medical doctors. There is a significant resource in the country in terms of the existing general practitioner network. It has been made clear by the Minister that he wants to see the provision of medical services as close as is possible to general practice. I held discussions last week with an accident and emergency consultant in a Cork hospital who told me that approximately 80% of the patients who attend his accident and emergency department are what he referred to as "ambulatory patients", in other words, they can walk in to receive services and they can walk out. He strongly believes - this is a premise supported not only by the Minister but by the general practitioner body in general - that we need to develop much more the primary care health system and to use the general practitioners. This consultant placed particular importance on using the training that his nursing staff have and stated the requirement on which we need to focus over the next number of years is to develop systems that allow general practitioners to engage more directly with specialists, therefore by-passing the requirement for patients to wait over long periods in trauma units. The reality, as the House will be aware, is that many patients are left waiting in accident and emergency departments because there are patients with more serious conditions being treated. In many cases the requirement for them to sit there could have been dealt with by their general practitioner and by units that could have by-passed the accident and emergency department.

It has been my experience that hospital managers seem to be a remarkably mixed group of people. In my time some of the best staff I have met in the health service have been hospital managers and some of the worst staff I have met have been hospital managers. It is welcome that the Minister is bringing the health services back under his control. It is far too easy, and, as happens frequently for us, dismissive, to speak about the failings of the health service without acknowledging some of the remarkable talents. This is, after all, a small country. It has a small number of hospitals and it has a small number of senior staff managing the hospitals. I suggest to the Minister - I am sure it is something of which he is aware already - that there needs to be more responsibility in the Department for identifying the better staff who have delivered in their hospitals and the professionals with the ambition and desire to continue to strive to improve the services that they can deliver; equally, to be ruthless enough to identify the professionals who cannot; and ensure we can deliver the best possible services for patients.

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