Billy Kelleher (Cork North Central, Fianna Fail)

It is difficult for people to take the Government's assertion that it will retain services in smaller hospitals seriously when the opposite is clearly the case. For example, strong, brave commitments were made about Mallow General Hospital. The Minister and I know that the accident and emergency department in Mallow General Hospital will not be retained but promises and commitments were made that it would be retained. The hospital will have a medical assessment unit and patients with serious injuries and illnesses will be transferred to the regional hospital in Cork. Promises were made at local level to retain the accident and emergency department and that undermines people's confidence in how health services are delivered.

On the broader issue of universal health insurance, we have heard a lot of noise about the merits of the Dutch model. What are the riding instructions and terms of reference of the implementation group established by the Minister to deal with the implementation of universal health insurance? The Minister said it is a long-term plan and the can has been kicked well down the road to the election following the next election. If it will be such a fundamental change to the manner in which health services will be funded in this State, it would be appropriate for us to have sight of the terms of reference given to the implementation group and to have a debate on this issue. Of all the provisions and pronouncements made by the Government, this is a fundamental issue regarding how our health services will be funded in the years ahead. No one other than the members of the implementation group, and perhaps the Minister, know the terms of reference and riding instructions, when it will report back and when implementation of the new universal health insurance will take place. The Minister should examine that and at least have a broader debate on the fundamental issue of the provision of health care in the country.

The Minister sacked the board of the HSE and took personal responsibility for it for a while, but that position has now changed in that in replies to parliamentary questions we are referred continually by the Minister to the HSE. I thank the Minister for that courtesy but he said he would adopt a hands-on approach to the provision of health care and that he would be running the HSE. We have now been informed we will have to wait a longer period than envisaged for legislation to be brought forward to change the governance structures of the HSE, but in the meantime who is running the health services? Is it the Minister, the Minister and the Department of Health, the HSE or who is it? This is allowing a drift to occur in the area of policy making, policy formulation and the implementation of Government decisions.

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