Bernard Durkan (Kildare North, Fine Gael)

I welcome the opportunity to speak on the important issue of health services, which affect every family in this country. Our current circumstances encourage us to focus on reality. I commend the Minister for Health and his colleagues on identifying the need for reform in the health service.

I am long enough in this House to remember when we were members of health boards. As part of visiting committees, our visits to institutions gave us the great advantage of becoming familiar with health services on the ground. This familiarity disappeared when the health boards were abolished and replaced with a free standing self-supporting system that was supposed to be the Rolls Royce of health service provision. As an Opposition Deputy I opposed the transformation on the basis that it would become an unaccountable entity with its own policy making department and no regard for supervision. It was claimed at the time that political supervision was bad and that politics had to be taken out of the health service. I am afraid that did not work.

The review now taking place has to identify the issues and, more importantly, introduce a system that is accountable to national Parliament, budget providers and the people who vote for the Department's budget. To endorse a system whereby the national Exchequer funds a devolved department is without question wrong - it can only lose. We, the people elected by the public, are the ones who will pay for it because none of these people will so do.

I emphasise the points made by Deputy Maloney about St. Brigid's nursing home in Crooksling, which is on the border of my constituency and his. The existing services provided to the very deserving patients in that women-only nursing home are second to none. The facility is state of the art and over the years it has been proven that institution is well capable of delivering the highest quality of service for the people for whom it was intended. Some, in the course of revisionism, will say we need to find new ways. We used to hear insulting remarks about bed-blockers. It was appalling to suggest that a patient was blocking a bed from somebody who was more deserving. All the people who require in-hospital health services or other institutional care are entitled to them. We have an obligation to ensure that the people, who worked all their lives in this country and who may need recuperative, supportive or ongoing full-time nursing care, get those services. I am sorry to say that over the years that has become very vague.

Some things in the HSE's pipeline have been proposed without having full regard for the extent of the requirement in terms of primary care or institutional care. It is wrong to suggest that primary care is less expensive than institutional care in all cases because it takes three times the staffing levels in community care if the patient requires continuous 24-hour nursing care.

The five minutes both of us had were simply not sufficient to cover the health services in any kind of detail and I hope we will have another opportunity to do so in the not too distant future.

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