Olivia Mitchell (Dublin South, Fine Gael)

I appreciate the opportunity to speak on this issue, which is of intense interest and importance to every citizen. An overrun in the HSE budget is nothing new, but this one is disturbing for us all. While I welcome the opportunity to debate the issue, I am disappointed in the wording of the motion which raises a very legitimate issue but offers no solution. It takes the easy option of demanding that services be maintained regardless of the overrun. All of us wish that services could be maintained but the issue is achieving it. The clear absence of any management structure when setting up the HSE was disastrous and it has dogged it ever since. It merely introduced a layer of management on top of the layer of management that existed for the health boards. It has struggled ever since as a result of that fateful decision. To this day governance in the HSE is problematic as is administration. Legislative change in the past few months, as mentioned in the motion, was not going to prevent a deficit emerging right now. Despite putting enormous amounts of taxpayers' money into the health system there is widespread dissatisfaction with delivery and regardless of what is often said about it outcomes are not up to international norms except in very limited areas.

A lack of money is not the problem nor is it the quality of personnel in the system. However, the management is a major problem. Management of something as vast, pervasive and complex as a health service is highly problematic and requires a management system with a clear line of command and responsibility that is second to none and we just do not have that. Most of the money goes into the hospital and that is where the problem is particularly obvious. I recently had occasion to visit a patient in what is regarded as one of our top hospitals. My observation of procedures and practices - medical and otherwise - were more than disturbing. In one example I observed a patient in a bed being moved to a different ward so the area had to be cleaned. On a Saturday afternoon I sat there and watched as three different cleaners came to clean the area - they all did exactly the same work and left again. While it is a very small thing it reflects the absence of anybody in charge and taking responsibility for management at ward level. Nobody is responsible for cost containment. As that was a Saturday afternoon, I presume the cleaners were not on normal rates of pay but on a higher rate. I do not blame the cleaners but management. How could that happen in a hospital where budgets were stretched?

I will not go into the other inappropriate and wasteful use of devices and the ordering policy. The point is that hospitals absorb a huge amount of budgets and without really strong management in hospitals we will continue to have these problems. I will not go into the issue of consultants and the management of patient care, which is also of concern.

Another area of concern is the area of medicines. Approximately €2 billion is spent annually on medicines and this is rising at an alarming 9%. While some reduction has been achieved the pharmaceutical industry must do better and come to the table in order to provide savings to the State, just as the State has responded to its concerns that we would support innovation and purchase of new and expensive drugs. The reduced prescription charges introduced by the two pharmacy groups is very welcome and I hope the competitive pressure will see this trend continuing and secure further savings for the State and private citizens.

I raised the issue of disabled school-leavers some months ago and I realised that it would only become obvious at this time of year. As able-bodied school-leavers are moving on and looking forward to new educational opportunities, holidays and trips abroad, disabled school-leavers are being sent letters to be informed that there is probably no service for many of them. I understand there is less money for everything but it cannot be that there is no money for some of these children. Every one of these children is entitled to some kind of service plan. Their parents who have done everything for them up to the age of 18 are getting old themselves and are beginning to worry about the future. They see other children having every opportunity while they have none. We cannot throw these children on the scrapheap of life now. I will not stand by silently if every one of these children leaving school at 18 is not provided with a day-care plan.

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