Brendan Smith (Cavan-Monaghan, Fianna Fail) | Oireachtas source

I wish to share my time with a number of colleagues.

Some weeks ago, HSE officials at senior level, but not including the recently appointed CEO designate, announced on behalf of the Minister a reduction of €130 million in his Department's programme of expenditure for 2012. The reductions affecting so many critical services stemmed directly from the absolute mishandling and presentation of the Minister for Health's Estimate for this year. We all realise the challenges that arise in funding the health service but, regardless of these challenges, the Estimate must be managed properly right from the start of the year.

It was pointed out repeatedly from early on in this year that the Estimate did not stack up. In the immediate aftermath of the announcement, Members on the Government side distanced themselves as much as possible from the Minister, Deputy Reilly. Strikingly, even the Minister for Social Protection, Deputy Burton, refused on more than one occasion to express confidence in the Minister for Health. The non-working relationship between Ministers in the Department of Health has been well-documented. Such non-working relationships are damaging the implementation of departmental plans and governance. What leadership is that?

Ministerial colleagues were not informed by the Minister for Health of the cutbacks or the resignation of the former CEO of the HSE, Mr. Magee. Those strained relationships must be to the detriment of providing services in what are challenging times. The Minister of State, Deputy Shortall, learned through media reports of the departure of the CEO of the agency charged with the delivery of health services. This clearly demonstrates the breakdown of a proper working relationship within the Department, never mind within the Government.

We all understood that the Minister of State, Deputy Shortall, had been delegated responsibility for the primary health sector, but we learnt through the extraordinary correspondence between the Minister and the Minister of State that no such delegation of powers had been effected 18 months after the ministerial appointments. That correspondence dealt with the blame game over budgetary overruns in primary care. The Minister of State, Deputy Shortall, clearly identified overrun problems emanating directly from the Minister's failure to generate savings on the drugs bill or through recoupment from the insurance companies. Clear commitments had been given at budget time by the Minister to effect such savings and the failure to do so has now had an impact on people with disabilities and the elderly. Where is the accountability when a Minister fails to bring through Government the delegation of powers to a Minister of State in such a critical area of administration?

Some six months ago, the then HSE CEO warned of the impending difficulties with the health Estimate, and that was brought to the attention of the Department of Public Expenditure and Reform. Over the years, there have been particular difficulties in the north east with the reconfiguration of services. A number of hospitals in Louth, including Dundalk, and Navan, Monaghan and Cavan come to mind. Over the years there has been a reconfiguration of services but it has not been completed. However, the reconfiguration that has taken place has brought about improved services in many areas. Those of us in public life have had to deal with particular difficulties in this regard. Current Ministers, including Deputies Noonan and Howlin, and former Taoiseach Brian Cowen and Deputy Martin all dealt with these issues. We faced up to them by prioritising the need to put the patient and safety first. This was not always the case in that members of the Fine Gael Party and the Labour Party, when in opposition, criticised the reconfiguration that was necessary and which has brought about improved services.

When the current Minister for Health was the Opposition spokesperson, he gave clear commitments in County Monaghan from the back of a lorry that the people of Monaghan would have to access fewer health services in Cavan and that they would be able to access more in Monaghan General Hospital. He stated at the time that fewer patients from Monaghan would travel the Cavan road to gain access to health services. In this regard, we should note what has happened in the past 18 months. The minor injury unit at Monaghan General Hospital has had its opening hours and services reduced. A proposal to provide medical assessment unit at that hospital has been reviewed time and again. Some years ago, a very successful medical assessment unit was developed at Cavan General Hospital.

That unit allowed other specialist services to be brought to Cavan General Hospital for the region. Previously, those services could only be accessed at one of the Dublin teaching hospitals.

As the Minister knows, the development of a service does not necessarily entail additional expenditure in the health budget. I implore him to act on the promises he gave to the people of Monaghan to the effect that additional services would be provided at Monaghan General Hospital. The proposals before his Department are sensible and practical and would not incur additional expenditure.

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