John Halligan (Waterford, Independent) | Oireachtas source

I thank the Deputy. I recall the times when maybe 50 or 60 councillors would turn up, and the staff from the HSE. The councillors got their travelling expenses. Everything was crammed into a two-hour meeting during which nothing could be achieved. If ever there was a waste of money, time and procedures, it is the health forums. The Minister should really examine them. If they were abolished we would save millions of euro.

When it was set up less than 14 years ago, the HSE was intended to move the health service away from the control of local vested interests that dominated under the regional health board system, but, as the cases of Wexford General Hospital and St. Luke's General Hospital revealed last weekend, this was not achieved. I welcome the principle behind these reforms. Without question, the HSE, its structures and its governance need to be changed now. We need far greater clarity in tracking the health budget, but I have serious concerns about how the proposed system will work in practice. As I read the Bill - I may be wrong - it proposes that we give responsibility for the health budget of €14 billion or more to the Department of Health, thus giving the Minister of the day the authority to specify priorities which must be followed in preparing service plans. Every one of us would have difficulty with that because my reading of the Bill suggests that this is a very general power and there is little information on the type of direction the Minister may make. This needs to be clarified in the Bill. For instance, people will ask whether we are giving the Minister and his Cabinet colleagues carte blanche to accelerate projects in their own constituencies to the detriment of other areas. That is a reasonable question. We need clarification on the specific authority the Minister would have. The legislation needs to state how and where a Minister may make directions. That is a reasonable request. If such an amendment is tabled, the Minister should consider it carefully. What we set in statute here may remain for another four, five or eight years. The present Minister may not be in government then and may well tell the next Minister for Health that he has too much power. We need to state specifically how and where the Minister will make directions because we need accountability in all aspects of the health service.

The Minister has also indicated that the new directors will be appointed following a competition from within the health service, which leads me to wonder whether the Minister will merely be shuffling deckchairs in making these appointments, because this happens when we reappoint within a working system. Giving each director the power to establish his or her own committee for assistance and to advise the Minister is creating another bureaucratic layer of outside advisers. Do we need this? We have enough of them already. I do not understand why are we going down that road, which adds another cost. There is also a general lack of clarity about how the new integrated care agency, which is a separate purchaser and provider of arrangements for health care, would operate in practice. That is a big issue for many people. I have gone through the Bill in detail and it appears to me that a great deal is left unclear.

I do not know what advisers put the Bill together, but my few points are reasonable recommendations. We need clarity. It is not always the case that those of us in Opposition want to oppose everything. Sometimes if simple amendments were tabled we would find it easy to support Bills. I would appreciate if the amendments that I am sure various Members will table are accepted.

When will the Minister introduce free GP care for those with long-term illnesses? He advocated this strongly when he was in Opposition. I do not see his White Paper on universal health insurance being delivered as promised. I do not see the free doctor scheme going anywhere. I have spoken to many doctors and they say they have not even been contacted. No discussions have taken place. The Minister has had two years in government. That was one of the big promises he made to many people. I spoke about this during Leaders' Questions last week. The cost of going to a doctor is huge, and if one subsequently goes to a chemist one can pay a total of €100, a third of the earnings of some people who do not qualify for a medical card.

The Minister should consider the amendments to this Bill carefully and be generous in assessing them. I listened to Deputy Ó Caoláin's excellent delivery. We have all put much thought and effort into this Bill to see how it would best serve the people. When we consider the amendments we might be able to support it.

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