John McGuinness (Carlow-Kilkenny, Fianna Fail) | Oireachtas source

-----and his reference to St. Luke's Hospital in Kilkenny. For many years Oireachtas Members on all sides worked with Garry Courtney and the leading staff members in the hospital. They determined what was needed and we pursued it politically. We had many achievements because we all worked together. The hospital serves not only Kilkenny but also Carlow and the region beyond. I commend Garry Courtney's imaginative work in the health service which is noted all over the country. There was a collective input into what happened at the hospital, but that is not the question which was raised by Deputies Billy Kelleher and Micheál Martin. They questioned how it was fast-tracked and dealt with, which is a different issue. We welcome the development at St. Luke's Hospital, as I am sure, the people of Wexford do. The other issue raised concerned governance.

Deputy Paul Connaughton raised another issue of concern to me which also relates to the Bill. I wish to deal with it separately before I make general comments on the Bill. I refer to the system for dealing with parliamentary questions. We are forced to table parliamentary questions about individual cases, HSE expenditure or its future plans which are generally not known in detail.

When one recieves a reply, it is almost too late for the individuals concerned because the action asked about has or has not already been taken, or the information sought on medical card applications has been lost. The parliamentary question system would serve us well if it were used correctly, but the Department of Health simply ignores it. The HSE ignores the right of Members of this Parliament to ask questions about individuals or the system within the health service or those organisations supported by section 39 grants. It would be an important and reforming step if the Minister were to say that, as and from 1 February, all parliamentary questions on health matters, be they about individuals or organisational issues, had to be answered within the specified three-day period. One could even allow a few more days to answer the more difficult questions. To receive no answer or receive a standard reply stating the matter in question is not one for the Minister but for the HSE is not acceptable. On asking a question, one must wait a number of weeks, if one is lucky, to receive a very poor response. This is unsatisfactory. To receive no response is a damning comment on the HSE and the Department.

Let us not ignore the fact that we let this happen. When Deputy Emmet Stagg was in opposition, I used to hear him talk about parliamentary questions and their importance. Now that his party is in government, it is business as usual and scant replies are given to parliamentary questions. This is not satisfactory and it could be corrected at the stroke of a pen if the Minister were of a mind to do so.

The Bill has been referred to as legislation bringing about reform. It is about the appointment of a director general and two to six other directors. It is not reforming legislation and to say otherwise is nonsense. To confine the competition for the job of director general and the other directors to those currently employed in the HSE is simply asking those who could not reform the organisation to date to deliver the necessary reform under a new title. This is a contradictory approach which will not impress those engaged with the administration of health services on a regular basis. It is not reform. I ask the Minister to reconsider this part of the Bill and allow the positions to be subject to open competition. Anybody within and outside the HSE who believes he or she is qualified and has something to offer should be allowed to apply. Instead of having an open competition, the Minister started incorrectly by appointing the current director general designate. It was a political appointment which he should not have made. Why did he not allow an open competition or follow the pathway of reform about which he spoke while in opposition? Why did he not declare that, as a first step, there would be a open competition at arm's length from the Minister and the HSE, as it stood? After this, he could have driven the governance reform that he envisaged in the context of the Bill. I ask him to implement change in this regard first. The people in the HSE who could apply for the positions in question stood over the activities raised by Deputies in the House. I refer to the medical card system, for example.

Officials from the medical card section appeared before the committee chaired by Deputy Jerry Buttimer. They spoke about medical cards at the Committee of Public Accounts also. Certain improvements were made, but it is still the case today that a person with cancer whose time on earth is limited cannot obtain the medical card that is so necessary for him or her to see out his or her last days with dignity. It is wrong that, on proving one has cancer, one should be subjected to the type of questioning engaged in by the medical card section in order to obtain a medical card. This questioning occurs, despite the medical evidence being in favour of the patient. It is simply wrong and the Minister could change it at the stroke of a pen.

Every Deputy will be aware of the number of people coming to his or her constituency office because of the cutting of home help hours. These individuals' home supports from the HSE have been cut and, in some cases, withdrawn completely. The Minister says he will examine each case and ensure that, where one is deserving, one will have one's home help hours or supports restored. Every single reply my constituency office receives from the HSE is the same. There is not one word that is different except for the name and address of the person on whose behalf one is making representations. All replies are negative.

I have received an e-mail that is representative of the e-mails we all receive. It is written by a neighbour on behalf of an 87-year-old woman who cannot make her own bed, dress herself, wash herself or look after her basic needs. Her home help, amounting to two hours a week, has been withdrawn. Nobody could agree with this. None of us in this House wants to see this happen, yet it is happening under the watch of the Minister who said every case would be examined genuinely. It is occurring under the watch of each of the people who will be seeking appointment as one of the two to six directors. This simply is not right.

Let us consider the section 39 grants and the recent decision to withdraw the financial supports and advisory services for childminders. There are 33 officers in all throughout the country. They were told only last week that they were out of a job because there was insufficient money available. This is after we have held a referendum in which we said children would be to the fore and that policy would look after them. The childminding services on which children rely so much are being withdrawn. The basic rights of children are being affected. This is happening under the watch of the Minister and those who will apply for the jobs to which I referred.

There are many other examples of a system that is simply failing the patient. While Deputy Jerry Buttimer's point that the patient was failed by the last Government and its predecessor is correct, this is happening under the watch of the Minister who spoke so much about reform. I am asking that basic steps be taken in the process of reform. I ask for accountability in the parliamentary question system. I seek honest answers to questions to the HSE about elderly patients represented by Members. It is a basic right to be given access to the relevant information. It is the right of every Member of Parliament to be given full information in response to a parliamentary question. These reforms could be achieved easily to everyone's benefit.

Having achieved these reforms, one could consider structural reform. In this regard, one should consider the commitment that every Member of this House would be brought before the HSE locally to deal with all relevant issues. The local HSE committees have been criticised in this House as the process is a complete sham. It involves a number of officials and bureaucrats meeting Members in an office with one intention, that is, to whitewash any point raised by these Members. It is a case of giving them a bum steer and wasting their time.

The greatest amount of time and money is being wasted by the group of officials that attend those meetings because they have no intention of giving the Minister the answer or the information required. That is so much the case that a question I tabled to one of those officials regarding an autism nurse resulted in a response coming to the office stating that the information was being gathered. I was only asking about an appointment, therefore, the information is a simple "Yes" or "No" or the giving of a date. They cannot even do that much for one because there is a culture of secrecy and an unwillingness to cooperate within the HSE and until that culture is broken we will be badly served by that organisation. This legislation will not break that culture because it is relying heavily on those currently employed in the HSE and it is not opening its doors to young people coming in with imaginative management ideas who can solve some of those problems. I need only point to the recent meeting between the Committee of Public Accounts and the HSE. It was nothing short of a disgraceful performance by the Secretary General of that Department and by the Director General Designate of the HSE but it tells one something about the organisation and if dogs resemble their masters, in this case we are in real trouble.

I refer to the audit committee that is to be appointed according to this legislation. I have seen audit committees appointed to boards and agencies within the control of the State and it is amazing to see the names that crop up on those audit committees and their qualifications. One will find very few auditors or accountants but one will find the safest pair of hands one could ever meet. They will not go astray or go off message, and they certainly will not audit. It is down to the Comptroller and Auditor General to audit the HSE to ensure we get accountability and transparency in the context of that audit. I would like to see the Minister spell out clearly in this legislation who should be on the audit committee, their responsibilities and roles because that clarification is absolutely necessary.

I turn to general public accountability. In a debate here which the Minister of State, Deputy Lynch, responded to I asked that we would investigate as a matter of urgency and in a public way the death of Niall Comerford. He was a young 22 year old man who went into hospital for a simple procedure and died within days. I was promised, as were his parents, Walter and Joan Comerford, that the national incident unit would investigate this matter speedily and that they would consult with the parents. I thought that was some sort of crack unit that would immediately go in and find out exactly what happened but not only are Niall's parents disappointed but I am disappointed because it is nothing short of more bureaucracy. All the family wanted was to find out what happened. All they wanted was to know the reason the information on deep vein thrombosis, DVT, was not made known to the patient before and after the operation. If it were made known, the chances are that young man would be alive today. They wanted no more or less than that but because of the actions of the HSE and the desire of the family to help others they are now being forced into a legal position either to sue the consultant or sue the HSE to get justice for their son and for other people who may be affected by that issue. It happens in the United Kingdom, and there is professional opinion that it does not happen here and that it should happen here. That sounds simple enough to me but it is being made mightily complicated by the HSE. That is the reason there are so many cases against the HSE. One will find very little humanity or compassion in the organisation, and I refer to the management of it as distinct from those who deliver the services on the front line because if the Minister were to listen to the people who deliver those services he would have it confirmed for him what is being said in this House by his own members of Government and by the Opposition.

I ask the Minister to consult again with the stakeholders, the patients, the doctors and those currently in a position within the HSE but who are fearful of speaking out because there is a bullying culture at certain levels within the HSE and they are fearful of losing their positions. He could learn so much from them. If he were to release them from that fear and take the time to listen to them he may learn a good deal about what needs to be reformed. He may learn a good deal also about the way he can better manage the €13.5 billion put at his disposal each year. That is €13.5 billion of hard-earned taxpayers' money, which is now very scarce.

I turn to the recommendations in a recent report from the Committee of Public Accounts. One of the recommendations refers to the recent report which was completed which examined the financial management capacity of the HSE and suggested that it should publish an implementation report which will outline the investment strategy on financial management infrastructure so as to ensure a robust and workable system for the management of the health budget. If we are to spend that much money on a health budget and drive it down towards the patient, which the Minister has said time and again is his intention, we must look at the costs associated with this Bill and with the change in management that is required. There is no reference to that in this Bill. The Minister can have all the reform and all the suggested change that he wants but if he does not have change managers put in place to drive the change that is necessary it will not be delivered for this Minister, the next Minister or the one after that. That is ignored in this Bill. There is no mention of it. The Minister should bring forward the appropriate amendments on Committee Stage to give greater accountability and access by the Committee of Public Accounts to section 39 agencies and to the private hospitals about which I have not spoken as I must conclude. I ask that these points be taken into consideration to ensure we have greater accountability, greater transparency and better value for the taxpayer and the patient.

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