Mattie McGrath (Tipperary South, Independent) | Oireachtas source

I stated last night that the Minister for Health, Deputy James Reilly, had made his own bed, and it is not a bed of roses in the Health Service Executive, HSE. There was no need to make any promises before the last election but he made so many that he has been in a tailspin ever since trying not to fulfil them.

We know the way the governance in the HSE was set up. There are nothing but problems in it. It is top-heavy with administration. There are many good people trying to work on the front line and in administration, but there is a lot of dead weight, inertia, unhappiness and unease. If anyone knew the HSE inside out it was the Minister because of his profession and his skills in negotiating with it in the past on behalf of his profession.

This short Bill is a cop-out. There is no intention to tackle the HSE or disband it. With righteous indignation the Minister and many others in opposition were tabling parliamentary questions and getting back replies from the HSE that the matter was not one for the Minister. That is a cop-out and an abdication of powers. That is probably the reason the HSE was set up, but the Minister promised to banish all of that. He said he would deal with it, cut out the dead weight, get answers and be accountable, but what happened? We know the way he handled the board and what happened with the chief executive officer. Last week we found out, thanks to an RTE freedom of information request, how projects in my region, the south east, were fast-tracked at the expense of others because, as the Minister proclaims, the money follows the patient, but the money here is following the Ministers. They were trying to save their seats by ensuring that money was spent in their constituencies, and the CEO of the HSE, Cathal Magee, and Brian Gilroy, who was always a very good public servant, did not know anything about it. They heard this had been done before the board even met. What we are doing in this Bill is tinkering with the system, but it will not make any tangible difference.

The Bill is intended to provide for a transitional measure, but that is the problem. There has been too much transition and not enough action in the HSE since 2004. The former health boards were accountable. I would love to know who drafted the Bill because it is couched in language that will continue to confuse. We will continue to have inertia and a lack of accountability in the HSE, and it will continue to be a monstrosity that is not serving the well-being of the people.

Accountability is referred to in the Bill, as are new posts. Separate from the Bill, but in support of the new directorate and administrative structure, the HSE has already initiated the process of putting in place the new HSE directorate management and leadership team. "Management team" and "leadership team" have become buzzwords, certainly in the past ten years, and these people are leading like sheep out of a gap. There is no vision or proper thinking on their part. We have reports from the Health Information and Quality Authority, HIQA. As I said last night, I was very disappointed with my local hospital, which was criticised because of the levels of dirt. There is no excuse for this. They can have all the leadership and management teams they want - bed managers, ward managers and floor managers, which they never had in the past - but there is no excuse for dirt in a hospital. When matrons were in charge of our hospitals, that did not happen. I am glad HIQA found that problem because it is not fair to patients or the public.

There is another issue in the hospital with patients on trolleys, the pressure of intake on the wards and the pressure the staff work under day in, day out. Front-line nursing staff, junior doctors and consultants are treating patients on beds in corridors. They should not be expected to work in those conditions. The European working time directive is being flouted in this case, yet in other areas EU directives are being implemented to the letter of the law. The staff in South Tipperary General Hospital are under too much pressure. They cannot cope with beds in corridors. They do a tremendous job for which they are constantly praised, but I blame that part of the HIQA report on a lack of resources, funding and support from the HSE nationally and regionally.

What happened last week undermined the basis of what we are doing in the south east region - that is, working towards a centre of excellence in Waterford Regional Hospital. The Minister of State has one in his region, and there are eight in the country. Many of us bought into that process reluctantly, but we sat down with the consultants, the nursing staff, the domestic staff, all the clinicians and the senior officials in Health Service Executive South, with whom I have had major issues and many of whom I distrust. I hate saying that, but they will tell one something in a meeting only for one to find out later that something different was done a week beforehand. That is the kind of spin that is going on. We bought into that project only to have a bombshell dropped before Christmas when Kilkenny tried to align itself with Dublin. That would undermine the basis for our centre of excellence in Waterford Regional Hospital, because we would not have the numbers.

The Taoiseach, in reply to my questions the other day, stated that conditions in St. Luke's General Hospital, with portakabins and so on, were appalling and that people were practically working in tin huts. That is not true. Issues arise in every hospital where portakabins and prefabs are used, but to demonise the situation in Kilkenny and Wexford - I have never been in Wexford General Hospital - is wrong. It is simple spin because the Minister was caught napping. He was caught engaging in cronyism of the worst kind, when we are dealing with people's lives. I will say no more on that, but we are awaiting a report from Professor Higgins, whom I was accused recently of maligning. I did no such thing. I merely stated that he is working out of Cork and, naturally, the more throughput he can get for that area, the better. I am sure he will do an independent report but the games being played and the brinkmanship being engaged in by the HSE are wrong. We have too many layers of management and, sadly, many of them have nothing to do but make work for pen-pushers and everyone else. We do not have the front-line staff where we need them, and this Bill will not change this.

I refer to the new posts. The five new national directors will be responsible at national level for the delivery of services in each service domain - that is, hospitals, primary care, mental health, social care, and health and well-being. It should be all about health and well-being; we can forget about the first four. They know what they have to do. We must get value for money from the hospitals and faster throughput. If the consultants want to use the public hospitals for their private practices they should be charged for that. When I was only a ladeen I recall Barry Desmond saying he could not understand why the consultants - and many of them were eminent people - should be allowed use public hospitals and charge enormous rates while veterinarians set up their own practices, bought their own equipment and so on. That is farcical, and the Minister is one of the people who subsequently negotiated some of those packages. It was from that time that the rot set in. Public hospitals should be for public patients, and if the consultants want to operate in private hospitals, let them do so, and they should give value for money.

The cost of health insurance is a rip-off. This morning we heard that VHI intends to increase premiums by 6% on top of what it got earlier. People cannot keep paying those premiums, and that will put more pressure on public hospitals. The charges VHI applies are immoral. I refer to ambulance services alone. I had need of one 20 years ago when I travelled the same distance as from here to Grafton Street. I could have walked it but I did not; I needed an ambulance, for which I was charged £500. It was daylight robbery. A case was recounted to me last week in which an ambulance that arrived to take a patient from Clonmel to Waterford came from Sligo. What is going on? That is mismanagement and bungling, because it is an eight-hour journey from Clonmel to Sligo, and that ambulance may have been needed elsewhere.

We are told that all of the new positions will be above board because the Public Appointments Commission will choose the candidates. I will tell the Minister about the Public Appointments Commission. He might be aware that in the previous Government the then Minister, John Gormley, in his wisdom, set up the Inland Fisheries Board and decided that the commission would choose the candidates. There was an advertisement process and I was chair of the interview board. We arrived into the Public Appointments Commission to interview the candidates who had been short-listed. I met a lady from the commission who told us the way the process would run for the day. There were three Oireachtas Members on the board: the then Deputy Peter Kelly, the then Senator Noel Coonan and me.

She went on to inform us that she had short-listed the candidates because it would be too hard for us. First, I wanted to have the interviews take place here on a sitting day, but they had to be held on a Monday at the Public Appointments Commission. I got an insight into what went on at these interviews. The number of former county managers and retired officials on the list was sickening. Every one of the first 20 was either a retired chief superintendent, a retired chief medical officer or another official who already had a big pension. I turned the list upside down and said we would start from the bottom up. I was looking for the candidates involved in fisheries and there were many such eminent people. We picked the three candidates and the lady involved in organising the interviews did not get her way, a point about which she was not too happy.

This is the charade that takes place across the country, which is why the country is the way it is. It is being plundered by officialdom; there are jobs for the boys and there is cronyism. I am not referring to political cronyism but inside cronyism, with no command over officials. No Minister will take on the officials because Ministers are afraid of them. I saw it happen with the late Brian Lenihan and see it going on in the Department of Finance. The officials who got us into the mess are still there, except those who were promoted to position in the European Union. They would not even see a hole in a wall and because they are so long in the system they are suffering from fatigue. I have no faith in the Public Appointments Commission because of its shenanigans. Those involved look after themselves and their friends in high places.

In the case I described the candidate list was filled with the names of this and that retired chief. It was as if they did not have enough in their pensions and pay-outs, while ordinary people who had applied were kept off the list. The same has happened in the case of the NewERA project in which people who applied for advertised positions did not even get a response. They are waiting for the Minister to choose, but we have seen what happened with the Minister for Justice and Equality. Their own cronies will be chosen again. If we do not break that system, we will not fix the country or sort out the mess that is the health system.

To whoever drafted this legislation, it is a pious and useless document. It is only a stop-gap measure and just playing the game. It is said it is a great game played slowly, but it is too late for that. The Minister for Health promised change, but he has no intention of sorting out the health service. This holding Bill to buy more time is a farce.

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