Joe McHugh (Donegal North East, Fine Gael) | Oireachtas source

While listening to the previous speaker, I was reminded of the question: how does one eat an elephant? The answer is bit by bit. I am not saying the HSE is an elephant. It consists of many good people who are doing their best in an unworkable system which was handed to them on a plate several years ago. The HSE structure welded together 11 health boards which, while not without their own challenges, were working at a local level.

It is important to remind the House of who presided over the change in structure. The HSE was set up by the current leader of Fianna Fáil, Deputy Micheál Martin, while he was Minister for Health and Children. He spent €16.8 million on reports during his four years in that office. These reports included a value for money audit which was produced in 2000 and, ironically, cost taxpayers €616,000. The absence of a real attempt to save money gave rise to the ridiculous situation where councillors from County Donegal had to attend meetings in Galway. They were eager to reflect the concerns of people in their jurisdiction, whether at primary health care level or in Letterkenny General Hospital, but became frustrated at the lack of opportunities to do so. I recall the cryptosporidium outbreak in Galway which presented a serious health concern for the people of that city. Councillors told me that they had attended meeting after meeting in Galway at which the issue was discussed. It was an important issue, but others also needed to be addressed. In stretching from Malin Head to north Tipperary, the HSE became unworkable. As all politics is local, people want to know what is happening in their own area and representatives need to reflect the issues on the ground.

It is welcome that the Bill sets out new arrangements for the delegation of functions by the new director general. A key principle of the new structure will be that the authority will make operational decisions delegated as closely as possible to the point of service delivery. That is a welcome development. We have a plethora of people engaged in positive and proactive work, from carers to home help organisations. They need an integrated plan at a local level, with greater communication and interconnectivity among them. I welcome the sharp focus on how services can be managed and delivered at a local level.

When I was on the hustings and doorsteps during the election campaign, people asked me why the Minister for Health, Deputy James Reilly, wanted to take responsibility for health services, given that the job was a crown of thorns or a poisoned chalice. Difficulties will arise and people will get upset in bringing about change. When the Minister attempts to restructure areas of the health service, there will be turf wars and personality clashes. The reality is that human beings do not like change and change comes slowly. Two years into his term of office he has brought about change that is not really reflected in the public domain. There are positive news stories that do not get mentioned such as the reduction by 24% in the number of patients on trolleys nationally - there were 20,352 fewer patients on trolleys in 2012; a reduction of 98% in the number of adults waiting more than nine months for inpatient and day case surgery; a 95% reduction in the number of children waiting more than 20 weeks for inpatient or day case surgery; and a 99% reduction in the number waiting more than 13 weeks for routine endoscopy, to name but a few. However, that does not get mentioned because it is not good enough fodder for the media as it comes in a positive framework.

I want to make reference to the work the Minister is doing on a cross-Border basis. He has built up a strong working relationship with Mr. Edwin Poots, MLA, his health colleague across the Border. I would like to compliment Mr. Poots, who - along with many of this colleagues, even in his own party, the DUP, such as Mr. Jim Wells, MLA - has a pragmatic approach to cross-Border shared services. At a time when efficiencies and cost-saving measures are introduced in the health services in both Northern Ireland and the Republic of Ireland, there is a pragmatic approach to joined-up thinking in shared services.

If we are looking at the community trust hospital model - I know the Minister is looking at different possible permutations, such as which hospitals naturally cluster together - I ask him to keep thinking on the same road in regard to reaching out across the Border. There is a natural alliance between regions such as Sligo and Letterkenny, where there are two hospitals that will form a natural cluster, but we should also be looking at ad hoccross-Border relationships between Sligo, Letterkenny and Altnagelvin Area Hospital in Derry. There is already sharing of resources between Derry and Letterkenny, and the Irish Government has contributed €19 million to the development of a radiotherapy centre with three linear accelerators at Altnagelvin. That is an example of how we can work together mutually for the benefit of people in their respective regions. Another example of how synergies can lead to win-win situations is in regard to ambulance services. There is no reason we cannot have a shared air ambulance shared service encompassing Enniskillen, Letterkenny, Altnagelvin and Sligo.

For counties such as Donegal and Sligo, the temptation is always to do a mapping exercise in which we look at Ireland on the basis of the Twenty-six Counties. While it is a 26-county jurisdiction from a Republic of Ireland point of view, the Minister has to continue on the road he is travelling with respect to shared services. He is already doing so in his positive and proactive engagement in regard to the children's hospital, for which I compliment him. However, he should not go down the road of being tempted by lines on a map and the way counties happen to be situated in the Twenty-six Counties.

While I have the opportunity, I will reference the Higher Education Authority, which is looking at third level colleges, including institutes of technology. However, it is looking at them on a 26-county basis, which is wrong. Underpinning every policy decision we make, be it for the north-west or on a cross-Border basis, is the Good Friday Agreement, to which we all signed up nearly 15 years ago. Within that was the north-west gateway initiative, which was signed up to by both the British and Irish Governments in order to work on synergies and close co-operation between the two.

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