Finian McGrath (Dublin North Central, Independent) | Oireachtas source

I thank the Acting Chairman for the opportunity to speak on this legislation. Before I start, I offer my sympathy and condolences to the family of the great President Hugo Chávez of Venezuela who died yesterday evening, and also my support and solidarity to the people of Venezuela. Hugo Chávez was a great man and a great president who looked after the poor in Latin America and in his own country, and his record in reducing poverty by 50% and his improved health services over the past ten years have shown that he was a magnificent leader. I offer my deepest support and solidarity to his family and to all the people of Venezuela. There are many Irish, both at home and abroad, who would agree with this position. I express my condolences to the people.

It is important that we welcome and look at the broader debate on this legislation, the Health Service Executive (Governance) Bill 2012. This is an important debate on the way we run the health service. This is also an important debate on reform and change in the health service. Change and reform are what we all, not only the Government parties, promised at the last election, given what had happened to politics in Ireland in the previous five to six years. Nobody denies that we need change, nobody denies that we need radical reform and nobody denies that we need a quality health service. To do this, the Government needs to bring the citizens and the staff in the health service with it, otherwise it is doomed to failure. Reform and change are part of the agenda and if people are not up for it, they should not be involved in politics.

There are certain aspects of this legislation which are a step in the right direction. I welcome strong aspects of the Bill. It is important when one sees sensible proposals coming from the Government, even though I am an Opposition Deputy, to look at them and support them because we all want to improve the health services for citizens. We all will be aware that we are spending €13 billion on the health service. We all want to achieve efficiencies, we all want quality staff and we all want to deliver an efficient service in a professional way. There is no contradiction and no opposing view on that issue. My personal broader view is that in the long term I would like to see a universal health service paid for out of taxation. At present, we are looking at the idea of universal health insurance and I will speak about that as well because there are aspects in this legislation which will be positive.

The Bill abolishes the current board structure governing the Health Service Executive, HSE, and replaces this with a directorate system, headed by a director general. The Bill also provides for additional accountability arrangements in the HSE. The directorate structure is intended to be an interim measure, pending the ultimate dissolution of the HSE, which will require further legislation. This Bill does not change the legal status of the HSE under the Health Act 2004. Basically, that is what the legislation is about.

This is where I welcome it. It replaces the board with a directorate system, headed by a director general. I want to see directors leading change and bringing in the necessary radical reform. There has been too much bureaucracy. From past experience, when I was pushing the issue with the previous Government, I am aware that there were cock-ups and delays, for example, in the provision of the cystic fibrosis unit in St. Vincent's Hospital where there was a turf war between the HSE, the Department of Health and the Minister's office. With everything like that going on, those who suffered in the end were the patients with cystic fibrosis. Thankfully, that unit was eventually built. I welcome the fact that was done but I remember dealing with those families every day and the trauma it caused. We need decisive leadership and if there are good proposals in this legislation, I will support them. I make no apologies for that. We need to ensure that there are drivers for change within these structures and I see the role of the director general in that light.

The one measure I very much welcome in the Bill is the additional accountability arrangements for the HSE. That is something that we all support. Whether it is a patient on a trolley or somebody with a disability, there must be accountability and there must be staff who take responsibility for the jobs. In a previous job, I worked as a principal in a disadvantaged school in the north inner city. I often laugh when I hear of the bankers and developers wasting money and speculating, and all kinds of things going wrong. I remember doing our books every June to have them ready for the cigire. As the Minister of State, Deputy O'Dowd, will be aware, the inspector would come in and if one was €10 over budget, he would be down on one like a ton of bricks. If I was €40 over budget, I had to go to the parents' council and ask could I take €40 from it to put into the school merely to ensure that books were in order. I always remember the efficiency of the inspector. I welcome accountability. When I saw what some others did, for example, in the regulation of the bankers, it blew my mind away.

The poorest schools in Ireland and the DEIS schools now were more efficient in managing public money than a lot of people who squander it. Public servants, whom I strongly support, have to deal with this issue of reform and take responsibility. Those in the HSE need to take responsibility and that is why the additional accountability arrangements for the HSE in the Bill represent an important reform. If people do not want to take responsibility or do not want to be accountable, they should forget the day job. We need people in jobs where they love their jobs. We also need to look at the idea of the good old-fashioned quality public servants such as teachers, gardaí, nurses and postal service workers, who like to serve their community and know they are paid out of public money and thereby develop accountability. Sadly over the past ten years that has not been in place in the HSE. There are positive aspects in the HSE. We have brilliant professional staff, but we also have major flaws and inefficiencies. People should do their best at all times in this regard. If 20 people are on trolleys in Beaumont Hospital tomorrow, I want the Minister to be accountable, but I also want the managers to be accountable and accountability should also come from the HSE.

In my speech I mentioned the late President Hugo Chávez, who spent much of his oil money on developing the health services and reducing poverty in Venezuela. We also need to ensure the €13 billion is spent in a sensible way. On the broader reform of the health service, we need to stop people going to emergency departments as much as possible because we need to ensure there are efficiencies there. Part of that policy must include dealing with the GP issue but also dealing with the medication issue. I disagree with the Government on issues such as cutting the respite care grant for people with a disability by €325. I do not accept that cut was acceptable at a financial level or from a human rights level. If we take money from people who are out in the community, at some stage they will end up involved professionally in the system and will cost more money.

Prevention is a very important part of any health strategy. Let us make sure that somebody surviving with a disability, for example, with a few extra bob through a respite care grant or something similar, is looked after. Many parents of children with disabilities regularly come to me and say that despite paying their taxes every week, when they go looking for a service they have to reduce service or take a hit. That is not acceptable - people forget about that. Some 13% of families are directly affected by a disability and I will be their voice in Dáil Éireann. They are telling me they go to work every week - those who have jobs - and pay their taxes, and so are entitled to look for a service. I do not believe it is acceptable. A very disabled young man in my constituency was getting a service five days a week in the CRC in Clontarf, but he is now reduced to three days. That is not acceptable in any society, regardless of what people say. With a €13 billion budget, I do not accept that some reasonable way cannot be found to fund that issue.

I support the reform proposals in the legislation. I have a broader view of the health service - I would lean more towards the Cuban model - I know the Minister of State, Deputy O'Dowd, will be interested in that.

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