Paschal Donohoe (Dublin Central, Fine Gael) | Oireachtas source

Now that Deputy Finian McGrath has successfully made the link between the death of President Chávez and HSE corporate governance, I will also touch on the point. He is correct in saying our minds should be open to new ideas and things that work well in other countries. We should consider models that work well elsewhere to see if they are applicable to Ireland. The most dangerous threat to the concept of representative politics is the idea that all politicians are the same, that ideology and policy do not matter, and that regardless of whom we vote for we will get the same outcomes and the same policy. That is something that is particularly relevant to Ireland at the moment as we struggle with terrible financial difficulty and look to exit a bailout programme later in the year. I believe it is also a concern across Europe as people look at the relationship individual nation states have with the European Union and their interaction abroad that regardless of the government, the outcomes will be the same.

In that spirit, I accept that the late President Chávez offered a different view of how his country could be run and the role government could play. Even though I had concerns over some of the things he did and some of the directions he wanted to take, he clearly mattered deeply to the people of Venezuela and showed that politics could matter and make a difference. Therefore, his demise should be recognised and sympathy should be extended. Deputy Finian McGrath is correct in that regard.

This debate is about the role of the HSE and its future. The opening ceremony for the London Olympic Games was a fantastic ceremony orchestrated by one of Britain's leading film directors. A striking point was the prominent role given to recognition of the NHS in that ceremony. People were celebrating the role of the NHS and of nurses, doctors and the people who run it. The vision of the people, such as Ernest Bevin, Clement Atlee and William Beveridge, who set up that organisation, regarding a welfare state and the difference it could make and the war on the four evils, as they described it, clearly resonates with the people of Britain to the degree that they wanted to celebrate it in the opening ceremony of the Olympic Games. The acting director general of the HSE was asked if a similar ceremony was organised in Ireland for the opening of a sporting event like the Olympic Games whether the HSE would receive that kind of recognition and get that kind of celebration. He was forced to reluctantly conclude that the answer to that question was that it would probably not, and I believe he is right.

We need to ask why that is. Is it because of the quality of our nurses and doctors? Absolutely not. I believe anybody who attends a GP or goes to a hospital or primary care centre comes away impressed by the quality of care and compassion they get from the people with whom they engage. Is it because of the quality of the people who are leading our hospitals? I have dealt with many of those people and I must conclude that the answer to that question is also "No". I have met the chief executive of the Mater hospital on a number of occasions and have met the people who run Temple Street Hospital and seen the work they do. They are second to nobody in terms of the commitment they have to patient care and to doing all they can to ensure their hospitals offer the best possible environment for people who need care and want to recover.

At the opening of the new Phoenix Care Centre in Grangegorman, which I attended and the Minister may recall for another reason, the Minister spoke about heritage and the tradition of compassion and care in such facilities on the part of staff there in terms of caring in the best way possible, despite the limitations on them, for people who are vulnerable. I also attended the Minister's opening of the new extension to the Mater hospital, which is an extraordinary new facility in the centre of the inner city. On that occasion, I again heard staff speak of the type of care they want to give people in that new facility.

In seeking to reconcile the difference between the quality of staff within our health service, the €13 billion being invested in it and the resonance, despite this, of the HSE with the people of Ireland, I am forced to conclude that there are difficulties in terms of the manner in which our health care services are designed and delivered and in the structure of the link between money invested in the health care system and the quality of care received by the patient. That said, despite the difficulties we are experiencing, huge progress is being made. There has been a reduction in the number of people on trolleys in our hospitals this year versus last year despite that, regrettably, less money is being allocated in this regard; the number of people awaiting operations for more than three months has also decreased and the number of children awaiting urgent medical attention, who should not have to wait for it, has also decreased, as has the number of adults on such waiting lists. Despite our difficulties, progress is being made in many areas.

This Bill deals with the design of the Health Service Executive and how we can change it further to ensure we get more from the enormous compassion and financial resource that exists in our health care service. I am certain that the direction in which this legislation proposes to move the HSE is the right one. Does any Member of this House believe that if he or she had the privilege of doing the job of the Minister for Health, Deputy Reilly, taking account all of the challenges and opportunities to deliver, he or she would be better placed to do that job following publication of this legislation? In my view, the answer to that question is, yes. The reason he or she would be better placed to do the job following enactment of this legislation is because it seeks to ensure a more consistent and coherent decision-making process within the Department of Health and its impact on care on the ground. It also seeks to strengthen accountability and the links of control around decisions made at policy level and how they are implemented.

I would like to focus on a number of additional areas I would like to see improved and believe will be improved in the coming years. I make the following suggestions based on my interaction on a number of occasions as a member of the Committee of Public Accounts with the Secretary General of the Department of Health and acting director general of the Health Service Executive. It strikes me that there are a number of areas worthy of further work and focus, the first of which is how we track and monitor through the systems in use within the Health Service Executive. During a meeting of the Committee of Public Accounts I asked Mr. O'Brien about the level of wages in the HSE, who is doing what, how allowances are allocated and efficiencies within the system. He made the point that despite its best efforts the HSE still does not have a single system that is capable of tracking the allocation of moneys in the health care system. In saying this, I am a aware that the caveat in this regard is that many of our hospitals are voluntary hospitals. In other words, they are not directly run by the State and therefore extension of IT systems in it, as compared with their extension into hospitals run directly by the State, is difficult. That being said, many of the pay-roll systems currently in operation have been in operation since the previous health board system. This is despite the fact that the Health Service Executive has been in operation for many years. As we grapple with the issues of consultant pay and implementation of the new Croke Park agreement, if supported by the unions, greater progress in the aforementioned areas is essential if this type of legislation is to make the difference needed.

Another issue of concern is the role of early intervention teams in dealing with many of the health and quality of life difficulties faced by citizens. I am particularly aware - I am glad the Minister is in the House as I make the following point - of the role of early intervention teams in the area of speech and language therapy. Many parents have raised with me the difficulties they are experiencing accessing the services needed for their children. While their children are in primary schools and are in receipt of support from their teachers, they need further support in terms of diagnosis of their conditions and early intervention in terms of the provision of appropriate care. The Minister, having been a general practitioner and having experience in this area, will know better than I that the earlier children receive care and support the better the outcome in terms of their quality of life and the opportunity to realise their full potential. The State also benefits and not only because the children realise the potential their families and we want them to achieve but because this the right way to run our health system and schools. I urge the Minister - I understand this will be difficult given all of the other issues he is currently managing - to ensure that as money becomes available - I am certain it will through the changes we are making - and our recovery accelerates everything possible is done to prioritise the care of these young children and their families. I also deal with people on the other side of the coin, namely, the young men and women we have trained in the area of speech and language therapy and who have enormous expertise in terms of diagnosis of the conditions from which children suffer. These people are currently unable to find employment in this country.

My final point relates to reform. I agree with Deputy Finian McGrath that there is no politician who does not favour reform. I have spoken on this issue many times in the past. In my view, we must reach a point of no more change. We need to put in a place a system and allow it to bed down and work. As much as I believe reform is required and will be implemented by Government I believe also that an agenda of continual reform and upheaval for those working in our hospitals is not good. Staff working in our hospitals, general practitioners, nurses and consultants are entitled to know, following reform, that they will be allowed to work for a reasonable period in that new environment and that further reform will not be sought until such time as there has been a review of how the new system works.

The Minister has worked as a doctor in various parts of the health service and I am certain he knows the value of this. In the United Kingdom the reform agenda was championed in particular by people such as civil servant Anthony Barber, and Tony Blair, Gordon Brown and David Cameron have also done work on this. They always speak about reform and seek to introduce radical change. When this change is introduced, and fundamental changes have been made with regard to money following the patient, governance and how we want to structure and merge the HSE and the Department of Health, we should let it be for a while to allow our energies and the attention of the Minister and the people working in our hospitals focus on how to make these processes work as opposed to continually looking at how the processes need to change radically.

In a discussion such as this it is vital to acknowledge the big progress made and the new facilities being opened. A primary care centre will be opened in Grangegorman within a few years. This is a gigantic change for the people I represent. I am sure a primary care centre will open in Summerhill in the inner city on a piece of land the late Tony Gregory identified. This is a colossal change and offers huge opportunities for the people we serve, in the same way the roll-out of the D-Doc service has provided a choice for people in where to go at weekends if they do not want to go to the Mater hospital accident and emergency department because, while their problem is serious, it is not serious enough for a hospital. D-Doc has given them an option as to where to go and it has made a big difference. Many of the waiting lists and the number of people on trolleys and awaiting particular operations are reducing due to intervention by the Minister and due to continued work by the people who really care, namely, staff, nurses and doctors. I look forward to seeing the Bill continuing this work and clarifying the lines of accountability in our health care system to ensure we come up with a system which reflects the aspirations of the people working in it and meets the needs of the people we look to serve. I am sure the Bill will represent progress on this.

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