Willie Penrose (Longford-Westmeath, Labour) | Oireachtas source

I am glad to have the opportunity to contribute today to this important debate on the Health Service Executive (Governance) Bill 2012. I am glad the Minister is present in the Chamber, as it shows the importance he attaches to trying to sort out this problem in a forward way.

Were I sitting in the Minister's seat today and taking account of the Government's efforts to set out a clear vision for the future of the health services and the fundamental and extremely important objective of ensuring greater accountability by the HSE to the Minister directly as Minister for Health and to his successors, I straight away would abolish and dissolve not just the board of the HSE. I would put in place a new streamlined governance structure, which basically would comprise directorates or heads, as the Minister has pointed out. I would abolish them straight away and would not have any interim steps, as I have good reason to have no confidence in the structure that has evolved and emerged since 2004, when the old health board structures were abolished. Many Members expressed their fears of what might emerge when this out-of-control bureaucratic labyrinthine structure was set in place and it gives me no pleasure to state their worst fears have been and are being confirmed. In effect, this was a pyramid of bureaucracy with well-paid managers put in place, all of whom were located well away from the local management sites in which they should have been placed, being based in Dublin, Naas or wherever. However, this structure was built in a pyramidal fashion upon the old health board management structure and, worst of all, effectively removed all decision-making functions and abilities from the local managers and administrators who always were best placed with intimate and detailed knowledge and who held the most ability to make critical and ongoing decisions at the level of the coalface, that is, right at the counter, face-to-face with the user or the customer of the service. Moreover, these decisions always were decisive and quick and notwithstanding the fact that one may not always have concurred with or liked all those decisions, nevertheless in general they were correct and one must acknowledge that. I reiterate they were decisive and correct and dealt with the problem there and then.

This clearly was the position during my almost 30 years of experience as a public representative when dealing with senior health board management officials in Longford, Mullingar or Tullamore. One had people who were familiar with the problems, backgrounds and circumstances, be they financial or relating to the health of a person involved, as well as the nature or degree of the emergency at issue. I pay tribute to these people, who epitomised everything one expects in public servants. They provided a top-class, efficient and effective public service. Moreover, it always was given with a smile, even if the decisions may well have been ones other than what the person who sought their help desired. I refer to people like the late Tommy O'Hara, a superb administrator with the Midland Health Board based in Mullingar. Similarly, Dorrie Mangan, Dick Stokes, Donie Murtagh, Derry O'Dwyer and Finbar Murphy - I could go on and on - all were extraordinary individuals who made thousands of decisions over the years in a highly efficient, productive, thoughtful and caring way, reflecting all that is good in respect of the ethos of public service and public servants. Moreover, they were aided and abetted by great assistance from their staff from the clerical officers right up through the ranks. However, I will cite an example of what the HSE then did in one area to which I also heard Deputy Healy Ray refer earlier, that is, the General Medical Services, GMS, and medical cards. The HSE took the processing away from this efficient form of local administration and centralised it at a post office address in Finglas - clearly removed from the people they needed to serve - thereby showing a disdainful disregard and disrespect for the people affected. This clearly was a retrograde step, which did not involve significant savings and which epitomised and encapsulates the reason the HSE has lost the confidence of the people and the broad mass of public representatives who come into contact with it.

In another example, people come to Members' clinics with various health issues, such as the need for urgent operations, dental or orthodontic issues in respect of young children, outcrops and everything else, schoolchildren under 14 years of age with significant dental problems and a host of other personal issues. If one raises such issues in the Dáil via parliamentary question, the Minister will reply to the effect it is a matter for the parliamentary division of the HSE to deal with and the Minister will refer it on. It is sent to the HSE, where it disappears into a black hole from which it may never emerge. Even if it does, the people may have borrowed money from the credit union - if they can get it now, given the new restrictions on them and on other financial institutions - or wherever and have the procedure carried out or they may have died in the interim. What kind of service is that?

In the good old days of the health boards, for all of their reputed faults and I agree it was necessary to have them upgraded, refurbished and brought into the modern era, they nevertheless still were highly efficient. One would have a reply within the week and could advise one's constituents accordingly. I would abolish this monster today and revert back to a system with an upgraded or modernised health board structure, which at least would have a local input and which would listen. What is wrong with politicians having an input, as well as various representatives of professional organisations and the staff? This is the way it was and in effect, Members had a representative role. People did not talk down to one, lecture one or make one feel like nobody. Above all, they had respect for one as a public representative. I have a sheaf of letters I could show the Minister that I sent to senior managers in the HSE, none of which were afforded the courtesy of a reply. I believe the biggest issue they had was wondering how I had got such accurate information.

The Minister expects me on behalf of the constituents of Longford-Westmeath, whom I am proud to represent, to have any faith in this body. I have none whatsoever when I am treated in such a disrespectful fashion. I always personally reply to people who make the effort to contact me. It is a fundamental precept of courtesy and respect even if I disagree fundamentally with them.

How could I have confidence in a structure that so blatantly colluded in depriving MRH Mullingar, one of the top three hospitals in the country for the past decade in efficiency, effectiveness, throughput, output and outcomes, of its rightful share of funding and which engaged in spirting it off to other hospitals. The executive is implementing a policy that is contrary to what the Minister has advocated - I have heard him say so at Cabinet - which is that the money will follow the patient where there is a clear and demonstrable increase in activity, effectiveness, quality, treatment and outputs. These parameters have all not only been achieved, but clearly exceeded in MRH Mullingar, which the Minister has acknowledged on radio and television, and that is why I have no belief in the HSE and I will continue to defy the Minister, no matter the intent of sections 5 and 6 and other amendments concerning the relationship between the HSE and the Minister and his successors. I wish him well in his ambition and I acknowledge he has put a great deal of thought into this. He will have my support to make HSE officials accountable, to make sure they reply to Members and to make sure the money follows the patients. That is the Minister's concept and that is what officials should ensure but I can give him examples where they do not do this and they refuse to reply. He will be aware of one or two examples. I do not spare the rod but I believe in being truthful; they do not. That is why I have no time for them.

The budget for MRH Mullingar was supposed to be €58 million in 2012 and the administrators spent €59 million. The budget has been reduced by another 4.4%, which means the number of people looked after has been reduced by more than 50. The hospital has lost 70 nurses with only 19 replaced, which means a net loss of 51. We have done our job. The accident and emergency department has experienced a 50% increase in clients, with people travelling from Roscommon, Leitrim and other areas. The acuteness of patients' conditions is also higher. Why did the HSE not give the hospital an additional allocation as it copes with a significant additional intake of such patients to ensure they are afforded the appropriate treatment they deserve? If the executive gave the hospital the amount it deserves, if only to provide limited accommodation for patients from outside its catchment area, there would not have been an overrun of €1 million in 2012. The overrun was clearly related to looking after people from other areas. It is clear from any objective analysis that the hospital was punished for being efficient whereas the opposite should have been the case.

This is why I look forward to the new hospital groups the Minister will announce shortly, which will see our excellent hospital grouped with the Mater hospital and St. Vincent's hospital in Dublin, two excellent hospitals. This is a clear recognition that MRH Mullingar will be the top hospital in north Leinster. If the Minister gives us a few additional resources, a major rehabilitation centre and approximately €30 million, which is required for new theatres and to refurbish current theatres, the excellent staff from consultants, doctors, nurses, paramedics to attendants will not let him down. They will deliver the next phase of the health reform programme he has planned in a positive and proactive way and we will play a constructive role in that.

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