Derek Nolan (Galway West, Labour) | Oireachtas source

Previous contributions, including the passionate contribution from Deputy Penrose, highlight that HSE is a damaged brand lacking credibility in which people have little faith. I do not say the organisation's staff are branded with that because anybody I talk to who has dealt with the health services speak highly of the staff they deal with. However, the organisation's bureaucratic structure, the way people interact with it and the way it operates infuriates people and is causing severe problems and issues for people across the country. That is why I welcome the Bill, which is a step in the right direction.

The Bill intends to be a step on the way to the UHI model. Of all the priorities in the programme for Government, our desire, intention and plan to introduce UHI and to finally take economics, ability to pay and personal circumstances out of access to health care is one of the reasons I support the Government so strongly. Anybody, regardless of their background or circumstances, will never have to worry about money in their pocket when accessing health care. If we achieve that during this term in government, we will have achieved something monumental. It is one of the issues on which I am particularly proud to support the Government.

There are a number of problems with the structure of the HSE, which were alluded to more eloquently by Deputy Penrose, but the accountability of expenditure is crucial. Earlier, I had a discussion with an official in HSE west about allocations for disability services. It is my understanding that a pot of money has been allocated for disability services nationally and the reduction of 1.2% in the allocation negotiated nationally is working its way down. However, the budget, as it has been allocated, is being interpreted differently in various HSE regions so much so that I still do not have a figure for the cutback in HSE west and it may differ from the percentage negotiated nationally. The concept of directorates, whereby the money will be disbursed to a single directorate and would mean, for example, the disability budget would go to the disability directorate, which would allocate and monitor the money to ensure value for money, is welcome. The HSE was a fake corporate veil. It was used to give the Minister the opportunity to say, "That is not my problem. That is for the HSE". It created an artificial wall between those responsible for the health service, which are public representatives and the Government, and the corporate entity at whose door we could lay accountability. That needs to change and this legislation is acknowledged by the Minister and his Department as a step along the way to the abolition of the HSE, which I welcome.

I refer to a positive development in the health service, for which I would like to give the Minister credit because he gets many knocks. He deserves credit for the way in which the health service in Galway has been transformed positively as part of the Galway and Roscommon hospital group. The new chief executive, Bill Maher, who came from St. Vincent's hospital, Dublin, and Tony Canavan, whom I know in Galway, are working hard to change the entire management concept of how the hospitals are run. They have a network of four hospitals Galway University Hospital, GUH, including Merlin Park, Portiuncula Hospital in Ballinasloe and Roscommon County Hospital and rather than saying every hospital has to provide every service, they have said GUH will be the acute centre, Merlin Park, the step down centre and the other two hospitals will be responsible for other functions. They are using their resources cleverly and properly, which is something we have not experienced previously. They are also introducing concepts, which anybody working in the private sector or cutting edge public service bodies knows should have been introduced a long time ago, such as key performance indicators, management plans, target and clinical director meetings where people administrating the service sit down with the staff and put plans together and follow through on them.

The people who are most impressed and heartened by this are the staff because they have worked for so long in a leaderless environment. To the shame of the previous Government, it was often said that GUH was the worst run hospital in the State but it is turning this perception around because it is putting in place a proper management plan and examining how it implements initiatives. The Government is only two years old but some of the changes that have been introduced in a short period have meant that, despite a massive increase in accident and emergency department activity - GUH has the second busiest such department in the State - trolley waiting times have reduced significantly. They have not been eliminated but they have been reduced and progress has been made. The hospital had one of the worst records for inpatient targets. It hit the nine-month target this year and is on course to meet the eight-month target in June 2013. There are 43,000 people on outpatient waiting lists. By simply going through them and analysing them, staff have taken 3,000 people off them.

See this speech in context