Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

-----which was selective in the sense that those whom it accommodated were a particular group which excluded the rest of us. I am so sorry to have to advert to it now but I remember being here during the course of it. Those were the halcyon times, which I am sure the Deputy will recall.

The House lacks the ability to address in legislation the issues which arise from time to time which need to be dealt with. We seem to react to them in off the cuff debates, emergency measures or short statements. The legislation required to deal with a structure as important as the health service is something we must all welcome.

It is not so long ago when the health boards were in operation. People who would normally be resident on the other side of the House are momentarily absent. When they were in control the cost of the health services increased fivefold in a very short space of time. One of the causes for this was they began to tinker with the system. When one begins to play around with a system adding balances, swings, roundabouts, weights and measures one ends up with something which does not work, and this is what happened. To resolve the problem what did they do at the time? I saw the same debate taking place then as is taking place now. They decided to abolish the health boards because they tried everything else and they all failed. The structure did not fail, but the boards failed because of the failure of the Government at the time to interact with the structures which existed, recognise what needed to be done and make changes. The health boards had one distinct advantage over anything else which superseded them; they had representation on the boards which consisted of GPs, nurses, the disability sector, consultants, management and every facet of the health service. Over a number of years people got lazy and did not really address the issues they were intended to address in the first place. They became distant and flitted over the issues in a way which did not really engage with the developing demand, to which I will refer later.

I am amazed at commentators who do not seem to realise what happens in these situations. The criticism at the time was one group was superimposed on another. The HSE was superimposed on the health boards and many of the same people were kept in place. How else would it have happened? How else could it have happened? Those with expertise who were involved in the delivery of services at the particular time were familiar with the services. Of course it cost more. All changes of this nature cost more. The question was whether they delivered the service. I remember posing the question of the first chief executive of the HSE as to whether he thought the structure of the HSE was the appropriate mechanism to deliver the health services throughout the length and breadth of the country. He stated he did not know. He learned subsequently.

In the debate which took place prior to the establishment of the HSE comparisons were made by well-placed economists between the population of this country and that of the greater Manchester area, with approximately 4.5 million people, and they argued it should be possible to deliver health services in the same way with the same cost effectiveness as was done there. This is rubbish because they were not comparing like with like. There is a hell of a difference between them, because one can walk across the greater Manchester area in half a day but there is a much greater distance between Kenmare, Carlingford, the tiptop of Donegal and Wexford. Like was not compared with like. It was then suggested the HSE would do the job cheaper. It did not because it could not be done.

As I stated, the groups of people involved in the old health board structures included GPs, the nursing profession, specialists and psychiatric representatives.

In addition, one had the politicians of all groups represented in the local authorities and the Oireachtas. The amazing thing about it was there was local representation and regardless of whether one likes it, that representation, elected by the people and selected by the professions, was there. Consequently, they were all together at meetings and were not obliged to consult anyone else or to consult consultants or to read reports. They were all present together in the course of the meeting and regardless of whether that meeting took place in the Western Health Board, the Eastern Health Board, the Southern Health Board, the Midland Health Board or wherever, all that was required to make a decision was to hand and they had the requisite information. In any event, this was dispensed with in favour of the structure that hopefully now is being disassembled once again. I believe eventually the point will come whereby there is direct local input in respect of the delivery of health services, which one must remember are demand-driven. One cannot predict them one or two years in advance or whatever the case may be. There will be glitches and blips from time to time when there will be demand surges to which there must be a response. It will be interesting to learn whether it will be a cost-effective move, whether the delivery of the services Members envisage will revert to being done in a way that it used to be done, whether the requirements of the people will be met and whether there will be a democratic structure that is accountable to the people.

I have heard many lectures from Members from the opposite side of the Chamber, which I reiterate is empty, in recent years as to accountability, the need for it and how there was accountability in the old days. I can assure the Acting Chairman there was none. When sitting on the other side of the House, I raised issues relevant to the health services numerous times and the only reply I received was the subject raised was a matter for the Health Service Executive. The reply would state it was a matter more relevant to the HSE and the Minister had no responsibility to the House. Yet, I hear Members sitting on the opposite side of the House mention repeatedly that the quality of service they get now is not up to what it used to be, is not what they expected or what they had. Such people are talking rubbish as the service given with regard to answers and accountability in this House is as good as anything that prevailed during the time after the abolition of the health boards and the establishment of the HSE. That is a fact and I will engage in chapter and verse with anyone who wishes to debate the subject at any time.

I had an interesting analogy to draw in the past couple of weeks based on another subject, namely, Irish Water. There were howls of derision and indignation from that absent side of the Chamber, because there were costs associated. It was cried there were costs associated with the setting up of Irish Water but what did they expect? From where in heaven's name were they coming? Did they really think there would be no costs associated with it? Did they think the people who already were involved in the provision of those services nationwide would be made redundant? That of course is what they were suggesting but they were putting a nice turn on it. That is what they wished for, to enable them to state it could be done for less. Nothing could be further from the truth. I will finish with this deviation by noting that amazingly, when Eircom was sold - there was no sharing of responsibility at all - it cost £55 million to handle the sale alone at the time. Consequently, I ask those who now give lectures to Government Members about value for money, the need to conserve and the need for openness, accountability and responsibility, to please give them a rest and not to go there any more. We have heard it all before and it does not get any better with repetition and the passage of time. We have seen it all before.

The invisible Opposition may not accept what I am about to say about waiting lists. Incidentally, that is an amazing feat. There once used to be a programme on television in which a guy became invisible when he switched a button or something like that. They must have done that all together. I presume they are there but one simply cannot see them. The entire question of waiting lists has been addressed in extremely difficult circumstances in which there has been a massive reduction in the funds and staff available. When Members on the opposite side of the House are pretending that there should be none of that, they should think back over the past couple of years. They should reflect on where this country went when there was a genuine lack of accountability and transparency and when the country went down the drain. Moreover, no one said a thing about it as they were too concerned about the frivolities of playing around with the luxuries that existed at the time of the peak of the boom. Nothing was said about it and the waiting lists were massive at a time when there were more resources available and less demand.

As the Acting Chairman is aware, I am a regular critic of services of all shades and natures and continue to be such. However, I must compliment the Minister for Health and his colleagues on doing the job they have done under appallingly difficult circumstances at an extremely challenging time. Moreover, they have done it with fewer staff and less money than it has ever been done with before. In the same breath, I compliment those health service operatives involved in the delivery of health services on the front line, at management level and in the hospitals, including nurses, doctors and consultants. I compliment them on doing the job they have been obliged to do in these challenging times. Moreover, one should be in no doubt but that it was a challenge. If one asked anyone in any branch of the public service in this country four years ago as to the direction in which the State was heading, they would have shrugged their shoulders. Consequently, I compliment those involved and recognise the job they have done in those circumstances. Members do this on a regular basis by interacting with the relevant people in local hospitals and the health services in general.

The issue of trolleys is an emotive subject. Good management and good operational procedures will eliminate the trolleys and this is being done to a much greater extent than was the case. Again, I accept that more must be done and that these are challenges. However, by making that additional effort, I believe a service will be delivered to which the public will respond. Moreover, Members must recognise the front-line staff are in the position of being inundated and challenged on a regular basis. When I hear admonitions coming from the opposite side of the House - where the invisible people are - I note they state "the Government promised". While such Members anticipated that someone made a promise, three years ago, the only thing that could be promised on this side of the House by either party in government is simply what the Government did, namely, to try to maintain as best it could the front-line services, notwithstanding the serious economic difficulties with which the country was faced. When I hear people asserting the Government has not done this or has not spent money on that, my response is we are lucky to be here at all. We are lucky to have survived what has been endured over the past three to five years. This country had gone down the tubes and as Ministers have acknowledged, the country was bankrupt and no one wished to recognise that. Moreover, from time to time one hears clever people coming forward to state there is some money out there the Government still can get. If there is, get it. That is the simple answer. Where is it? Ireland was on its knees but I am glad to state that under good, careful management, it is crawling back. That is due in large part to good leadership and largely is due to the willingness of people to take responsibility, recognise what had to be done and stick with it. They have done so and they also are to be complimented on their efforts over the past three to four years.

As for projections, over the years I have tabled numerous parliamentary questions to determine where overruns took place. Needless to say, when a member of a health board, I used to do the same thing. It is a simple matter to work it out because all that is required is to divide it by 365. One adds in the blips and glitches that will take place, one recognises the increased demand, which obviously is the situation in which we find ourselves, and one then comes up with what should be sufficient to run the service. Thereafter, one must include for contingency purposes a sum to cover those unforeseen circumstances that will arise from time to time. It is difficult to do that and to come out at the end of the year with a clean slate. It has been particularly challenging in the health services but amazingly,what comes from that side of the House is criticism of the Minister and the Government for their alleged failure to deliver services with a decreased budget and a reduced number of staff, while they failed to do it with all the staff and all the resources.

If anybody wants to make the comparison they can do so, but it is there for all to see. We must recognise these matters in the debates in this House. When I see this posturing from the invisible multitudes over there about the idea that there is something wrong here, that the Opposition has not got to the bottom of it yet but that if they keep going they will, I know we are on a doubtful path.

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