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

I must declare a family interest in so far as opticians are covered in this legislation.

The Bill’s purpose is to subsume the Opticians Board into the Health and Social Care Professionals Council which has caused some concern among opticians in general. From my point of view as a public representative, I do not have a problem with this move as long as the quality, standards and degree of services available to the public are maintained while nothing militates against the provision of a steady stream of professionals to provide these services, a problem that has occurred in other areas. However, as has happened in other health areas, because of the competing demands within a professional council, there might be a diminution of interest or emphasis on supervision, encouragement or representation of individual professional areas.

In recent years, the view has emerged that by putting several agencies together, one gets efficiencies. This is not necessarily the case. One may get financial efficiencies with a reduction in overall costs but one may not get an improvement in the provision of services by professional bodies. For example, the idea of administering the medical card system from a single centre did not work simply because the sheer volume of queries to that single centre was impossible to be dealt with unless massive numbers of staff were recruited. The economies achievable in such circumstances are debatable at the best of times.

If it has worked well, then let it continue, but if it is not working well and it needs review and revision then by all means let us deal with it. That is the purpose of Bill in general.

We must remember one point in the context of the delivery of health services that has been referred to by a number of speakers. I was concerned to hear GPs are protesting outside the House. That is a serious issue for a number of reasons. The issues involved include lack of resources and a lack of investment in the provision of the services they require. Changes continue to take place in the way the health service is being delivered throughout the country; some for the better. Other changes are still in the test phase. We must be mindful that health services in general are demand driven. It is not something for which one can necessarily plan ahead in general because one cannot anticipate various illnesses or epidemics that might occur. We must examine the extent to which the professionals in the field are happy in their work. If people are content in their workplace and have job satisfaction, they will deliver a better quality and standard of service and in general the community at large is the better for that. I hope in the course of the discussions now taking place both in the context of the Bill and in the general area of the delivery of health services that sufficient dialogue can be entered into with the professionals to try to ensure the issues on which they have expressed concern are addressed.

Deputy Twomey referred to the training of junior hospital doctors and the fact that so many qualified professionals and postgraduates go abroad. There are various reasons for that – sometimes conflicting ones. For the past 15 years I have made the point that it should be a priority to encourage, or at least give the opportunity to professionals to provide a service in this country in the first instance, having trained them to a high standard. The lure of other parts may be great. Sometimes, far away hills are greener than they look. It would be hugely detrimental to the delivery of health services if it were to transpire that our professionals go abroad on graduation. I was given various reasons for that when I raised the issue previously. They range from a lack of job satisfaction, lack of fulfilment and doubt about a reasonable career. They are all issues that must be addressed. That said, we must also try to encourage graduates to have a greater regard for the needs of the population in this country, which is growing. It is almost twice what it was in the mid-1950s. In the next 20 years we can expect the population to grow further. We must plan ahead for the provision of the full range of disciplines that are required in the health service in the future.

There are plenty of examples from which we can choose. We heard in recent years about the French system, the Dutch system, the Canadian system, the Cuban system and other perfect systems. In Cuba, the professionals might not be at the top of the salary scale. The fact remains that health is a serious issue that concerns every single person in the country; the young, the old and middle aged, without exception. At some time in our lives every person in this House will have to have recourse to medical aid in one form or another.

It is obvious there are serious deficiencies in the health service at present. They are not new as they have existed for some time. I was strongly opposed to the dissolution of the health boards and the creation of a single system of administration for the entire country. It did not work. It is as simple as that. Every time the current system comes under pressure we hear the same story and the same issues arise again and again. One of the reasons given for the dissolution of the health boards is that different criteria were applied in respect of qualification for medical cards in different areas. The simple response to that is to ask why that was the case when the same legislation applied across the country without exception. If some people took the law into their own hands and decided to set their own standards, there were ways and means of dealing with them and the issue should have been addressed. Having served for a long time on a health board, it was clear to me that the quality and service was much more personal, available and accountable than is the case currently. The key word was "accountability". All of the responsible professions came before a board on which they themselves were represented and they had to answer questions in a meaningful way that were raised by public representatives and their own members. Matters had to be addressed at an early stage.

I have listened with a certain amount of inward mirth to the calls from some Members on the other side of the House. I remember being in this House when the system was breaking down simply because the plan was not right. Once the system broke down and the focus was taken away from the management and delivery of services to the public, and people began to defend their own turf, then the health boards became weak and unaccountable. People went through the form and did not engage to the same extent. The sad part about it was that as a result the then Government decided to increase the number of health boards to 11 or 14, which was another foolish mistake. It was a case of going in the wrong direction. The proper structure to deliver the health services in a country of this size is approximately four regional structures, all of which are governed by the same rules and laws where the health Act applies, not one which we had until recently – we are gradually moving away from it – whereby a single health board administers the entire country. There was a time when you and I, a Leas-Cheann Comhairle, could table a question and have an instant answer but that is no longer the case and has not been for a long time. I compliment this Administration not for political reasons, but due to the major improvement in the response we can get to some of the questions we raise. We at least get a reply which says the matter has been referred to the HSE and it will correspond with the Deputy in due course. It does not always happen in the way intended but there is a considerable improvement between what happens now and the situation that prevailed during the previous seven or eight years.

In the context of the various reformations of the health service, we must upgrade our services and provide a higher quality and standard of service. We must also provide state-of-the-art services that are accessible in all regions of the country without exception. It should not have to follow that somebody in one part of the country has better access to health services because of their geographic location. It is as simple as that. Many consultants’ reports have been produced on the management and delivery of services in this country and elsewhere. It seems to be difficult to achieve what is required, and from time to time there are changes in how best to deliver. Delivery is the important part. If we lose contact with the need to deliver a service quickly then we have lost the battle in terms of the provision of health services. There is no good in people on the opposite side of the House saying that did not happen in their time. I am sorry; it did but it was a lot worse.

There is no doubt about that and such improvements continue to be made. I hope this remains the case but we must recognise that we cannot relax on this issue because it changes from year to year and sometimes from month to month. Demands change all the time and if we do not make provisions, we will not be able to provide the service the public deserves.

In the 1980s there were five or six health boards in the country and administration was duplicated. Comparisons were made between Ireland and the Greater Manchester, Calderdale, area, which had a similar population, and it was suggested our health system should be similar to the one in Manchester. That was wrong as the situations were like chalk and cheese. One place was a concentrated area of population that one could walk across in a couple of hours while the other was a country a couple of hundred miles in breadth. The comparison was nonsense and this has been proven over the years.

The Irish health service is in a state of evolution and we must take account of how to deliver an efficient service quickly and evenly throughout the country. This does not mean we should cut back on what is required to deliver the management of the service but that we should plan for the future. We should plan in terms of the number of consultants and radiographers required and continue such plans across the board. It is no good starting to plan when deficiencies become obvious as it is necessary to lay the groundwork well in advance.

I welcome recent indications relating to the national children's hospital as the matter should have been dealt with years ago and I am glad it is coming to fruition. There are competing suggestions as to where the hospital should be located but I hope this issue has been resolved. Some of these competing suggestions only served to delay the provision of the service and we cannot afford this.

The public, rightly, has higher expectations now than in the past as standards have risen in every profession across the board, with the possible exception of the likes of the construction sector. The public expects improved service delivery. I was amazed in previous debates on the location of the children's hospital that proximity to public transport was deemed to be an important factor. However, when the mother of a sick child learns that child needs urgent treatment, she will not take the bus, train or Luas to the hospital, rather she will take the fastest mode of transport available to take the child to emergency treatment in the shortest possible time. This is of great importance when it comes to some illnesses, such as meningitis. I could never understand why bus access was deemed a reason to promote the previously suggested location because that is not how it works. At last, this part of the problem has been resolved. It is a question of providing maximum quality of service in a place that is accessible at all times, regardless of time of day, traffic and so on.

This legislation is, essentially, regulatory and I hope my optician friends will be satisfied with the final draft, after amendments. I hope the other professionals affected by the legislation will find that it does not impede their enthusiasm for providing health services to the public through the public health sector. I could go on about the differences between the public and private sectors, including costs, but I will not. Instead I compliment the Minister of State on her work and dedication and her knowledge of the health service in general.

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