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

This is one of many debates of an emergency nature we have had about health during my time in the House. Like others, I spent considerable time as a member of both a local authority and a health board. The conventional wisdom at the time was that the health boards were a failure and we needed to change the structure. The latter was duly done and I am of the opinion that it was a mistake. I held that view for a long time. I agree with those who say the HSE needs to be abandoned and that a new structure somewhat along the lines of the old health board system should be put in place. That system should not be as convoluted as the old model and there should not be as many health boards. The structure put in place should have more clarity of direction and should be able to respond to the needs of the people in a region. The centralised system currently in place is seriously lacking in that regard.

Another issue that must be dealt with as a matter of urgency relates to determining how our health service compares, in terms of expenditure, with those in adjoining jurisdictions. A report was produced some time ago which indicated that we spend relatively more on health services than many adjacent jurisdictions. The question is whether we obtain value for money. I agree with the suggestion that an audit should be carried out in order to discover exactly where our weaknesses lie. What is happening with regard to expenditure in this country compared to others? For example, why is there repeatedly congestion in accident and emergency departments? Is it because of a lack of nursing staff and accommodation or people's failure to get into the system in any other way? The latter appears to be the case. Is it because of a lack of primary care in local communities? This also appears to be a factor. To what extent will the primary care centres address the issue? It has been suggested that the existence of primary care centres does not seem to divert attention from accident and emergency departments in local hospitals. We need to re-evaluate where we are going with our health service. We can spend as much money as we like on it but if it is not spent in the right areas at the right time and with the correct agenda, we will not succeed in making progress. We will have a very expensive health service that does not deliver. Having listened to debates like this on many occasions, that is what concerns me most.

Like many other Members, I am strongly committed to a public health system. It is absolutely essential to realise that we need a strong public health system which is capable of competing with the private sector. Both areas will improve and benefit from that kind of competition. The failure to move into the market and be prepared to compete with others, whether in the public or private sector, is of no advantage to anybody.

We must consider how the numbers in the health service have dwindled in recent years. This happened for obvious reasons. There was an embargo, which was understandable, and very difficult economic periods. Nobody is suggesting that we could expect an expansion in that environment. However, we need to examine the areas which may have suffered before the embargo and the economic recession. The position relating to them will have become immeasurably worse. If we expect services to improve and become responsive and for the public sector to be competitive with the private sector and have a bring future as a result, we must find out where the weaknesses lie. I tabled a parliamentary question some time ago and I discovered that the biggest single diminution of staff was in nursing, which is the very first area with which a patient would have contact when referred to hospital. I cannot understand how that could have been the case. Everybody who spoke in and outside this House repeatedly mentioned the need to ensure that administration could be reduced as much as possible and that front-line staff could be maintained in every possible way. That did not happen, which is sad. It should surely have been obvious to all of us that this was of primary importance. If those on the front line did not have adequate support, the service would creak at the seams and fail. Consequently, what could be delivered would be diminished. Public confidence in the system would also be diminished.

One of the faults of the HSE is its remoteness. It tends to become centralised and self-dependent and refers to itself as a means to assess its own behaviour. For example, how often have we come across cases where HIQA makes a statement to the effect that a hospital, ward or institution is closed down? It is in the business of health and safety. As a result of its involvement, other issues can be exacerbated in terms of overcrowding of accommodation and use of personnel. To what extent could we at this stage expect a total evaluation of the delivery of the services expected by the general public? They expect us to be able to deliver a service, although I am not so sure about a first-class service. It should be a good service, 24 hours a day and seven days a week. It should not be intermittent and it should not be bureaucratic in nature. It should not be immovable but should be transparent.

Transparency is another issue that should be borne in mind. Under the old system, public representatives and members of the medical profession, including consultants, nurses, chemists, etc., were represented on health boards and they all had the opportunity to make an input. That made for a far better delivery of a more comprehensive and cohesive service and the system worked reasonably well.

The next question is whether the structures in place are adequate to meet the challenges of an increasing population with an expectation of better delivery and a higher quality of response. I am sure many people have had the following frustrating experience. Issues relating to medical cards should be simple enough to deal with - we have all been obliged to deal with such issues from time to time - but the system is not as responsive as it should be. It is completely impervious to the individual circumstances of people. A classic example is the patient suffering from cancer who is suddenly beset with the challenge of all that disease entails. The patient and the family are worried and they need a medical card urgently. A card will be supplied as a matter of urgency provided that other conditions are satisfied. That process could take two or three months or even longer. That is simply unacceptable. If a person is suffering from a serious illness of that nature, his or her life is dedicated to doing what he or she can in order to try to survive. The entire day is taken up with the constant worry and threat of the illness.

It should not follow that some bureaucrat sitting in a corner somewhere suddenly decides whether they will get the service.

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