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

The Leas-Cheann Comhairle will recall the position at the time. What actually happened was that in the month of September, a diktat would come down from the Minister for Health which said "You are over budget, pull it up." We were to apply the hand brake and correct it immediately. That is what happened. That is why it did not go any further. That was lost.

Deputy Donnelly also alluded to a few other things. He referred to the long years of waiting lists. I am awfully sorry to disabuse him of that idea. He mentioned three and a half years but a wait of eight years was commonplace back in those days. I dealt with such matters. I was there at the time. An individual would ask if we could do something about his or her hip; maybe eight years had passed since it was determined he or she should have a hip replacement and he or she was in severe pain and came in asking if somebody could do anything about it. All that has been forgotten and it has been convenient to forget it. That is the way it was then.

For all the time I was on the health boards, we were always told by experts that politicians should not be involved at all and that it was a matter for experts. They had expert opinion and the answers to all the problems. Even though all the groups and professionals were represented there, the idea was to get politicians off the boards in order that proper management and the closure of some hospitals could take place. That is a quotation. We were repeatedly told that there were too many hospital beds in the country and that half of them should be closed down. Half of them were nearly closed down. That was at a time when we had experts telling us where we were going wrong. What we did have, to be fair to them - Deputy Kelly referred to this - were politicians at local and national level who were on the board. These individuals were not always right but they had a point of view and they were not shy of expressing it. Whenever they expressed their point of view, they represented the people. I am not sure whether the board structure we have in place now is the answer. There needs to be representatives of the professionals involved in decision-making at local and regional level. In the period from 2005 up to now, we have had separate bodies working in watertight compartments as it were, none wanting to concede to another. As a result we have had dissatisfaction. Many of the very good professionals working in the health services will tell us that readily. They will say their views are never listened to.

I hope that the Bill before the House will at least address the issue of the chain of command. That is essential. It must start with the patient, whose interest must be represented at all times. Everything else is secondary. I hate to be harping on but Deputy Donnelly also mentioned the Royal Adelaide Hospital. He is right. It is one of the most expensive hospitals in the world. It was opened in 2017 and was some years in preparation. It cost the Australians $2 billion and there are 800 beds in it. I am confirming that the Deputy was right about this because he was wrong in most of the other things he said. Time will tell when we find out what the original guesstimate was for the cost of the Royal Adelaide. I do not know but I am sure somebody out there does. Deputy Donnelly would have volunteered that information to the House if he knew it and I would encourage him to so do.

The theory is that a regional structure will be introduced. However, I am not so sure it is integrated in the plan to the extent it should be. If that regional structure does not apply, I do not think this system is ever going to work. Spokespersons on both sides of the House have addressed this over a long period. The Manchester formula was the one recommended in the 1970s, 1980s and 1990s when we had a different system. The idea of the Manchester formula was that, since the population of the greater Manchester area and Calderdale was similar to that of this country, it was quite obvious that the same costs should apply. This was absolute and total rubbish. It was a totally different system, particularly in view of the vast geographic expanse of this country and the compact area that one could virtually walk across in a couple of hours in the Manchester. I had the occasion of visiting the system there as a former school colleague of mine, God rest him, was mayor in Calderdale. It was a case of chalk and cheese. We eventually determined that the single board we got in the form of the HSE was going to be the answer but it was not. That was obvious from the outset.

Constant dripping does not wear a stone in these particular cases. I cannot understand why it takes so long to get the message across, even for fools like me and other Deputies who were members of those old boards and know how they worked. If any kind of emergency that necessitated action occurred, we would have know all about it at the board meeting on the Thursday night. We were tipped off about it beforehand and we immediately knew what was going to happen. If it did not happen, there were problems. That was long before computers were available and there was considerably less technology, but it worked quickly.

I mentioned that all the professionals were represented on the old boards. Between the old health boards and the local health advisory authorities, every aspect of the health profession was represented. Everybody could contribute at meetings that were held regularly. Pharmacists, nurses, psychiatric nurses, special needs professionals, doctors, local GPs and the consultants were all there. They had the opportunity to exchange views on a one-to-one basis. They did not have to write to them down or send emails. They did not have to wait for a fortnight or three weeks for someone to come back to them; they got the information there and then. It was laid on and ready to function.

I recall visiting a hospital where things were not going as they should have been. It is interesting how things have changed. It was obvious to those unfortunate members of what was then known as the health board visiting committee that things were not going right. We were advised not to cause too much disturbance because there could be a general and all-out strike as a result of our intervention. It must be remembered that we were only ordinary elected public representatives and we would not know about the niceties of these things. However, such was the severity and serious nature of the problem that we decided it would be better to have an all-out strike or a closure of the facility unless something changed. Amazingly, within 12 hours everything changed. The things that could not be done beforehand were all changed. Suddenly, all the neglect that had not been challenged before could be and was addressed.

We lack some of those things now. We are not as good at that as we were in the past, which is sad. Those self-contained compartments have grown up in the meantime. A walled system has developed and, as a result, we do not get the same interaction and transmission of authority. We do not get the same accountability or good governance. We do not get the same quality of response and delivery of services to the patient. This means that things are becoming increasingly expensive.

I hate to raise this matter. Deputy Donnelly kindly reminded me of something that amused me. In 2010, the number of patients on waiting lists was approximately one third of what it is today; that is true. However, the Deputy missed out on one thing. The country was bankrupt at the time - flat broke. Therefore the overrun was a bigger one than anybody thought about. I am sure he meant to mention that to the House, but he just stopped and I can understand how that would happen. I hate to mention these things-----

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