Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I commend Deputy Ward on bringing this motion to the House. It is comprehensive, detailed and timely and I urge the Government to support it if it has not already indicated its position.

Having listened to the Minister of State's contribution a short while ago, a couple of issues arise. I will pick up on the final point made by Deputy Duncan Smith about the Minister of State's call for a national director for mental health. It is scandalous that there is not a national director for mental health. The Minister of State said she made that call several times. She is the Minister with responsibility for this issue. Is the senior Minister not listening to that call? Is that role not valued by the Government? It should be not be the case that the Minister of State is making the call. Given that she has political responsibility for this area, she should be insisting on it happening now rather than it being a call in the wilderness. People in positions like that in the Department need to stand up because this matter is too serious. The Minister of State needs to ensure that what she is demanding is responded to. That needs to happen.

I will pick up on a few other points the Minister of State made. She noted that this report being referred to the Garda. My heart sinks when I hear that because it happens all the time. Major reports about various scandals come out and are referred to the Garda. We heard yesterday about the report into the Grace case, which was referred to the Garda. That involved an appalling litany of failure and no action is being taken by the Garda, so it has come to a dead end. We also have the Brandon report and without impacting on that too much, the same thing has happened. It has been referred to the Garda, so we await what will happen with it. We do not hold our breath when these reports are sent to the Garda.

A step that comes long before matters are referred to the Garda is the proper management of people who work in senior positions in the health service and ensuring those who are paid to manage do so and are accountable for their work. There is a big distinction between management and administration. Sometimes, when we have large numbers of managers in different organisations, especially State organisations, they are engaged in administration rather than management. Management is about accountability at the end of the day. We organise our health services in such a way that there is not accountability. That is what we do, as has been recognised for some time.

A very important element of the Sláintecare work involved looking at those elements of our health service and the HSE that are dysfunctional and result in people who depend on the State to provide good quality health services being let down. A basic requirement in any developed country is to have in place a properly functioning public health service. Why is it that our health service does not work well?

There are approximately 113,000 staff in the HSE, including a considerable number of managers. Managers are important and I am not disrespecting them but they have to manage and be held to account for their roles. Another feature of the HSE, one which has been identified and talked about for a long time, is the way in which it is structured. An organisation with 130,000 staff and a budget of €20 billion, which is bigger than those of several Government Departments combined, will not be responsive and agile unless it is properly structured.

Constantly now, when there is a crisis, we have Mr. Paul Reid coming on the airwaves to address and apologise for it and talk about a systems' failure. That is just not good enough. This has been identified very clearly in the work done in the Sláintecare committee. It made a clear recommendation on the need to restructure the HSE on a regional basis in order that we end this ridiculous scenario of community organisations doing one thing and acute hospitals doing another. They have their own budgets and there is no co-ordination or proper management of that. That is why a recommendation was made to establish six regional bodies within the HSE to combine the work of the acute hospitals and community sector under one management structure with a single budget. That is how we drive a system that ensures money is spent in the right place and gets the right results. Unfortunately, that restructuring has been resisted by senior people in the HSE and the Department of Health. That has to be addressed and must happen. It is the reason we are dealing with many of these problems.

This is not just about structures. It is about ensuring that when we have a regionally based management structure within the HSE, senior managers are legally accountable for their jobs. It is all very well to say matters will be referred to the Garda or the CEO will take disciplinary action if required - "if appropriate" was, I believe, the term he used. There is no provision for that in contracts at the moment. That is why we do not get the kind of accountability that is required for senior people to do their jobs properly.

Part and parcel of that recommendation from the Sláintecare committee on having a regional structure is having legal accountability built into the system so that either at senior administrative management level or senior clinical management level, there is statutory accountability for the provision of services and spending of budgets. That must happen. If there is a serious problem in the north west, senior management in the north west must respond to and account for it and there must be consequences for them if things go wrong and they do not do their job properly.

Another essential part of this is that resources must be allocated on the basis of need. We talk about the postcode lottery. It is just crazy at the moment. Three of the community healthcare organisations account for much more than 50% - the figure is something like 80% - of the waiting lists for child and adult services. The way funding and resources are provided is entirely ad hoc.I queried this with senior management because there is a very long waiting list for a particular service in the area I represent on the north side of Dublin. I compared it with Dún Laoghaire, for example, where the waiting list was a fraction of what it was in CHO 9. I was told that Dún Laoghaire had a much smaller population. That does not make any sense. Resources have to be allocated on the basis of need, that is, population need, socioeconomic profiling, age profiling and rurality, for example. We must allocate resources on the basis of need. Unless we do that, the system is run on the basis of chance.

Unfortunately, in spite of everybody talking about being shocked at what the Maskey report revealed, the reality is that we could have a similar shocking report about any of our health services in any part of the country. We do not know what is going on because the HSE is a big, amorphous body and we cannot identify what is happening. Are resources adequate to meet existing needs?

Is there an issue with management or human resources in those areas? Why is it not functioning? We cannot answer those questions at the moment.

We should, of course, allocating adequate resources to mental health services. Contrary to what the Taoiseach said, we do not allocate adequate resources. It should be at least 10% of the health budget. We have clearly failed children in south Kerry in this matter. However, the reality is that we are failing children and others in disability services and failing older people in services because there is not adequate management or adequate targeted resources.

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