Joe Costello (Dublin Central, Labour)
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I welcome the Minister of State, Deputy Seán Power, to the House. I am glad to have an opportunity to speak on this legislation. The Health Bill 2006, which will establish the Health Information and Quality Authority and the office of the chief inspector of social services, will provide for a scheme of registration and inspection of residential services for older people, people with disabilities and children who need care and protection. It is hard to read this rather turgid 65-page Bill without thinking "so what". Why have all these provisions not already been made? Why are these offices not already in place? Why have we had to wait until the seventh year of the 21st century for someone to be appointed as the chief inspector of social services? We would have expected basic protections, such as the scheme of registration of residential services for older people, people with disabilities, people at risk and children in care, to have been put in place within the system long ago. The rights of these vulnerable people have never been properly protected by the State, despite the lip-service to "cherishing all of the children of the nation equally".

While the Bill before the House is welcome, it simply underlines the State's long-standing neglect of its duty to meet the basic entitlements of, and provide basic protections to, all its citizens. The legislation does not reach the heart of the matter — the malaise in our creaking and rudderless health service, which is drifting from crisis to crisis. We have to deal virtually every day with the nursing homes scandal and the ongoing accident and emergency crisis. The accident and emergency unit in Beaumont Hospital had to deal with record numbers this week. I am familiar with the waiting times in the Mater Hospital's accident and emergency department. No agreement can be reached on the location of the proposed national children's hospital. The entire system is rudderless and in a state of malaise. The lack of leadership at ground level is at the heart of this problem.

The insidious policy of creeping privatisation is espoused by the Progressive Democrats. The Minister for Health and Children, in particular, champions privatisation as a means of easing bottlenecks and streamlining the system. Fianna Fáil is tolerating this approach, obviously. The Labour Party has indicated that it will reverse this trend if it gets into office. The Minister, Deputy Harney, said during her first couple of weeks in office that she intended to conduct an audit of all the land owned by the Department of Health and Children. The Minister of State at the Department of Finance, Deputy Parlon, has been hawking land like a street trader buying and selling in the capital and putting prices up around the country in his decentralisation process. The Tánaiste and Minister for Justice, Equality and Law Reform, Deputy McDowell, has been likewise hawking as much public land as he can. He has even sold his own offices in St. Stephen's Green for €52 million or €53 million and has moved into private rented accommodation which will cost the State an arm and a leg for the foreseeable future.

The first action taken by the Minister for Health and Children was to seek an audit of all health authority lands. She wished to identify lands that were surplus to need, mar dhea. This was then transposed into a policy of co-location of hospitals where the private sector would be allowed buy the land and build private hospitals with tax exemptions and reliefs. The private sector would operate these hospitals which would enjoy full access to the facilities and equipment in the public hospitals on the co-located site.

As I understand, there will be a private 80 or 90-bed unit constructed on public lands at Beaumont Hospital and this private for-profit health enterprise will have access to all the facilities in the public hospital. This operation will be replicated all over the country through the Minister's policy of providing a two-tier health system on the spurious grounds of creating 1,000 extra private beds and taking the same number of private beds out of the public hospitals. There is no guarantee whatsoever that the private beds in public hospitals will go. I challenge the Minister to give the House such a guarantee in her response to this Second Stage debate. We could have the worst of both worlds, where private hospitals will continue because of the squatter principle held by the consultants. We are all familiar with the history of Beaumont Hospital which was kept closed for four years because the consultants insisted there was no way they would work in Beaumont Hospital unless they were given their private beds. They would not tolerate a system of being employed to work in the public sector. They insisted that Beaumont Hospital could not open unless they were given their private beds and so the hospital was closed for four years. I do not think the consultants who have the existing private beds will run away from that cash cow. I can see these new private hospitals co-located in public grounds will be operating to their own dispensation but with access to the public operating theatres and facilities in the adjacent hospital. The Minister must clarify to the House how she will ensure that the 1,000 private beds already in the public hospital system will be dispensed with and how such beds will revert to public use.

If more proof was needed of the creeping privatisation of the health system, I can easily point to significant indicators. One third of all cataract operations in the Royal Victoria Eye and Ear Hospital are now being conducted through the National Treatment Purchase Fund, even though there are 12 consultants working in that hospital who could easily perform this surgery. They are not performing surgery because of the insufficient number of beds for elective surgery in the hospital. A total of 4,000 children are waiting for eye consultations in the Rathdown clinic in my constituency. Two ophthalmologists would solve the problem but the HSE is prepared to leave the children waiting for more than two years without treatment rather than make these appointments. This issue has been brought to the attention of the HSE on a number of occasions by the medical staff in Temple Street Hospital. Children with eye problems on the waiting list are in limbo and will not be dealt with because two additional ophthalmologists will not be appointed to carry out the required work. It is the old system of keeping them waiting for the private sector to deal with the problem.

The new phenomenon is that casualty patients are now occupying elective beds and this is not a progressive phenomenon. An astonishing 20% of hospital work is now elective while 80% is casualty. There are not enough beds in the system but the Minister will not supply them to the public hospitals and this is the reason the Minister's ten point plan for accident and emergency departments has not worked. This is the reason there is no solution to the problem for the foreseeable future but we will eventually reap the whirlwind because there has to be a domino effect. The public system will deteriorate as it is increasingly starved of resources and morale will reach rock bottom. We will end up with a two-tier system. Even the Minister has acknowledged that more people are opting for private treatment. The public sector has been deliberately run down with the result that waiting lists and accident and emergency departments are driving patients out, as are the fears about MRSA. Both the morale in the system and its nuts and bolts must be taken into account.

The accident and emergency departments of hospitals are in a deplorable condition. The HSE figures are inaccurate regarding the daily number of patients waiting in the accident and emergency units for treatment beds as the figures refer only to patients who have been seen by a doctor and are to be admitted. These figures do not reflect the numbers of people who are waiting many hours to be seen and who are discharged without admission.

Last Saturday week I visited the accident and emergency department in the Mater Hospital. It was crowded. I spoke to one elderly man from Glasnevin who had fallen down the stairs in his home the previous Saturday. He had damaged his back and fractured his arm. He sat uncomfortably in a chair in which he had been for a full week. He had a week's stubble on his face and his arm in a sling. He had not had a shower in that week. He did not know if or when he would get a bed or a trolley or whether he would eventually be sent home after a week in a chair. This is not right and it can never be right. It is an undermining of human dignity. It has nothing to do with medicine but everything to do with dignity and how we treat our people who are ill or elderly.

The Minister and her predecessors have signally failed to provide a service which respects human dignity and which is efficient. More beds, better management and state-of-the-art casualty departments are essential to smooth the interface between the patient and the hospital service. This is not the ultimate goal of a world class health service——

Ivor Callely (Dublin North Central, Fianna Fail)
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What about Smithfield?

Joe Costello (Dublin Central, Labour)
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——but it is the minimum requirement for human dignity.

Pat Carey (Dublin North West, Fianna Fail)
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Deputy Callely should allow Deputy Costello to continue.

Joe Costello (Dublin Central, Labour)
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It is high time that primary care is put in the system. It has taken ten years to see any element of primary care and it is coming in dribs and drabs.

Ivor Callely (Dublin North Central, Fianna Fail)
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I am not referring to primary care.

Deputies:

Deputy Costello without interruption.

Ivor Callely (Dublin North Central, Fianna Fail)
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Deputy Costello does not know what I am talking about. It is in his own area.

Joe Costello (Dublin Central, Labour)
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Most of the time I do not know what the Deputy is talking about.

Ivor Callely (Dublin North Central, Fianna Fail)
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It is in his own area. He should know about it.

Deputies:

I ask both Deputies to allow the Deputy who is contributing.

Ivor Callely (Dublin North Central, Fianna Fail)
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It is a shame.

Deputies:

Deputy Callely will have time to speak to a few minutes.

Joe Costello (Dublin Central, Labour)
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The issue of the children's hospital has been a bone of contention. The overdue decision to refurbish Temple Street Hospital and to place it on the site alongside the Mater Hospital has now been extended to be a plan for a world class national children's hospital. Anybody visiting Temple Street Hospital would deplore the fact that it has taken more than a quarter of a century to deal with the Dickensian conditions there.

Whether the site is adequate is a non-issue because this question had been examined by the task force established following the Mackenzie report, which decided the site was adequate for the purpose. If further expansion is required, there is a 20-acre site across the road which is currently occupied by Mountjoy Prison and the prison Garda station. The Minister for Justice, Equality and Law Reform has indicated long and loud he will close both facilities so there should be no difficulty in getting a certain amount of space from that site, which is literally across the road from the Mater Hospital. For the long term, considerable space is available.

Third, access is not an easy matter anywhere in this country or city due to the extraordinary congestion and traffic problems. However, there is a proposal for one of the metro stops to be located on the grounds of the Mater Hospital. It will be serviced with state-of-the-art public transport and is adjacent to both Connolly and Heuston stations, as well as being convenient for the North Circular Road and the Luas line coming from O'Connell Street.

For all these reasons, it is a desirable site. I firmly believe the project should proceed as expeditiously as possible. I would like it to be completed without further rancour, debate or controversy.

Deputies:

Is that agreed? Agreed.

Ivor Callely (Dublin North Central, Fianna Fail)
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I welcome the opportunity to participate in the debate on the Health Bill. I have expressed my concerns previously about inconsistencies in standards in long-stay institutions throughout the regions. Therefore, I welcome the establishment of an authority that creates a registration and inspection system for residential services for children, people with a disability and older people in need of care and protection.

We must leave until another day the debate on the issues of a reporting structure and how Members will be able to debate and get information on the separate authorities and inspectorates that will be established. I welcome the fact that we are establishing a registration and inspection system, but I am not satisfied this should be the end of it because when we establish such systems, we are inclined to lose the connection we need to tease out issues related to the authority or service. That debate is for another day.

I am not sure all Members or the public were fully aware of the registration and inspection system we had in place or that they are aware of the new system that will now operate. I welcome the registration and inspection requirements that will apply equally to all providers of residential care centres.

The main objective of the Bill is to provide for the establishment of the Health Information and Quality Authority, HIQA, and the Office of Chief Inspector of Social Services within that authority. In reading the Bill and the explanatory memorandum, I like to think all the i's have been dotted and all the t's have been crossed. That is not my area of expertise and I trust those charged with that responsibility have ensured this is so. It seems, however, the Minister is doing her best to ensure a rigorous and robust registration and inspection system will be in place and that the relevant authority will have extensive powers to carry out its functions.

One might think the reason the Bill is before the House is because it is responding to a small number of cases given significant public attention. It is not; the picture is bigger. Thousands of people receive professional and caring services from both public and private service providers, but a difference has existed between the application of regulations in the different services.

I support the Bill as it sets good and fair standards across all providers of services. In fairness, the Bill could not be introduced or implemented in the past as some of the statutory providers might not have been able to meet the new standards. While private service providers had a system in place, there were inconsistencies. However, the House should acknowledge the dedicated and committed people involved in the provision of long-stay accommodation across the public and private area. These people have provided TLC to people in need 24 hours a day, 365 days a year.

I pay tribute to and congratulate all those involved in the provision of long-term care to people in need of such care. The welfare and happiness of children, people with a disability and older people in need of long-stay accommodation is paramount and a reflection on us as a nation. It is only right that the public should have confidence in the provision of service and that there should be no difference in the quality of care in public, private or regional services as in the past.

The new registration and inspection system meets the best international norms. I always like to set higher standards and feel we should go a bar higher. As a nation, we have the ability to set new best international standards. God knows we need change. If this truth is not recognised, all the restructuring, reform and sophisticated specialisation will be of little benefit.

As the population increases — our population is estimated to reach 7 million by 2021 — there will be greater demand for long-stay accommodation. It is only right, therefore, that all service providers will be required to meet quality standards and there will be open and transparent monitored enforcement of standards.

Other speakers raised the issue of acute hospital services. I have the height of regard for Deputy Costello, but I am disappointed that he seemed to cherry-pick certain issues relating to accident and emergency services. I can relate to what he said, but I am surprised he would not give credit to some of the success stories in our services. When I mentioned Smithfield, the Deputy seemed to be at a loss and started talking about primary care. He does not seem to know what is happening in Smithfield, which is in the heart of his constituency. What is happening there will have a significant impact and has already had an impact with regard to those who attend the Mater Hospital to which he referred. I suggest Deputy Costello should visit St. Mary's rapid access facility and see what is happening in Smithfield. I would like him to come back to the House when he has done so to say what he thinks of that service.

I am aware the leader of the Opposition, Deputy Kenny, is desperately trying to gain political support and yesterday on the Order of Business he raised the issues of the accident and emergency department at Beaumont Hospital, St. Joseph's Hospital and St. Mary's Hospital. Regretfully, as is normal with Deputy Kenny, he got it all wrong. That is no surprise. He is dedicated to too much comment on his incorrect diagnosis and not enough on a proposed solution to problems in the services. I am not alone in saying this; it is being said on the ground and the Fine Gael Party knows that is the case.

I have a great knowledge and understanding of the services emanating from Beaumont, St. Joseph's and St. Mary's hospitals. I have worked with these authorities along with other service providers in the area to enhance and develop services. I salute all the personnel in these hospitals, who provide tremendous care and give of their best in the delivery of services.

Beaumont Hospital undertakes tremendous work as part of its regional and national specialty. Just as Deputy Kenny challenged people on the Government side of the House, I challenge him to come with me and visit the neuro-surgery ward at Beaumont Hospital to see the good work being carried out there. He should also visit all the other wards in the hospital to meet the dedicated personnel, in particular, a geriatrician named Dr. Ciaran Donegan who is doing extraordinary work.

I agree, that like busy stations, Beaumont Hospital has some pressure points that are a source of concern. There is a bottleneck in accident and emergency departments and I am concerned about delays in the accident and emergency department. Like Deputy Costello, I share the concern about the figures being presented to us by the HSE. I stated previously on the public record that the jury is out in the case of the HSE.

I concur with what Deputy Costello stated about the figures being presented. I know well their source, Ms Helen Stokes, because I worked with her, but I do not know who is asking her to provide the figures as they are being presented. Figures in my possession indicate that on 10 January eight out the 33 accident and emergency departments — 24% — had nobody waiting for admission and 16 out of 33 accident and emergency departments — 48% — had nobody waiting, and that, as late as 21 February, eight out of 34 accident and emergency departments — 23% — had nobody waiting for admission and 15 out of 34 accident and emergency departments — 44% — had nobody waiting, and then one sees a phrase, "from the time they had been referred by the accident and emergency team for admission", under the latter figures which gives the distorted picture on which I concur with Deputy Costello.

What surprises me is this. When I was in the Department of Health and Children I initiated the Rapid Access Clinic, which avoids entry through accident and emergency. It has proved so successful that the Department is now providing special funding to set up a new centre in Smithfield, not alone to accommodate the Mater Misericordiae Hospital's accident and emergency department but also Beaumont Hospital's accident and emergency department. Deputies Kenny and Costello do not seem to understand this. They are looking at their own political, general election orientated diagnosis of a situation, but there is much good work taking place.

Deputy Kenny got the geography of St. Joseph's incorrect. I am delighted that I, when in the Department, allocated the first funding to St. Joseph's for a special rehabilitation unit for stroke patients, which heretofore we had not got in the services.

Deputies:

Deputy Callely should conclude.

Ivor Callely (Dublin North Central, Fianna Fail)
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If one looks at the bigger picture, we have seen a tremendous development of services for cardiac care and heart and lung transplant. It is regrettable that I am out of time. I acknowledge the Bill is of some worthy benefit and there is much good work being done, but I also acknowledge that there is a great deal more to be done.

Damien English (Meath, Fine Gael)
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I am sure Deputy Callely, like everybody, would like to expand his local hospital, but I will bring him to my hospital where he can see what happens there under the same Government. Yesterday Deputy Kenny tried to raise facts about what he saw on his visit. We all know much good work goes on in all our hospitals, and especially in Beaumont Hospital, but it is his duty, as an Opposition Deputy, to raise issues that are not satisfactory. He will continue to do that and Fine Gael will always do so until we get the chance to fix them. One should not pull him down for doing so. That is his duty and he is doing a good job. If it touches a nerve, that is the Government's problem.

Ivor Callely (Dublin North Central, Fianna Fail)
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Give us the solution.

Damien English (Meath, Fine Gael)
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My party has plenty of solutions. Deputy Twomey has an endless number of solutions.

Ivor Callely (Dublin North Central, Fianna Fail)
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He has no solution.

Deputies:

I ask that Deputies stop interrupting each other and Deputy English proceed without interruption.

Damien English (Meath, Fine Gael)
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I point out that Deputy Callely mentioned some solutions he himself put in place, which are impressive and which have been used in other hospitals around the country. My difficulty is when something good works in one place they do not try it everywhere else, and this is a matter which we should examine throughout the Department. There are some initiatives working in various hospitals that would work quite well in my local hospitals as well, if they were given the money to implement them or made a priority. There are solutions arising from both sides of the House, but we need to get them into every hospital. Certainly, I cannot stand here and accept that an Opposition Leader cannot raise issues that are obvious to the eye.

Deputy Callely mentioned Beaumont Hospital and other speakers mentioned other hospitals. Many clients in my area in County Meath who must attend neurologists, surgeons and other consultants in Beaumont Hospital could have to wait a year and a half to get an appointment. That is somebody's fault and it needs to be fixed. I acknowledge excellent work is done when one gets to the relevant person but a year and a half is a long time to wait to get an appointment.

Ivor Callely (Dublin North Central, Fianna Fail)
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Where does the fault lie?

Damien English (Meath, Fine Gael)
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We will go into that here. We get successive announcements from the Minister for Health and Children, Deputy Harney, that waiting lists have been shortened, and yet the waiting lists to get on the waiting lists have lengthened. The National Treatment Purchase Fund was a great initiative. I accept that it solves a problem within a couple of months for a person whereas years ago that was not the case, but it is no good massaging the figures creating a long queue of people on waiting lists to get on the waiting lists, which happens in the case of all the hospitals in my area, the figures for which I will get if they are sought. That does not help. Deputy Callely mentioned Ms Stokes and I receive her replies to parliamentary questions as well. We must get honest information and have a proper debate on it. One must not try to massage the figures because that does not help patient safety at all.

The Bill falls well short of the protection for patients we in Fine Gael and Labour want to provide and our document published a number of months ago highlighted clearly what we want to do. While I can go through this step-by-step if need be, I suggest Deputies read it so I may go on to other matters. It is clearly stated there, however, that we want to go a step further.

It is a pity the Minister would not take on board some of our initiatives and just accept them. It is the same old story here. Good ideas get put to one side due to politics and people continue to suffer. I am sure it has happened in the past and it is not all one-sided, but it should not happen. When something is good, we should agree, implement and accept it. Deputy Twomey, along with his colleagues in Labour, produced a good policy on patient safety and a patient safety authority. It contained much which was good which could have been improved, but yet this Bill comes far short of it. That, in itself, is a disappointment. We will push to get improvements in that area.

The Minister is already speaking of introducing amendments to the Bill on Committee Stage to provide for whistleblowers. Such a provision, which must be introduced as an amendment, should be a given in a Bill on patient safety.

The health service is covered by a veil of secrecy dating back many years. The walls hear and one cannot speak. I have worked in it and I know what it is like. People are afraid to open their mouths in case someone next door, through a ten-foot wall, will hear them. That is the extent of the fear in the health service and it still exists among staff. They are afraid to open their mouths when they see problems, they are afraid to speak and they are afraid to question and consult. That has not changed yet under the HSE. I assume it will and hope it does. I assume and hope Professor Drumm will drive changes. I have spoken to him about it.

However, this issue still arises. One can state that maybe it arises only in my area, but I know it arises and it must be sorted out. If people who work for the State see a problem or have a question or a better idea, they should not be afraid to open their mouths and doing so should not result in difficulties down the line. That, in itself, is a form of bullying. The Minister of State, Deputy Brian Lenihan, is looking at me as if I were speaking nonsense. I am not. It is a fact and we need to sort it out. Whistleblower legislation is certainly an essential ingredient in sorting that out.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I do not think he is speaking nonsense.

Damien English (Meath, Fine Gael)
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Good. I do not blame a particular Government for the veil to which I refer, but we must admit it exists and sort it out. A Bill like this is a way to tackle that and to legislate to protect whistleblowers and those who want only to have everyday conversations never mind whistleblow on a serious matter. There is that feeling among staff in the health services that they cannot speak out and get involved. That is a pity because we need to hear everyone on these issues.

The people in the health service must realise their job is to help people provide a service, not to block access to a service or create issues to prevent a person from getting the help and service he or she needs which also happens. Often there are good staff in the wrong positions and bad staff as their bosses, and that needs to be sorted out. There is much expertise and many excellent staff among the health services who are not being used to their full ability. It is a shame and people will suffer as a result. There is a need for a root and branch review of everyone's position in the health service, which I thought would happen under the HSE but which has not happened. Instead, there have been more layers of bureaucracy and red tape. Eventually, maybe this will lead to a result. In some areas it has already, but in many cases it has not. I accept that such change takes time but we need to drive it much faster in some areas.

In her speech the Minister spoke of the importance of bringing the Dáil back early for this legislation. The Dáil was rushed back in January to discuss this Bill. A Bill like this probably would not even get on to the third or fourth page of a national newspaper in another country because issues like this authority and other patients' rights would be accepted as a given and would not even need to be discussed, but due to all the scandals and bad news over the past few years in this country it must be discussed and this necessitated calling the Dáil back early to debate it.

Despite all the Minister's hype about bringing the Dáil back early a month ago to discuss this Bill, we are still here discussing it. It was off the agenda, then it came back on the agenda for two weeks and we did not get to it, and here we are a month later discussing an urgent Bill. We had proof last night of what can be done if something is urgent. If this was so urgent and at the centre of the Minister's heart, why are we still here a month later discussing it?

In her speech the Minister stated that step by step, in the reform programme and legislation, we are leaving behind the old system. As I mentioned earlier, I am not convinced we have left behind the old system and in some cases it is a matter of step by step in reverse. Efforts to achieve accountability are going backwards. We can no longer obtain answers in a few days regarding the problem of a client — doing so can now take months. It can take and has taken three or four months to obtain figures on waiting lists. We are going backwards in terms of accountability and responsibility for the health service. The Minister seems to have put the problem to one side. Responsibility for every second parliamentary question on the health service, if not more, is passed to the HSE.

The Minister stated we are leaving behind the old system in which vital information on health was not gathered comprehensively, and in which the assessment of new technologies and new drugs was not done clearly and systematically to serve the interests of patients and taxpayers alike. Let me hone in on new drugs. There has never been a full debate on methadone in this House. I have tried to obtain information on it left, right and centre, but it is very hard. The buck is being passed between the Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy Noel Ahern, and the Minister for Health and Children, Deputy Harney. Nobody will make a decision on it. The State is spending vast sums on methadone without debating fully whether it is the best product and examining fully other drugs and initiatives in other countries. We are not trying to take people off methadone and not doing so can be serious. Doctors are prescribing it to get patients off heroin, which is a step in the right direction, but patients should not remain on it. There are thousands of people taking methadone with no date specified on which they are to stop taking it. This incurs a high cost and a better approach could be taken.

The Minister listed all the changes she is making and the initiatives she has implemented. It seems she operates a system used in business called "just in time" in that she seems to implement many initiatives just in time for the election. It is a shame because I believed she would do a lot more for the health service.

One function of the Health Information and Quality Authority is to set down standards on safety and quality for all services. What will happen if those standards are broken? It is not clear in the Bill. Will the authority set down further standards regarding the delivery of services?

If an elderly person needs an assessment to have his house adapted, enter a nursing home, obtain treatment or receive a visit from a consultant, he will be put on an endless waiting list and may have to wait from one to 15 months. At no stage is a red flag waved to indicate this period is too long. It is waved in respect of the national treatment purchase scheme but in other areas one could have to wait a long time just to be assessed or obtain information or an appointment. A standard should be set down to ensure the existence of a set waiting time. If a patient must wait beyond two months to see a consultant, a red flag should be waved and the HSE should step in and provide the service in another way, be it privately or otherwise. We must have standards and patients need to know what is in line for them.

The Health Information and Quality Authority will be able to carry out reviews to ensure best outcomes and value for money for the resources available to the HSE. What powers will the authority have in this regard? If the reviews highlight a problem, what action will be taken? Will another report sit on someone's desk or will it be forwarded to the Minister? Will the authority demand action on foot of the information it gathers for its reviews? There is no point in reviews if they do not achieve anything.

The authority is to evaluate information available on services provided by the HSE and other service providers and on the health and welfare of the population, identify information deficiencies and advise the HSE and the Minister accordingly. It should advise the public and not just the HSE and Minister. A body produced a document before the Christmas holidays on the future of Irish in schools. Neither I nor the public has seen it because it is with the Minister. If we are to have an authority to prioritise patient safety, it should surely make its advice available to the public first, or at least at the same time as it is received by the HSE and Minister. It should not be handed over on the quiet in a little document to be read by someone when he or she has time to do so. This defeats the purpose.

The chief inspector will have the power to operate and register the various centres. The Minister stated registration details will be available to the public on the Internet. Not everybody has access to the Internet although we wish they did. Ministers have a habit of talking about the Internet, but retirement groups, Active Age members and representatives of the Older and Bolder campaign tell us at their meetings that not everybody can use it. We must therefore make registration details available from other sources, be it in hospitals or HSE buildings. It is not satisfactory that the Minister's speech refers to making information available on the Internet and nowhere else.

Under section 50, the chief inspector can cancel a registration, vary a condition of registration or impose new conditions. Will the legislation leave the cancellation of registration straightforward? I am not convinced it will. Will there still be a grey area that will not be addressed for a long time? I want this clarified because it is important.

Hospitals, nursing homes and health and social service departments can best be described as places where patients go to receive care and get better. They trust the system to keep them safe, look after them and make them feel and get better. Sadly, this does not happen in this country. The trust has been abused and patients have been let down, albeit only in certain places. This is why we are debating this Bill. Thanks to my colleague, Deputy O'Dowd, this matter has been highlighted in recent years. It is a case of "recent years" rather than "recent weeks", yet nothing has been done. In some cases, it is question of too little, too late, but at least we are moving on.

The needless death of Monaghan man Pat Joe Walsh from a curable ulcer occurred because of the apparent lack of a bed in neighbouring hospitals. While hindsight will not bring him back, sadly, it proves that several hospitals were available. Pat Joe Walsh and countless others like him should not have died, yet they did. The question of why is still unanswered and many people from Monaghan and others with similar tales are still asking it. Will the authority prevent needless deaths, protect patients' rights and make information available? Patients are not being looked after and do not feel safe.

MRSA and other superbugs such as the winter vomiting bug have infested hospital wards, striking fear into vulnerable young people and cherished elderly, who believe a routine hospital stay may result in their acquiring a more serious and vicious illness than they already have. This is certainly not right or fair and should not be acceptable in 21st-century hospitals. However, it seems to be acceptable because not enough is being done to stamp it out. Getting rid of MRSA is not rocket science. There are some simple and complicated solutions and we could certainly make a real effort to implement them. The authority has a role in ensuring MRSA is stamped out.

The MRSA problem has been neglected in recent years and has not been solved quickly enough. Announcements were made to the effect that money is being spent on it, but there is no real effort to stamp it out. We published a Bill on the matter and launched an initiative but we have been debating it for months. For a start, a person responsible for overseeing cleaning should be put in charge in each ward. This is the number-one requirement.

Many hospitals and health centres have contract cleaners who clean other buildings on certain days of the week. They are not specially trained to clean hospitals and theatres and therefore do not clean to the high standard required. We should address this. Years ago, there were in-house cleaners who worked with the nurses, thus keeping the hospitals clean. In some cases, extreme measures were taken, nevertheless we must ensure that professional people who know exactly what they are doing are put in charge. Their expertise should be in the area of cleaning hospitals and hospital equipment. This is very important.

The Teamwork report sets out the future of services in the north east. It is a worthy document in its own right and has much good content. It indicates where we want to go and I and my party fully support it. It recommends building a brand new regional hospital to serve the north-east region and this makes total sense. However, at best, this will not be built for seven or eight years and will probably take ten to 15. The document specifies a target of approximately ten years. The authors of the report, which has been accepted by the Government and HSE and which is being enforced, recommended a reduction of services in many of our hospitals. One of the short-term aims of the report is to remove the emergency surgery facility from Our Lady's Hospital in Navan, County Meath. This has effectively been done but nothing better has been put in its place. Patients have been diverted from Navan Hospital to Our Lady of Lourdes Hospital in Drogheda, which is under unbelievable pressure and cannot cope. This Bill provides for patients' rights and protections, yet the patients will be put in danger because services are being withdrawn from existing hospitals in Navan and elsewhere before a new and better facility can be built. That is a disgrace and will result in people's deaths. The Minister of State has visited Enfield to open creches, so he is probably aware that it is a long journey from there or Ballivor to Drogheda.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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My constituency is adjacent to County Meath, so I am very familiar with the area.

Damien English (Meath, Fine Gael)
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The Minister of State therefore understands that the roads in County Meath are not as good as those of other counties and that people have a long way to travel in an emergency. We are all aware of the need for crash or heart attack victims to be treated in a hospital within the golden hour. I acknowledge that plans have been made to introduce modern technology and additional paramedic staff in the north east but these facilities are not currently available, so it would be wrong to withdraw surgical services from Navan Hospital. A reduction in services certainly would not protect patients.

However, nobody has met the people of County Meath to discuss the issue properly. We are told in meeting after meeting that surgical services in Navan were not adequate but the answer seems to be to withdraw the services rather than propose ways of improving them. The real solution involves providing additional staff and resources so that the hospital has a proper surgical department which serves the needs of the area. Ten years is a long time to wait for a new hospital, especially when the existing services have already suffered from ten years of neglect. The last time proper capital investment was made in Navan Hospital was under the rainbow Government. The accident and emergency department has been housed in a portakabin for the past 30 years.

The report, which is supposed to set out the future of health services in the north east, recommends a reduction in the services provided at the hospital. That does not appear to be patient centred. I have asked Professor Drumm, who says he would be happy to debate his ideas for the health service with anybody, to explain his intentions to the people of the north east because we do not believe him. The hospital has been neglected for years and we hear daily announcements that services are to be withdrawn. The laboratory service has been reduced, with the result that blood samples and other material are sent at great expense to the UK for assessment.

I ask that the Government engages with the people of the north east rather than lecture us. Few people in County Meath are trained to Professor Drumm's level but we know what we want and need. It is up to the Minister for Health and Children and the professor to tell us we are getting a better service or else to admit that our existing services are being withdrawn.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I would have been happy to share my time with Deputy English because he was speaking well. I had presumed he was a small child when his party was last in office.

Damien English (Meath, Fine Gael)
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I was never small.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I do not want to upset him further when I say a visitor to my packed clinic in Tallaght last Saturday had an address in Navan. The person apparently heard I was good, so had come to see me.

Damien English (Meath, Fine Gael)
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I am sure the person had a health problem.

Charlie O'Connor (Dublin South West, Fianna Fail)
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Funnily, that was not the case. Deputy English mentioned Navan several times, so I hope I will be permitted to make at least one mention of Tallaght.

Damien English (Meath, Fine Gael)
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There was logic to my argument. County Meath is being neglected.

Charlie O'Connor (Dublin South West, Fianna Fail)
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The Health Bill 2006 is a central element of the health service reform programme. The Bill provides for the establishment of the Health Information and Quality Authority and the Office of the Chief Inspector of Social Services with specific statutory functions.

I always welcome the presence of the Minister of State, Deputy Brian Lenihan, and I look forward to seeing him in Tallaght tomorrow, when he will accompany the Taoiseach to An Cosán in Jobstown to formally launch the childhood development initiative and a place for children in west Tallaght. The project in west Tallaght, the young Ballymun project and the northside partnership project were invited by the Minister of State to submit proposals for funding. He has recently confirmed that the Tallaght application was successful and that a service level agreement has been reached. In the context of this discussion on health, it is important that we welcome initiatives on caring for children.

Yesterday, the Taoiseach, the Tánaiste and the Minister for Social and Family Affairs announced a initiative by the Government on social inclusion. The area the Minister of State will visit tomorrow has benefited significantly from the enlightened approach in recent times to social inclusion. I am in this House as the successor to the long-serving Tallaght-based Deputy, Chris Flood, who as a Minister of State pursued the goal of social inclusion. I am glad that I have been able to take up the torch in that regard.

I cannot engage in debate on any health matter without referring to Tallaght Hospital and the challenges it faces. I always speak positively about that hospital and health matters generally in the Tallaght area. I bring my own life experiences to my political work, including the health scare I experienced when I had a mild heart attack eight years ago. We can criticise hospital services but I am proof of the positive effects hospitals can have. I must give credit for my recovery to the cardiac rehabilitation staff in Tallaght, who convinced me, when I was not sure, that I should run for election.

I became a member of the Eastern Health Board in 1994 and was the founder chairman of the South-Western Area Health Board. I listened carefully to the issues raised this morning by Deputy Callely, who was also a former health board chairman. The experience I gained from my time on the health board in terms of visiting hospitals, nursing homes and other institutions throughout the eastern region gave me a clear insight into the health system. I am not afraid to admit that I questioned the abolition of a system in which visiting committees and public representatives had regular opportunities to visit hospitals. I do not want to be disloyal with regard to decisions made by the Government but I believe processes should be in place which allow accountability to be challenged and health institutions to be visited. Given the issues that have arisen in recent times, it is important that we understand the need for accountability.

The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, is aware of my particular interest in the issues that come within his remit. I congratulate him in this regard. Within the context of today's debate, it is important he should understand the concerns of Members in respect of establishments and institutions.

I have often visited homes and other residences. I have told the Minister of State a number of times that several weeks ago, I visited the Central Mental Hospital in Dundrum with other colleagues. While this was not my first visit, it was a profound experience and such occasions are challenging. One is anxious that those who may be a danger to themselves or to others should have secure accommodation. At the same time, issues are often raised during such visits and some were raised with the delegation. It was organised by Newstalk 106 arising from a discussion that was broadcast one night. I was accompanied by Deputy McManus of the Labour Party and Dr. James Reilly from north Dublin, who is a former member of the health board and has a background in the Irish Medical Organisation and we saw things that worried us. The Minister of State, Deputy Tim O'Malley, has taken a particular interest in this subject and I am aware he is considering the challenges facing institutions such as the Central Mental Hospital. It is important for him to so do and that Members are not afraid to raise such matters.

There has been much recent talk on hospital services. This important issue was raised during Leaders' Questions last Tuesday and again yesterday, when I had the opportunity to refer to it. I will not comment on who goes to what hospital on guided tours except to state that many Members, particularly those on the Opposition benches, are suddenly talking about the general election. I will not lose my focus. As far as I am concerned, unless the Taoiseach decides otherwise, no election is imminent. He made that point last Tuesday. Until a few years ago the Taoiseach of the day called the election, after which all the candidates were selected. I was selected two years ago, which is different. Previously however, candidates would knock on doors for three weeks. At present, Members are in the midst of the longest-ever election campaign in the history of the State. It has certainly been the longest of my lifetime. This has created a false atmosphere and I presume Opposition Members have been given a script because they are all mentioning it.

Damien English (Meath, Fine Gael)
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There is no script. Members of the Opposition use their brains.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I believe someone suggested all Government initiatives should be responded to by claiming they are related to the election. Regardless of whether it is good or bad news, it must pertain to the election. However, the election has not been called yet and Members must remain focused. I am not looking for a job as I already have one, which I wish to complete. Thereafter I will go before the people to ask them whether they wish to retain me. I am a democrat and this is what I want to do.

Damien English (Meath, Fine Gael)
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Deputy O'Connor should have some sense.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I will knock on every door in Tallaght, Brittas, Bohernabreena, Firhouse, Templeogue and Greenhills to bring that message to the electorate. As is my custom, I will talk to and listen to people every day at my work and at the eight clinics I hold every week, as well as at the other activities in which I engage. I will listen to people's concerns, including those pertaining to health.

While people may discuss Navan Hospital with Deputy English, they certainly talk to me about Tallaght Hospital. I live within sight of the hospital and have been a patient there. I am very proud of my involvement with the hospital over the years. The current Ceann Comhairle appointed me to its planning board almost 20 years ago. I was on the hospital's management board as a nominee of the Eastern Health Board when it opened in 1998 and I feel strongly about it. Moreover, I am concerned by what I have witnessed there, as I visit it regularly to see friends. For example, my niece was there a few weeks ago. I have regular opportunities in this regard. The hospital faces issues and challenges that I am not afraid to raise and I will continue to so do on a regular basis. For example, I have strong feelings on the question of future cancer services in Tallaght Hospital and I believe that Tallaght must be one of the designated centres on publication of the Department's cancer report. I will be deeply unhappy otherwise.

Moreover, I have been consistent in my views on children's services at Tallaght Hospital. They were established in 1998 by a charter upheld by the Taoiseach, when the Adelaide, Meath and National Children's Hospitals all moved to Tallaght. At that time, there was a clear understanding that the children's hospital had been located in Tallaght and would remain there. Regardless of other decisions taken, the issue of the Mater Hospital, the location of the new super children's hospital and regardless of whether I live in Tallaght, it is clear to me that Tallaght's children's hospital services must be retained. This is my bottom line.

While I apologise for mentioning Deputy English so frequently, he was the previous speaker and I listened to him carefully. He referred to drugs services about which I have always been strongly supportive and proactive within the community I represent. All Members should feel strongly in this regard, as it is often extremely difficult to have such services accepted in some communities. However, they should be supported.

I am glad the Tallaght drugs task force and the various services in the Tallaght region, including the JADD group in Jobstown, the St. Dominic's services in Millbrook Lawns, the various community organisations in Tymon North, St. Enda's and Brookfield, are all doing tremendous work. The same is true for the Tallaght Rehabilitation Project in Kiltalown House, which had its new premises launched recently by the President. I am also highly supportive of the SWAN family support group in Springfield. I mention those groups and the latter in particular because the previous speaker made a point about how services are funded. I have no problem with the HSE monitoring such services or inspecting them. However, it sometimes occurs to me that it should be pressed home to the HSE that it allows some projects to fall through the cracks. It becomes unclear exactly what are the services, what they should provide, with whom do they compete, who should give them money and how much should be given. I make another plea on behalf of such local organisations and for the SWAN group, the family support service in the Springfield estate where I live. It needs such help in this respect and it is important to make this point.

I wish to make another general point on health services in Tallaght and I will mention the hospital again shortly. However, when issues such as safety and the adequacy of facilities and so on are discussed, I have referred several times, both in this House and as the Government convenor on the Joint Committee on Health and Children, to the development of primary care services in the Tallaght area. Some fine health centres now operate in Tallaght. I refer in particular to the Mary Mercer centre in Jobstown.

However, while I do not wish to be parochial or to confuse Members on Tallaght's geography, a health centre exists in Millbrook Lawns in Tallaght. Some Members have heard me mention it more than once. I raise it regularly in the House and at HSE briefings. This centre was badly damaged by fire eight years ago and it is relevant to discuss it briefly in the context of the legislation under discussion. The HSE must understand by now that it is time to redevelop that centre. It is not good enough that staff, clients and the public must tolerate a building that was badly damaged by fire and that still awaits redevelopment. However, when the HSE confirms plans for its redevelopment, Opposition Members will claim this it only due to the forthcoming election. I will be obliged to tolerate this and to keep my focus. It is time to redevelop the Millbrook centre and this is another bottom line for me. Whatever happens to me in the election, I will still fight for those services. It is time the HSE did so.

Colleagues mentioned the HSE. I will not pile misery on it except to state it should be more pro-active than it thinks it is on issues brought to its attention by Deputies. I have a health board background, I attend all the briefings and I put down Dáil questions. The HSE claims it is trying to improve the system. However, it is frustrating to put down Dáil questions and receive holding answers. Professor Drumm was a bit vexed with me when I mentioned an occasion when the HSE phoned me to ask the location of Millbrook Lawns health centre. For a public representative such matters are a bit annoying to say the least. The HSE must continue to grapple with the problems before it.

They provide the service which people expect. It is about providing safe environments in which to provide health services, whether in health centres, doctors surgeries and, in my case, Tallaght Hospital. People from Tallaght use other facilities such as the Coombe, St. James's and even Beaumont. It is important to state that.

Regarding the Bill before us which I have been discussing——

Damien English (Meath, Fine Gael)
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Deputy O'Connor has two minutes left.

Charlie O'Connor (Dublin South West, Fianna Fail)
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Is Deputy English watching my time?

Damien English (Meath, Fine Gael)
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Does Deputy O'Connor know what the Bill is called?

Charlie O'Connor (Dublin South West, Fianna Fail)
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I am impressed such a prominent member of the Opposition and such a favoured comrade should stay to hear me speak. I might do a press release on it.

Much criticism has been made of the health services. I am not afraid to state from the Government benches that people should be entitled to services. I come from an old Dublin which had hospitals everywhere. I lived within sight of Mercer's Hospital, the Adelaide Hospital, the National Children's Hospital and the Meath Hospital. As one may gather I lived just up the road. Funnily enough, I am not from Tallaght. I am from this parish. I remember those days. Perhaps times have moved on.

Damien English (Meath, Fine Gael)
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That makes 80 references to Tallaght.

Charlie O'Connor (Dublin South West, Fianna Fail)
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Perhaps all we need to deliver hospital services is a number of big hospitals. However, they should be safe environments. People are entitled to make political points. Opposition colleagues are entitled to be critical. This Bill and others introduced by the Minister try to get the job done. I attended a meeting of the Oireachtas Joint Committee on Health and Children a few weeks ago. Deputy English should hear this before he leaves.

Damien English (Meath, Fine Gael)
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I must attend a committee meeting.

Charlie O'Connor (Dublin South West, Fianna Fail)
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At that meeting no less than the SDLP spokesperson from Northern Ireland stated she was very impressed by what she sees of the work of the Minister for Health and Children, Deputy Harney. I do not ask the Deputy to believe it, I am only stating what the lady said. The Minister is a former colleague of mine. She represented my constituency very well. I was happy she decided to go to another constituency to give me a chance. I look forward to supporting the Bill and I thank the Acting Chairman for his courtesy.

Martin Ferris (Kerry North, Sinn Fein)
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This Bill is too little and too late. However, it is no surprise that we are disappointed yet again by the Government when it comes to delivery of equity and the highest standards in our hard-pressed health services. I want to pay tribute to the frontline workers in the health services who must work against the odds because of the disastrous policies of this and previous Governments. I wish to state categorically my meetings with health care providers in Tralee General Hospital have shown me the nurses and doctors working there are second to none.

It is a disgrace that members of the Irish Nurses Organisation and the Psychiatric Nurses Association have been driven to take industrial action, beginning next week, because of the failure of the Government and the HSE to ensure proper working conditions and standards of pay for these workers. I urge people to support their lunchtime protest on Monday, 26 February at Cork University Hospital, to be followed by protests at other hospitals in the coming weeks. Members of the IMPACT trade union in the health services also had to put industrial action on the agenda because of the way their workers have been treated.

When the task force report on accident and emergency services was published last month the Health Service Executive claimed a major improvement had been made in accident and emergency services. However, it then admitted it only begins to count the waiting times for patients in accident and emergency units from when consultants decide to admit them as in-patients. No account is taken of the time, often amounting to many hours, spent waiting to be seen by a consultant.

When one examines the figures, one sees no improvement whatsoever has been made. In February 2006, the highest daily figure for people on trolleys and chairs in accident and emergency units was 392. This month, February 2007, has already exceeded that figure because yesterday, 21 February, 412 people were on trolleys and chairs.

This week we had a scandalous situation at Beaumont Hospital in Dublin where there were 52 people in the accident and emergency unit and the hospital appealed to people to stay away. This is the proud legacy of Fianna Fáil and the PDs who have been in office for the past decade with three Ministers with responsibility for health, all of whom failed miserably.

I will speak parochially on the provision of health services in Kerry. According to the INO, people lie on trolleys nearly every day of the week, despite claims to the contrary by Government politicians and the HSE. Kerry General Hospital's accident and emergency department is still without a consultant since the resignation of Dr. Barry O'Rourke, who resigned more than a year ago because of the shortage of a registrar and other staff. Kerry General Hospital is chronically understaffed, particularly in the accident and emergency department, and we understand a recent review of staffing levels revealed that at least 70 new staff must be recruited.

I also wish to draw attention to psychiatric waiting lists. Last December it was revealed that children may have to wait years for psychiatric treatment and that Kerry has the longest waiting lists in the country where children must wait up to four and a half years to be assessed. It is no coincidence that County Kerry has one the highest rates of suicide in the country. The fact that children and young people do not receive treatment in time is a major contributory factor in disruptive behaviour resulting from ADHD. While other issues have been raised by groups with close involvement in the area, it is nonetheless vital that those who are referred are seen within a reasonable timeframe.

Unlike most of our EU counterparts, Ireland does not have a nationwide cervical cancer screening programme whereby all women aged between 25 and 60 years are invited by the State to attend their GP or family planning clinic for a free smear test every three to five years. In 2006, the Government promised such a programme would be rolled out by 2008 under the auspices of the new national cancer screening service which was to come into being this year. Will the Government confirm that screening services will be available nationwide by 2008? Will women in every part of the State be able to avail of the service? Must women in counties such as Cork and Kerry wait several years like they had to wait for the roll out of BreastCheck?

A related issue is the length of time it takes for women to be seen and to receive the results of their smear tests. At present, the average waiting time for women to receive the results of cervical smear tests is between four and nine months whereas in countries which have national screening test programmes the average waiting time is only six weeks. This makes a massive difference to women in terms of reducing their anxiety and allowing them to access any necessary treatment if the tests prove to be positive. Therefore, it is vital that such a programme is made available in this country.

When will this Government and the Minister for Health and Children finally admit the seriousness of the problem with hospital infections such as MRSA? Why are they afraid to admit the extent of the problem? Is it because they truly believe it is not that bad, or has it more to do with hospitals being chronically overcrowded, understaffed and underfunded, and they know MRSA cannot be tackled until the problems in hospitals have been dealt with? Perhaps if the Minister was as passionate about sorting out the public health system as she is in pushing her privatisation agenda, people would not be afraid to go to hospital for fear of becoming ill. I know people are afraid to go to hospital because they fear they will contract the MRSA bug. Last evening I was in Tralee General Hospital where I met a person who had had a hip operation a number of months ago. He has unofficially been told that he has MRSA, yet the hospital will not officially confirm this. I know another person who has refused to go into hospital, despite being in need of treatment, because of a fear of contracting the bug. The Government and the Health Service Executive must face up to their responsibilities on the MRSA issue.

I have spoken with many who work in the health system and the overriding opinion they express regarding MRSA is that many hospitals do not even bother screening staff because they know that the superbug is widespread and that it would be too costly for them to eradicate it. My own daughter who works in a hospital gave birth to her baby in Holles Street prior to Christmas. She was told, after being examined, that she was an MRSA carrier. She had to go through special procedures to eradicate the bug before the baby was delivered. She had been screened nine or ten months before but was not told anything. The bug is widespread and I can say without fear of contradiction that it is the result of understaffing and the lack of attention paid to it.

We buried a great woman in Tralee this week who had met the Minister for Health and Children a few short months ago. Ellen Rowan led a campaign for almost 12 years for a community hospital for County Kerry. I am thankful she has gone to the next world knowing it will happen. She campaigned with other senior citizens for many years in order to bring this about and it is a tribute to her and the people around her, many of whom have passed away, that this will be a reality. A community hospital should be provided as a right and people should not have had to campaign endlessly to secure a service they should have been entitled to.

The rushing through of emergency legislation, while necessary to retain risk equalisation, has exposed the inequitable and inefficient way in which health services are funded. The Government has downgraded the public health system. As a result, people are being forced to take out private health insurance. This means they are paying on the double through the PAYE and PRSI system, as well as through insurance payments. There is a fear that they will not get the care they need in time within the public system. The Government's privatisation of health services, including the scandalous private hospital co-location plan, is undermining the public system.

This debacle exposes the need for radical reform of health funding. Sinn Féin proposes the immediate establishment of a health funding commission to report within a reasonable timeframe on the projected cost of the transition to an all-Ireland system of universal public health care provision. This would take into account all spending on health services under the current systems, including State funding and spending on private insurance, and make recommendations on how the State could best harness these resources in the interests of more equitable and efficient delivery.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputies for their participation in the debate. I note and welcome the support expressed by many for the introduction of this legislation, but I am disappointed that the spokesperson for the main Opposition party is not supporting the Bill.

A fundamental principle of the health service reform programme is that the users of health and personal social services should be placed at the centre. It is important to stress that the Bill will bring about real and significant changes for service users. It establishes the Health Information and Quality Authority, incorporating the office of the chief inspector of social services. This independent organisation will reinforce the safety and quality of health and personal social services to ensure all service users can be assured that the services they receive are of a uniformly high standard. These statutory functions give the HIQA a significant role in shaping the health service and the standards set by it will provide a clear blueprint for a quality driven service.

The HIQA also has a health technology assessment role. Health technology assessment is widely regarded as able to deliver succinct, high quality and trusted evidence to decision makers at all levels of the health care system. It is envisaged that the HIQA's health technology assessment function will support evidence-based decisions and that the availability of impartial evaluations of the clinical value and cost effectiveness of complex health technologies, including drugs, will be an invaluable tool for service providers and health care practitioners and policymakers. I should emphasise that the role of the HIQA will be to advise the Minister and the executive on this issue.

The HIQA's evaluation role in regard to health information will lead to better information for supporting evidence-based approaches to health care which, in turn, will achieve improved health outcomes. The need for information that facilitates prioritisation, planning, evidence-based decision-making, efficient service delivery and monitoring and evaluation at all levels was acknowledged in the health strategy. The national health information strategy, launched in 2004, lays the foundation for the provision of enhanced health information across the health service. It recommends the necessary actions to address current deficiencies in health information systems and put in place the frameworks needed to ensure the optimal development and utilisation of health information. The HIQA will now have a central role in health information development and the implementation of the recommendations set out in the national health information strategy.

I would like to briefly touch on some issues raised by Deputies. They were interested in clarifying the status of the HIQA, accountability issues, the extent of the body's remit, the standards referred to in the Bill, the role of the chief inspector of social services and inspections of residential centres. The HIQA will be an independent agency, completely separate from the HSE, and have its own budget. The Bill provides for the CEO of the HIQA to appear before Oireachtas committees.

In the context of the HIQA's remit, some Deputies commented on the exclusion of a reference to mental health services from the Bill. I stress that this is because the legislative and regulatory framework is already in place under the Mental Health Acts, the Mental Health Commission and the inspector of mental hospitals.

Concerns were expressed that acute hospitals might also fall outside the HIQA's remit but that will not be the case. The HIQA has the power to set and monitor standards in respect of acute hospital services and can also operate accreditation programmes for hospitals. I should mention also in respect of hospitals that, as indicated by the Minister, the commission on patient safety and quality assurance has been established to look at the issue of the licensing of hospitals, with an associated enforcement regime. A requirement for all health-care providers, public and private, to be licensed for service delivery by the State would ensure minimum standards of professional qualifications and premises quality would need to be complied with.

Bernard Allen (Cork North Central, Fine Gael)
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I attended this debate to listen to the Minister of State's speech, but I am amazed no one is here. May I call for a quorum?

Pádraic McCormack (Galway West, Fine Gael)
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Will the Minister of State give way to Deputy Allen to raise a point?

Tim O'Malley (Limerick East, Progressive Democrats)
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Yes.

Bernard Allen (Cork North Central, Fine Gael)
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No. I want to call for a quorum because no one is in the House. This is an important issue.

Liam Twomey (Wexford, Fine Gael)
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And the Minister of State is getting it wrong.

Tim O'Malley (Limerick East, Progressive Democrats)
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I take issue with the statement made during the debate that the Health Bill does not deal with patient safety because patient safety is at the heart of the Bill. The Bill empowers the HIQA to set nationally applicable standards in services and gives it extensive powers, set out in Part 9, to monitor compliance with standards and undertake investigations. As well as patient safety, the Bill will ensure current good practices are embedded and developed. The setting of standards for health care is, therefore, a key function of the HIQA. Regulations may be made by the Minister in respect of procedures to be followed by the HIQA in setting standards, including procedures on consultation and publication.

The chief inspector of social services will be an employee of the HIQA and have statutory independence in decisions on registration and inspection of residential centres for older people, people with disabilities and children in need of care and protection. The centres will be known as designated centres under the Bill. The chief inspector may also appear before an Oireachtas committee to give a general account of the activities of his or her office.

The regulatory arrangements for inspections will provide an objective, robust and transparent inspection and registration system for designated centres. Registration of centres is for a three-year period. It is deliberate that the Bill does not specify how often a designated centre must be inspected within a given timeframe. It is better not to be overly prescriptive in this matter, as it should be for the judgment of the chief inspector to make decisions appropriate to each centre. Deputies expressed the opinion that the inspection of designated centres should include unannounced visits. The Bill is not prescriptive in this matter, but the interim HIQA has indicated that there will be unannounced visits.

I should make it clear that the chief inspector inspects against standards set by the HIQA and regulations made by the Minister. These standards will be published. Registration information will be available to the public on the Internet. No residential centre will be able to operate if it is not registered and people can be assured that it is operating within the terms of its registration. The chief inspector must be satisfied as to the suitability of those participating in the management of a centre, an issue raised by Deputies.

Regarding standards in residential centres for older people, I take this opportunity to refer to a working group, chaired by the Department and set up with representatives from the Health Service Executive, the social services inspectorate and the Irish Accreditation Board, to develop national standards for long-term residential care settings. The draft standards produced by the working group were formally published by the Minister last month and handed over to the interim HIQA which will oversee a public consultation process. The draft standards provide the HIQA with a useful and comprehensive template for circulation with relevant parties as part of a comprehensive consultation process. The draft envisages core standards that will apply to all residential settings where older people are cared for and for which registration is required. Under the provisions of the Bill, no residential setting for older people will be allowed to operate without being registered.

The draft is set out in two parts, the first of which focuses on the standards concerning the resident as an individual and includes personal identity, social connectedness, rights and health care. The second focuses on the organisational aspects of the residential care setting and includes management, staffing, care environment and health and safety. The publication of the standards by the Minister was the first step in the process. The interim HIQA has established a working group to develop the draft standards further and oversee the public consultation process.

In debating the Bill Deputies spoke of an advocacy role and the need for a framework for complaints. By virtue of its functions, the HIQA is a patient advocate. There are other patient advocacy agencies. In addition, the Health Act 2004 (Complaints) Regulations 2006 were made in December that year and make provision for complaints by persons to the HSE and service providers and require the establishment and operation of procedures and arrangements intended to achieve a fair and reasonable resolution.

I note the importance placed by Deputies on the inclusion in the Bill of provisions regarding the protected disclosure of information or "whistleblowing". This issue will be dealt with on Committee Stage. I thank the House for facilitating the Second Reading of the Bill. We are on an important journey with the health service reform programme and, with this Bill, have taken a big step along the way.