Joe Behan (Wicklow, Independent)
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I thank the Ceann Comhairle for allowing me to raise this matter on the future of the HSE in the light of recent developments.

We are all aware, and I certainly acknowledge, individual staff members in the HSE are conscientious, diligent and public-spirited but time and again the HSE as an organisation has proven to be disturbingly dysfunctional and unfit for purpose. Sadly, in recent days we learned the failures of this organisation have had lethal consequences for some of the vulnerable people with whose care it was entrusted.

These past weeks have given us proof of the dysfunctional nature and cataclysmic failures of an organisation entrusted by the Dáil with the care of vulnerable children. We learned of the troubled life and sad death of Daniel McAnaspie, a young man in need of a caring environment, in need of a support structure, in need of help. He was a member of a family which had to face a number of serious crises and traumas in their young lives. His was a family failed by the State-care system and Daniel, a young man, allowed to fall through the cracks. His life is now over - a young man whose needs were well documented yet ignored.

It is not only the vulnerable young who have been let down by the HSE. We also heard the heartbreaking stories raised in this week's excellent "Prime Time Investigates" programme on the lack of support, the lack of services and the lack of a strategy to help those affected by Alzheimer's disease and dementia. In the programme, we saw older people and their families fighting for services to which they are entitled including respite care, home help, day-care facilities, residential care facilities of an appropriate standard and counselling for the women and men struck down by this insidious disease and their families. The evidence of this programme should not be forgotten such as the tears of frustration of grown men caring for their mothers, doing the job of the State and struggling to make up for the failures of the HSE.

We are witnessing the gradual shutting down of HSE-run nursing homes, very often without proper consideration being given to the option of upgrading those local facilities. Instead, the elderly and frail patients of these public facilities are being bundled out the doors into private nursing homes without any serious consideration for their feelings, their former friendships or their sense of belonging. Sadly, many of these people have died shortly after being moved and nobody in authority seems to care.

I could go into detail about the number of separated children or unaccompanied minors missing from State care. HSE data in 2007 show 41 children went missing from care. In all, between 2000 and 2007, 441 separated children were recorded as missing from their care placement and of these only 53 were accounted for. What is that if not an admission of abject failure?

We are only now getting a glimpse of the outrageous power struggle being played out in the corridors of power in the past few days. The organisation, tasked with responsibility for the health of our nation, at first refused to provide to the elected Government and Dáil information on the number of children who have died in its care. It was only after a contentious meeting with the Taoiseach, as reported in today's The Irish Times, did the organisation backtrack on that stance. This is simply outrageous. It begs the question, who governs this country - the Government or the HSE, the Taoiseach, Deputy Brian Cowen, or Brendan Drumm?

Members should now join forces to demand an end to this monstrous bureaucratic experiment called the HSE. It is dysfunctional, dangerous and defeated. I believe it no longer commands the confidence of this House or the people we represent and it should be brought to an end.

It is high time for us to hold a mature discussion about what we can do to replace this dysfunctional organisation with a health care system in which we can have confidence to look after the care needs of the entire population.

Michael Finneran (Roscommon-South Leitrim, Fianna Fail)
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I thank the Deputy for raising this issue and I welcome the opportunity on behalf of my colleague, the Minister for Health and Children, to reaffirm the Government's commitment to the principles underpinning the establishment of the Health Service Executive as a single, national authority with responsibility for the management and delivery of health and personal social services. While I understand the Deputy's concern in respect of some of the issues raised by him, this should not detract from the significant progress that the HSE has achieved on several fronts in the reform of our health and social care services since its establishment five years ago.

The strategic reasons for abolishing the health boards and certain other agencies and replacing them with a single national authority remain as valid as ever. Reform of our health system was driven by the need to bring about improvements in services to patients and other users through the organisation and delivery of consistent national services, based on objective standards and implemented in a uniform manner throughout the country which made the most beneficial, effective and efficient use of taxpayers' money.

The vital work that is now well under way to implement a national cancer control strategy was made possible by the unified HSE structure. Similarly, the implementation of national standards for nursing homes throughout the country has also been greatly facilitated by a single structure, as has the introduction of the Fair Deal nursing home scheme. Likewise, the implementation of critical primary care and chronic illness strategies also require a single, national management structure. Over time, these strategies will deliver real and tangible benefits that would not have been possible to achieve under the previously fragmented system.

The HSE has recognised that its own internal structures must be reorganised to improve the delivery of health and personal social services on an integrated basis and to improve accountability at all levels of the organisation. That is why it has moved to put in place an administrative regional structure, within the national structure, to drive operational performance and accountability on the ground.

The sheer scale and complexity of the health service reform programme cannot be underestimated. It is the biggest reform project ever undertaken in the country and change of this magnitude can only be successfully achieved over a timeframe of several years. It is inevitable that deficiencies will come to light as the reform programme evolves and it is imperative that the HSE takes the necessary corrective action to address these as they arise.

However, as I stated earlier, the policy objectives behind the establishment of the HSE are as valid today as they were seven years ago when the Government took the strategic decision to establish a single national authority to replace the seven regional health boards, the Eastern Regional Health Authority, the three area health boards and several other agencies. Improving the range and quality of services to patients, clients and other users of our health and personal social services is at the heart of the reform programme and the Minister for Health and Children remains steadfast in her view that this can best be achieved through a unified national structure as the progressive implementation of the national cancer control programme has clearly demonstrated.