Seanad debates

Wednesday, 26 May 2004

Health (Amendment) Bill 2004: Second Stage.

 

11:00 am

Photo of Labhrás Ó MurchúLabhrás Ó Murchú (Fianna Fail)

Cuirim fáilte roimh an Aire Stáit agus gabhaim buíochas leis mar gheall ar an soiléiriú a thug sé dúinn maidir leis an mBille seo. I welcome the Minister and thank him for the clarifications he has given us. He mentioned that what we are dealing with is interim legislation, the first of two Bills which will be coming before the House. The purpose of these Bills is to give legislative effect to the proposals of the reform package the Government is bringing forward on the health services.

It is right also to make the point that the health service has served us well over the past 30 years and we should salute all those who made a contribution to that service. The health boards in particular should be given credit for the work they did. They were the conduit between the service and the community, and we all realise the importance of that in this age of transparency and accountability. The local authority members who served on those boards were in touch with the needs of the community. They were often able to undertake fire brigade action where that was required. The people on those boards were very committed, and they had a good knowledge of the way the service worked. Anybody who studied any of the boards over the years will realise that without them we may not have had the same observance in regard to the delivery, quality and accessibility of service, which is particularly important.

When the Minister is considering the new fora which are intended to allow input by public representatives I ask that he ensures they have teeth and that they are not merely advisory bodies which exist to question the executive. They should be given a status, which in many ways they deserve, and their expertise and experience should be availed of. In view of what the Minister of State said in his speech it is clear an opportunity exists to closely examine this proposal before we deal with the further development of the new structures being brought forward.

It is not an exaggeration to say that good health and a good health service are fundamental requirements to any society, particularly a progressive society. The health service is always a priority in public debate, as it is with the Government. However, we sometimes make the mistake of equating money with service. Over the years we have seen that irrespective of the amount of money that has been invested, there is not a commensurate return for that expenditure on the ground. It behoves a Government to ensure we get value for money, particularly when such a large amount of the total budget is expended on health. That has been a consistent demand of media commentators and public representatives over the years.

There has been much confusion in trying to analyse value for money. There are many demarcation lines within the service where people take a particular stance and where consultants, hospital management or whatever have their own agendas. I do not say that in a critical way. It is understandable but it is important that there is cohesion among all the interests because the patient, like the pupil in school, is the most important person in this debate.

We should also give credit to the religious orders which played a central role in the delivery of the health service in this country. There is not a person in this House who, over the years, has not remarked on the excellent management, including the overseeing of a medical input structure, provided by the nuns. Many would bemoan the fact that they are no longer available to us but society moves on. In any hospital I have had the opportunity of visiting, particularly in the early part of the 30 years under review, we got value for money and a professional approach. Compassion was also always provided, an important element which should not be overlooked.

To return to the issue of quality, what we are dealing with today is totally different from what we dealt with 30 years ago. Those of us who are old enough to look back on the history of Dr. Christian Barnard will remember his work in the area of heart surgery. Many people felt at the time that he was indulging in a form of black magic yet what is happening in that area today is almost like cosmetic surgery. We all see the wonderful results which have been achieved as a result of progress in medical science but it also puts pressure on the health service because what is being offered today is many times greater than what was being offered years ago. We have to bear that in mind when we try to assess progress and what still needs to be done. It is like saying that An Post provided a much better service 20 or 25 years ago in that one could send a letter to some area of the country and it would arrive the following morning. Even in that case one has to acknowledge there is a much greater volume of mail than there was in those years. The first action we must take, therefore, is to examine the services now being provided.

Second, we have to be particularly careful in our criticism. While there must be criticism it should be balanced. Often a controversial approach is taken to many issues, particularly health. One would imagine that no hospital was delivering a good health service and yet when one talks to patients — this has been my experience throughout this debate — they invariably say that when they went to a hospital they were well looked after. They praise the medical staff and the structure. When we make reforms we must not throw the baby out with the bath water. We must look at what has delivered the service and at the commitment of those who work in it.

People have different expectations within the health service today. Nurses now take a different approach and it is not for us to say they are wrong in considering their job to be a career rather than a vocation. Everyone else has moved also. A good service is being provided but if we want to have transparency, quality and accessibility, which are the aims of Government and of the public, we must put the necessary structure in place. No service can be delivered without a proper structure and that is the position at present.

Senator Feighan was correct when he referred to confusion with regard to the Hanly report. That confusion arose when people rushed to comment on the report before they had a full understanding of what it set out to do. I am not sure that we fully understand it yet. However, as the debate proceeded people got a greater understanding of the report, alarmist headlines disappeared and the attitude of political point scoring became less prevalent. I do not blame a particular political party for that. Politicians are right to look after their own functional areas with regard to any service, particularly the health service. Those who are proactive in a debate make a positive contribution to it. As the debate proceeded people gained a clearer understanding of what was being proposed and of the need to provide acute and specialist services where and when they are needed for all people and not just those who have insurance cover. If the Hanly report had received that type of attention early on we could have sought information, analysed the report in greater detail and indicated where corrections, if necessary, might have been made. Senator Feighan was right to say we started from a base of confusion which clouded all opportunity of extending the debate in the future.

The strengthening of governance and accountability is vital. If we continue to allocate State resources to health but cannot see a net result of that, we will have this debate all over again. The Government is right to be courageous and strong in its approach to this issue and the Opposition is right to tease the matter out and to question where we are going. However, the health system must not become bureaucratic to the point where common sense, local knowledge and individual concerns can not find accessibility.

That is why I return to the question of the proposed fora. It has been suggested to me that they might be like the advisory committees which existed in the past. Nothing which existed in the past should be revived simply for the sake of saying we have local democracy in the new system. The Minister must examine this issue very closely. There remains an opportunity for flexibility. I recently attended a seminar on this issue in Tipperary where the issue of local authority representation in the health service was discussed. It was clear that local authority members were not interested in jobs for the boys or in holding on to what they had. They were principally concerned with having the necessary expertise and with delivering on their responsibilities exceptionally well. They were determined that local representation would be an ingredient in any future reform.

I wish the Minister well in what he is trying to achieve and reiterate the four points which have been mentioned: better health for everyone; fair access; responsive and appropriate delivery; and high performance. If we keep within those four guidelines it will be possible, with the constructive and positive help of everyone, to get this right once and for all.

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