Martin Mansergh (Fianna Fail)

I welcome the Minister of State. We all have an interest in the successful implementation of the national health strategy. I agree with my colleague, Senator Ó Murchú. Despite what I read about problems in the health service, the experience of those close to me has been, on the whole, good. They have not experienced the health service as the lurid disaster area depicted in the media. Nonetheless, I accept there are serious problems and pressures, which are particularly heavily concentrated in the greater Dublin area. We need to remember that the population of the country has increased from little over 3 million in 1971 to almost 4 million today.

I have mixed feelings about the abolition of the health boards. Their establishment was one of the pieces of genuine decentralisation, in the sense of devolution, we have had. We are now saying that has not worked efficiently and we must have a centralised delivery system. I have concerns about that. Some of the controversies which have arisen are due, in part, to a resistance to centralisation. This is so in the case of Cavan/Monaghan/Dundalk and of radiotherapy services in Waterford, for example.

When we talk about the health services we talk in terms of delivery but we must also think about the people who are in receipt and need of services. We must not simply consider efficient management from the point of view of the providers of the services. We must also look at the service from the point of view of the patients who need care. I recently attended a meeting in Carrick-on-Suir which discussed the pressing need for a radiotherapy centre in Waterford to serve the south east region. Today's newspapers contain a report of the very different outcomes for cancer patients in different parts of the country. This must have something to do with proximity and access to services. The journey from Waterford to Dublin takes a minimum of three or four hours by car. A patient must spend an entire day coming to Dublin for a radiotherapy treatment which takes between a few minutes and an hour. Cancer patients are not, in the main, particularly well and this journey puts considerable strain on them.

From the point of view of efficiency of delivery and throughput, I can see why this service should be centralised in two or three places. However, we must look at the service from the point of view of the patient. The south-east regional authority has suggested that a new look needs to be taken at the Waterford radiotherapy issue and I am totally in support of that suggestion. When I was still working in Government Buildings but heading in the electoral direction, I had an argument with a former adviser to the Minister for Health and Children. When I told him I supported the Waterford radiotherapy centre he replied that I was sounding like a county councillor. I respect county councillors and so did not take that as the insult that was, perhaps, intended.

There is a disadvantage in downgrading democratically elected representatives. I agree with Senator Feighan that local representatives have not treated decision-making on a highly partisan or biased basis. My experience has been — I can only speak for the South Eastern Health Board area — that public representatives want to do the best job for people in their area. Obviously, there are sometimes arguments about what should be prioritised and where best to locate facilities. I am not happy about moving elected representatives from a co-decision making function to a purely advisory one. I agree with Senator Ó Murchú and others that the issue needs further consideration.

A particular problem for health boards has been the issue of resources. A lively debate is currently ongoing in Tipperary regarding the allocation of resources for the completion of Clonmel hospital and the knock-on effects of that for Cashel. It is easy to believe, when one has a problem in any area of Government, that if one changes the structures or the name of the Department, one is somehow solving the problem. Sometimes that works. However, if something is not working one may have to try another way of dealing with the problem including trying new structures. Very often changing structures is a cosmetic panacea which does not get at the real problem.

I am a little sceptical about what is being proposed. We have to try it because the current system is not working. I implore Ministers not to accept uncritically the mania for centralisation. Patients want facilities that are reasonably close and accessible to them. Cancer patients, in particular, are entitled to such services. We must rethink the issue of providing only a few centralised facilities which deal too much from the point of view of the medical professionals and not enough from the point of view of the patients who need the services.