Seanad debates

Wednesday, 26 May 2004

Health (Amendment) Bill 2004: Second Stage.

 

12:00 pm

Photo of Jim WalshJim Walsh (Fianna Fail)

It must be noted that not all consultants have embraced the scheme because they believed it would impinge on their level of income. This has emphasised that the issue of vested interests must be tackled as a priority. However, the vast majority of professionals working in the system provide excellent care and service to their patients.

If we value our republican ethos, we cannot allow a situation to continue where consultants who are contracted to provide care to the ratio of at least 80% public patients and 20% private have moved to a skewed position of 60% to 65% public and 35% to 40% private. Considerable incomes can be earned because of the skewing of the system. It demonstrates a structural failure which needs to be addressed. Priority for hospital treatment must be based on medical need and not on the ability to pay. I wish the Minister well in his deliberations with the consultants to establish new contracts and to employ consultants who will be dedicated to public service.

The Bill deals with the change in the structure of the health boards. I acknowledge the points made by other Senators that a significant contribution has been made by both local and national public representatives who were part of the health board system. In the early days of the State, county councils administered many of the health services, including the management of the hospitals, and were then replaced by the regional structure of management.

The Brennan report recommended that the health board structure should be retained, although their number and functional areas should be reviewed to safeguard the need for local democratic representation. One of the major reports on which the future of the health service is based recognised the benefit of that local input and the necessity to ensure it continued in the future. Much emphasis has been placed on the Hanly report, commissioned to deal with the working-time directive. In view of the implications of the directive, Hanly's remit went much further than the narrow remit given at the outset.

I agree with Senator Mansergh that the Hanly report may not have been properly digested by everybody and therefore much of the criticism is misguided. A balance must be achieved. This is the era of specialisation. Most sensible people will accept that it is neither possible nor affordable to have the full range of every specialist service available in every hospital. However, some recognition must be given to the practicalities of certain situations.

Both Senator Mansergh and I are from the south-east. He spoke about people from the area travelling to Dublin for radiotherapy treatment of five or ten minutes a week which adds to the stress of the illness. That facility will be available in certain strategic locations and there is a compelling argument, because of our situation in the south-east, for a facility to be located in Waterford hospital.

The organisation chart of the new health board structure shows the Minister and his Department at the head. The Health Services Executive Board and its chief executive is on the next level followed by the national hospitals' office which will manage the acute hospitals sector, which I regard as a good initiative, and the regional health offices are on the next level. From a corporate governance point of view, a board at national level in control of an expenditure of €10.2 billion is unlikely to be able to exercise the influence required of a board of directors. A company of that magnitude would have subsidiaries and subsidiary boards. If the health areas are to be reduced to four, there is a strong argument to be made for revisiting the proposals. Instead of executives reporting to executives, each area should have a board with some local input of a specialist nature, but not including those with a vested interest, and some public representatives.

I welcome the regional health forum which is a good initiative. It would be preferable to reintroduce local health committees at county level because public representatives will, in the main, be interested in what happens in their own functional area. I am sure other Senators will echo my comments as regards their counties. My interests are Wexford General Hospital, St. John's Hospital and other hospitals in the county as well as the regional hospital in Ardkeen. This should be recognised in the new structures.

I will make two points regarding the success of the health reforms. First, it will be incumbent on all stakeholders to adopt the role of interested participant, rather than pursuing vested interests, if we are to achieve the best possible service for the patients they serve. Second, people, through taxation, fund the health service and are, accordingly, entitled to representation at all levels to ensure an effective input into the provision of such services. The Minister will discharge this role at national level but councillors, given their representational role, wealth of relevant experience and historic contribution since the foundation of the State, must be given a meaningful input into all areas of the health services at regional and county level. This is an imperative for the successful implementation of the health reform programme.

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