Joe O'Toole (Independent)

Our earlier discussion was focused on this section. This section on the object and functions of the executive and the one dealing with the plan are the two that give me the greatest cause for concern. I do not get comfort from this section as a good receipt for our €10 billion or €11 billion. We need to know more. What is the deal here? Earlier the Minister of State referred to efficient management. Senator Feeney talked about the importance of consultation. Has anyone noticed that three major trade unions have declared war on the executive before it even starts because of lack of consultation?

This is supposed to represent good management. How can I have confidence in this structure if even before it starts it seems to have got things wrong? I am told that the contract, which exists between every GP and his or her local health authority, is not automatically transferable to the new HSE. Every contract will need to be renegotiated. The Minister of State understands contract law better than anyone in the House. As the GPs' existing contracts are not automatically transferable to the HSE a major renegotiation and consultation will be required, which has not even started. We are two weeks away from D-day on this matter. I cannot have confidence in it.

While I will not rehearse the difficulties in appointing a chief executive, that person in the main will be charged with the delivery of the objectives. While I do not blame the Government for the problems that arise in this matter, a chief executive designate should have been appointed before starting this arrangement. The failure to make such an appointment does not instil confidence.

Section 7 is exceptionally vague. Even accepting the point made by the Minister of State that it is not possible to legislate for every issue that might arise, the Bill contains phrases such as the following:

The object of the Executive is to use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.

While I agree with all that, what does it mean? What is different about that from what the health boards are supposed to do at the moment? Why will I get better value for money having it written in this legislation than I got when it was written into previous legislation? More pressure should have been applied, but was not.

We should have spelled out what we want here. Reducing the problems with accident and emergency departments, having more efficient bed management and ensuring the availability of the appropriate number of therapists and specialists in various areas should have been set out as clear objectives. While this would not take from what we require, at least I could say that I knew the areas on which we would spend €10 billion or €11 billion each year. If they were not achieved we would know the executive was not delivering. What will change and where we will get better value for our money and a better service? While that may be a somewhat rhetorical question, it is not rhetorical to ask for section 7 to require the executive to deliver those requirements.

It is implied that we will get a better framework for the staff. There is responsibility towards employees. There is the question of having a better health service for patients. However, how will it happen? What will be different? Where will it start? If we had picked one of the health boards and eliminated the others and had asked it to run the whole country rather than one area, the authority would be centralised, which is one of the main objectives of the legislation. However, nothing would be done differently. I see certain improvements in accountability and ministerial influence, which should always have existed. As discussed, other matters are not included. I cannot see us being in a better position after enactment of this legislation.

The Bill will open the doors to private medicine here. That does not reflect any philosophical position, but is a statement of fact as I see it. While the Government may want to do so I do not see this as a recipe for improvement. Does the Bill address new contracts for consultants or the arrangements for medical personnel at all levels? No requirements are made of them to do specific tasks. While we need not tell them how to go about their business, we need to outline the requirements. I would love to require the executive in its plan to produce a set of objectives with a timeline. Section 7 should outline the objectives we want reflected in the plan. As Senator O'Meara said earlier, it is about having a mission statement in another way with clearly defined objectives. The new health service executive should be required to produce a plan outlining what it will do against each objective and a timeline for each against which we can judge its effectiveness. Otherwise how will we measure it?

I know the Minister of State can point to section 10, which provides that the Minister can do this, which is fine. However, why should the legislation not specify it? This is fundamental enabling legislation. It is not housekeeping, scheduling or something we make up from time to time. This is about having a service available and making certain demands.

The point was made earlier about the lack of specialists in certain areas. In my view it would be better to do that. Why is the Department of Education and Science responsible for medical schools? The fact that it is responsible for education is not a good enough reason. Responsibility for those schools and delivery of medical education should be rooted in the health service.

I look forward to the Minister of State's reply but there are so many things missing from the section, which is vague, that it is difficult to have confidence in it as a way of obtaining recompense for the hard-earned €10 billion we have paid out in taxes.