Camillus Glynn (Fianna Fail)

I look forward to the contributions of my colleagues to this timely debate in which everyone has a relevant contribution to make. As Members of the Houses of the Oireachtas we must change the health services. In the past few years the demands on the health services have changed dramatically. The population is getting older and living longer. There is a greater inclination to avail of elective health procedures. Some 30 years ago, when a person went to hospital half of the community would cry at the terrible event. Nowadays, people can drive, take a taxi or cycle to the hospital for procedures.

There is demand for additional health services and we must examine how these are delivered. Are we afraid to change established practices? Are we deriving optimum benefit from services? Apart from our longer living and ageing population, the population has increased significantly through immigration. Many people have come to the country from eastern Europe to contribute to the economy and they are very welcome.

What are the reasons for the changes we seek to make? Some years ago the health services were administered by the county councils. The Health Act 1970 and the establishment of health boards caused a hue and cry. Some suggested the health services would be far better under the county councils. Whatever we may say about the health boards, many of the regional specialties would not be there without regional health boards. Some people may agree or disagree with this but it does not alter the facts.

Nothing remains the same. The health boards had a number of deficiencies. I bemoan the democratic deficit, about which I have spoken to the Minister. Representational fora exist but should meet more often. It is important that locally elected representatives can be updated by the powers that be in the HSE. Locally elected members are the conduit between the ordinary person on the street and the health service delivery organisation vis-À-vis the HSE. The Minister should examine whether these fora could meet more often and be given more teeth. Many members feel these fora have no powers and are not performing the function expected.

Under the health board system varying degrees of qualification were required for medical cards, for example. Different levels of nursing home subvention were available. I am delighted with the home care packages. A member of my family is in the early stages of Alzheimer's disease and lives in a three storey house in another country. It is a beautiful house but is unsuitable for someone with this condition. It was advised that the patient would be better off remaining in familiar surroundings. Placing the patient in new surroundings would add to the patient's confusion. It is important that old people be cared for in their homes. We must laud the home help service. Every effort must be made to extend this marvellous service and increase the hours. This is better for the health of the person and generates a few extra euro in the community's economy, especially in rural areas.

We must examine new models of care. Some years ago my brother-in-law and I visited his mother, who was in her 90s. She was in a two storey nursing home in London with in-house carers. The apartments were self-contained, with independent cooking facilities, a sitting room and a kitchen. There was also a community hall. Specially selected people fulfilled the role of watchdogs and it worked very well. It would be worth viewing this model and taking it on board.

Infrastructure is imperative for the delivery of services. As I have said previously, here and at the Oireachtas Joint Committee on Health and Children, we must find a way to fast track capital projects. This involves serious money and the Minister is doing her best but sometimes project teams add extras and facilities which takes forever.

I spent some years in the area of nursing and am delighted at the extended role given to nurses. I have long argued that junior doctors performed functions that could easily have been performed by nurses who in turn did jobs that could have been done by people with a short spell of training. This was a waste of a valuable resource.

I commend Mr. Carey, one of the Minister's officials who is here today, on his proactive approach to nurse training and his role in the establishment of the College of Nursing in the midland region. We are not, however, winning enough recruits for nurse training to care for those who are mentally handicapped or sensorily disabled. I will not get involved in industrial relations but I strongly support the nurses' cause. I have spoken to them and believe they have a strong case. This is in hand and industrial relations negotiations are difficult enough without people like me in a public forum complicating the issue. Some people with a qualification in nursing the mentally handicapped took a care assistant position because that is better paid. That is regrettable and must be addressed. Although there is an individual in the midlands who has revolutionised orthodontics some difficulties remain, of which the Minister is aware.

I am pleased the Minister will increase the number of consultants and reduce the number of junior doctors because consultants are important. I worked with a certain kind of consultant for many years and am aware that consultants play a pivotal role in the delivery of health services. I wish the Minister and the Health Service Executive well in the negotiations on the consultants' contracts because this is a difficult area. The Oireachtas Joint Committee on Health and Children has discussed the fact that when recruitment of a consultant is approved the money is available but the appointment takes as long as a wet Sunday. There must be some way to fast track this process.

A couple of years ago a delegation from the committee went on a study trip to see the primary health care system in France. There is a great differentiation between general practitioners' fees there and here. Running a practice is expensive but is it possible to examine and compare practices in the two countries because here fees are sometimes high. I have been asked several times to raise this issue.

We debated MRSA last week but it is worth repeating the point that it involves operational matters. It is not for the officials of the Department of Health and Children or the Minister to make sure that hospitals are clean. People are appointed to positions of responsibility to do this work. A famous doctor from St. Loman's, who twice stood for election in Dublin, used to repeat ad nauseam that no antibiotic should be prescribed without a culture and sensitivity test. I endorse Senator Henry's point that some people who visit a general practitioner feel that the consultation was a waste of time if they do not get a prescription. That is nonsense. I spent some years in Britain where advertisements in the national media told people to take their doctors' advice because that was often the best treatment. There was no reference to a prescription. People should think about that point.

The appointment of mental health teams should be expedited. There are some in place but it is necessary to go further with this work. I am aware that there have been improvements and that the Minister has devolved significant additional resources to the mental health service but this has been something of a Cinderella service. The Minister has corrected that situation but that should continue.

The Minister must try to tackle the scourge of diabetes which is a silent epidemic and will have a major impact on all aspects of the health service. I thank the Minister for listening and know that she will take cognisance of what I have said.