Brendan Ryan (Labour)

I explained why it was the case during the debate last week on MRSA. The fundamental problem with the health service is that the quality of its management is abysmal. It is entirely recruited from inside the service and does not have the necessary injection of external expertise to manage the system. It has the largest budget in the country but is managed by people not qualified or experienced in dealing with budgets of that scale. That is not an excuse for turning it into a privatised service, which is what the Government is in danger of doing.

The only way to make management better is to make it open, transparent and accountable. No decision should be taken in the health service which is not accompanied by the name of who took it, so that a person who did not agree with it would know whom to talk to about it. That happens in every private organisation and I know the pharmaceutical industry quite well. It is not possible to move a bucket across a room without a document stating that, for example, Brendan Ryan moved it. That is the way to maintain clear lines of accountability. One can go into a hospital to find a ward closed in the morning but no one to say who was responsible. That person must not be able to hide behind public relations people but must face up to the consequences of the decision. In that way we will guarantee that anybody who is not up to the job will leave and take early retirement. It is not as simple as that because all sorts of interests, such as trade unions, have a say in such matters but that is the required fundamental reform.

I do not understand why a rich Government did not expand the proportion of the population eligible for medical cards to 40% because that is an obvious way of taking some pressure off the public hospital system. The only reason I can imagine is one of ideology. Why are we carrying out another study into the number of acute beds in the country when we know from the OECD that our figure is among the lowest in the world?