Jim Walsh (Fianna Fail)

Perhaps the Minister of State might give us two minutes of his time. I thank Senator White for sharing her time with me and giving me the opportunity to contribute to the debate. Like other Senators, including Senator Ulick Burke, I listened with interest to what the Minister had to say. Her contribution reinforced my opinion that the Minister and her two able Ministers of State, Deputies Seán Power and Brian Lenihan, provide a formidable team to meet the strong challenge in the health service. The debate is about health service reform. Undoubtedly that is overdue. I welcome the fact that it is now happening.

Within the health service there are more than 100,000 employees, the vast majority of whom are dedicated and caring in the manner in which they approach their jobs. However, there is a need to tackle some systematic failures that have existed for a considerable period under many Ministers, including Ministers from all sides. It is wrong to make a political football out of an issue that is so important to the life and well-being of our citizens.

In regard to some of the negotiations taking place, I am already on record in complimenting the Minister on taking a firm stand to ensure that bad practices, which have preserved unsustainable benefits and systems for those who work within the service, need to be brought to an end. I hope there will not be any fudging on that matter. The time has come to make the changes that are essential.

We all know from our dealings with people who go through the health service that as soon as one gets access people are positive about the service provided. I have found that because of the systems working within hospitals that patients who might be discharged on a Saturday, Sunday or bank holiday are not discharged simply because the consultants do not operate a system that allows that to happen. That is not in the interests of the patient and it is certainly not in the interests of those who are waiting to access the services. All of that needs to be changed.

There is also the issue of the two-tier system. I am a strong proponent of people participating in and using health insurance but access to the services should be strictly on the basis of health need rather than on who and how much the consultant is getting and from what source. That is an issue that badly needs to be corrected. It has been recognised by the chief executive of the Health Service Executive and the Minister and clinicians need to be put in charge and given the management responsibility to ensure they function properly and effectively.

That we have a higher number of nurses than any other country needs to be examined. The amount of investment in the services has quadrupled during the past decade without a commensurate output and benefit to patients from that investment. Some of the difficulties and management lacunas which apply need to be examined, evaluated and changed so that we have a health service of which we can all be proud.

One hears complaints of the Caredoc system. I am aware from speaking with people that many go to accident and emergency departments simply because that service is not as good or as available as it should be. Any such changes in services constantly need to be re-evaluated to ensure their focus and target is what was intended. Where doctors have invested in significant property developments, whether in pharmacy or the lease of premises to a pharmacy, there has to be an issue of conflict of interest which must be examined to ensure we get better value for money for medicines than heretofore. There is a huge element of waste in that sector.

In regard to governance, I welcome the fact that there have been some changes but the HSE is too centrally focused. The system at regional level, where executives report to executives at national level, is fundamentally flawed from a corporate governance point of view. There is a need for a system of accountability at regional level. I have advocated previously that we should also look at having accountability within counties because it is at that level at which most public representatives are interested. In the past our local health committees served a useful forum for identifying weakness and ensuring they were addressed. There is a range of issues that need to be examined.