Liam Twomey (Fine Gael)

I congratulate the Minister, Deputy Harney, on her reappointment as Minister for Health and Children. It is three years since the Minister was first appointed to this office. One can ask what success has been achieved within the health service. There is no doubt money has been spent but the successes are few. Part of the problem is a combination of incompetence and complacency about what is happening in the health care service. I do not believe the Minister is personally responsible for all the problems. It may be the case that the Minister's partners in Government have no interest in the health service. It may also be the case the Department of Health and Children is not fully au fait with what is Government policy. It is also possible the HSE is completely at sea in terms of looking after the health care of the population.

In 1996 the then Minister for Health, Deputy Michael Noonan, drew up a cancer strategy. It was ten years before the Government, of which the Minister was a part, drew up its own strategy in 2006. As yet, there has not been any implementation policy for cancer treatment within the health service. Appointing a tsar from England to make changes will not make any difference unless the Minister is certain about the type of change that is proposed. Reference was made to eight hospitals but the Minister did make any clear statement of her intentions. It is a bit like BreastCheck; it gets rolled out bit by bit. The same situation applies to cervical cancer screening. Screening has not been extended beyond Limerick city in over seven years.

As Fine Gael spokesperson on health, I drew up a policy on cancer screening as far back as 2005 with the assistance of one researcher. How is it the case that the Minister, with 500 people at her disposal in the Department, cannot draw up a policy on cancer screening across the country rather than make an announcement about the possible screening for bowel cancer next week? I am not sure what staff in the Department are doing especially when the HSE appears to run parallel to the Department.

Let us look at what is happening on the ground. In Wexford the steriliser for cleaning the colonoscopy which is used in the diagnosis of bowel cancer has been broken for the past two months. Accordingly, the diagnosis of bowel cancer for patients is being postponed for a further two months. Is it on the basis of the money saved in not treating bowel cancer the HSE officials received their bonuses two months ago? This is not just happening in County Wexford, it is happening right across the country where similar stories can be heard in every single constituency of ineptitude, complacency and downright waste of money by people who are supposed to be running the health service on behalf of the people of Ireland. That is what the Minister is overseeing, as part of the Government. She is not getting to grips with what is happening.

When I was health spokesperson for Fine Gael in the Dáil I always backed up the Minister in making difficult decisions I thought would help people. I said I would back her on a public-only contract for consultants. What has gone wrong in that regard? Before one can make cancer treatment services work, one must have the consultants in place in hospitals. They must be working in teams in a way that will deliver a service. Why is it the case that the talks on contracts which began as far back as 2003 are still in limbo in 2007? Four years later the talks are going nowhere. When I backed the Minister early in 2006, I stated there was a good chance this would happen, yet the Minister allows this train to chug along. That is what is happening with the health service.

What about the reforms the Minister mooted as far back as 2001? What changes to work practices in the health service has the Minister overseen in the past three years? The sector has been benchmarked and increases have been paid. A total of €900 million of the health service budget is based on changes in productivity and in how people work. What are those changes? We do not see them and there has not been an improvement in access to health services for patients.

The Minister stated outcomes have changed but she was referring to a base that was disastrous. If change had not occurred the Minister would have been imprisoned for negligence. We expected improvements would take place. When one benchmarks cancer outcomes in this country against other countries in Europe, we are not doing so well. In fact, we are doing pretty badly. The Minister should not be benchmarking herself against the lower base that prevailed in this country in different economic circumstances.

The Minister must also examine what she wants to do. For the time being I am keeping the discussion global. I do not believe the Government has a coherent policy on what it wants from the health service. Let us look at what happened in the case of Leas Cross. Patients were dying of neglect in this private nursing home. When reports were made to the HSE it took it a year and a half to respond. When the Leas Cross report was published, more energy and effort was expended by senior management in the HSE in making excuses for their behaviour than in trying to make changes. The Minister introduced legislation on HIQA, the Health Information and Quality Authority. At the time she stated this body would protect patients. In the course of the Dáil debate on the matter I contended and still believe that we need a statutory patient safety authority that is not answerable to any Minister as such but to the people, or at least to the Oireachtas. The Minister disagreed with me and set up HIQA.

When a crisis occurred in a private hospital, it emerged the remit of this organisation that came into legal effect at the beginning of 2007 does not cover private institutions. What passes for Government policy currently is to move health care into the private sector as evidenced by the co-location of private hospitals on the grounds of public hospitals. I accept this is a difficult issue for some of the Minister's party colleagues but this is what is happening. Beds are being provided in the private sector where the standards cannot be checked by the organisation that was set up by the Minister to monitor this area. That is a perfect example of why things are going wrong in the health care service. In order to get it right the Government must organise a cancer care strategy in a way that works for patients.