Frances Fitzgerald (Fine Gael)

Another example is where all involved want to be paid as they were in charge but nobody wants to show leadership or responsibility.

The Minister states she wants her legacy to be one of good access for everybody, whether he or she is a public or private patient, but I wonder whether her legacy will be one of supporting a range of private facilities while the public health service remains under enormous pressure. There seems to be a preferred policy of confrontation by the Department and the HSE with partners at local, regional and national levels. I call on the Minister to replace this with a culture of consultation and the concept of working with all the partners in the health sector. The Minister stated it in her article today, but it has not been the experience on the ground on a range of issues. There is a real problem.

This was evident in the report published last week dealing with hygiene in hospitals. There is a feeling that the HSE does not deliver and is not accountable. There are no guarantees of performance, no measures and no targets. The hygiene report states there is no managerial responsibility and no governance in hospitals. There were no targets or clear management guidelines on what they wanted to achieve in years one, two and three. The Minister spoke about that issue some years ago when she said she was determined that, for example, MRSA and the hygiene problems in hospitals would be addressed. Three or four years on we have a report clearly stating those targets were not set in the first place, which is extraordinary. Last week in the House I quoted a number of lines about the gaps in management regarding that issue. That is just one example. We have the advantage of having this carefully prepared report in contrast to the Health Service Executive report on the same topic which came out more favourably in terms of the hospitals. There is something missing in terms of the issue of management and responsibility.

The structures of the HSE in its performance to date should haunt the Minister. She repeatedly said she wanted to return to the Department of Health and Children and that she has said she is delighted to be there but how can she be satisfied with the results to date? The issue of the structures of the HSE have not been tackled head-on by the Government. For example, the Minister was in power in 2000, although it was a Fianna Fáil Minister then, when Portlaoise hospital was designated as a centre of excellence. The Minister prides herself on delivery but what steps were taken at that time to ensure Portlaoise hospital, then designated a centre of excellence, had the state-of-the-art equipment needed for the diagnosis of cancer? The announcement was made but there was no follow through in terms of giving it the services it needed to be a centre of excellence as it was designated at that time.

There have been many announcements but the concern is that there has been no follow through. That is the same challenge the Minister will face in terms of what she told Senators earlier. Many Members of this House would agree with much of what the Minister said but to persuade people that it will work is a major task.