Joe O'Toole (Independent)

It is difficult to take an independent line in these debates. I welcome the Minister to the House and thank her for her generosity in making herself available, on which all sides can agree.

I support what the Minister is doing in terms of centres of excellence and the cancer strategy, but I have many codicils. I have listened to oppositional politics for 20 years and Senator Feeney, in a fine speech, told us not to scaremonger, but I will make a few statements. I became a Member in 1987 and, during my first week, I lunched with Barry Desmond, who had just finished his tenure as Minister for Health. He expressed his rage when discussing his problems in closing hospitals. I remembered the news coverage of the event, but he gave me a vivid image of when the leader of the Progressive Democrats and the Democratic Socialist Party's Jim Kemmy linked arms on their way through Limerick to try to stop the closure of Barringtons Hospital. Those two parties were looked after.

I remember the Minister for Enterprise, Trade and Employment, Deputy Martin, being in deep trouble for the appalling nursing homes mess. I went to the trouble of reading the background to the issue. The provision was introduced by a Labour Party Minister for Health who received legal advice from his Department to the effect that what he wanted to do was wrong. He brought the matter to a Fine Gael Taoiseach and Minister for Finance who, despite the legal advice, cleared the provision. Every subsequent Minister of all shades allowed the situation to continue.

I remember Deputy Noonan ten years ago, who I refer to because these people were at the centre of media demonisation. When Minister for Health, Deputy Noonan made a mistake in terms of the advice he received in respect of the Mrs. McCole case, but that did not take from my admiration for him as a Minister and what he was trying to do against all sorts of odds.

I have heard it all when it comes to people having a go at Ministers and it is occurring in the case of the current Minister, Deputy Harney. I admire her work, but I disagree fundamentally with some of her issues, which I will put on the record as I proceed. We need to examine the matter. Let us begin with the role of Professor Drumm. When the Health Act passed through the House in 2004, I raised concerns regarding the chief executive's role but got no support from any side. All parties accepted that the legislation would not allow the chief executive to be critical of Government and ministerial policies. I have raised this issue in respect of the appointment of every chief executive to every State body since I became a Senator. As the provision was voted on and accepted, there is no point in our whinging. I do not know Professor Drumm's policy, but we passed legislation that requires him to take on board the Government's policies and objectives. Before we examine those, we should examine how we make appointments. I have reminded some of my consultant friends how hard it was to appoint a chief executive to the HSE when it was established. It is important to recognise that the people who knew all about it then were not queuing up for that job. We demand that Professor Drumm be available to give an account of the general administration of the health services to an Oireachtas joint committee. I disagreed with this set-up then and I disagree with it still. Chief executives should be allowed have a view, say what they believe and drive policy as well as implement it.

I was delighted Senator Fitzgerald raised the issue of governance, accountability and responsibility. It is the height of nonsense to blame the Minister or the chief executive of the HSE when a hospital cannot be kept clean. Senator Fitzgerald is correct that there should be risk audits in hospitals to ensure they are kept clean. If they are not, someone in the hospital must be accountable and action should be taken.

My heart goes out to the consultants. They are afraid to criticise civil servants. If someone in a hospital says boo to them, that hospital will not be supported. I do not buy that one. I have spent my whole life fighting with civil servants and I will tell the House how it works. If one takes them on about a school, a hospital or any other matter, the word will come back to play it cool, to keep one's voice down and not put a head above the parapet because one knows what will happen. If one takes it that way, nothing will happen. Civil servants, however, are very predictable. The minute one puts the boot in hard, raises the ante and puts it in harder, raises the ante again and buries them, they recognise it is easier to do business than to walk away. That is how it works with civil servants.

It is unacceptable for a consultant who found dirty equipment at Portlaoise Hospital to claim the answer was to write a letter to the Minister. What do they do about dirty hypodermic needles? Do they write a letter about that? My view on this case is simple. They should have stopped using the equipment there and then and made someone deal with it.

Last week on radio, the Minister said she hoped to conclude the contract with the consultants by the end of the year, only for that to be contradicted an hour later by the consultants claiming that under no circumstances would it be finished by then. I want to hear more about this development.

I disagree fundamentally with the Minister, in principle and in practical terms, on bilocation. In practical terms, it is duplication. I believe consultants do a fabulous job and I am a great admirer of them. They are entitled to every penny they earn and I do not begrudge them a shilling of it. However, I want the world to know they earn their money using, at no charge to them, our hospitals, our beds, our nurses and our equipment. This is where I disagree with the Minister — I would make them pay for these services. Instead of building a second hospital on the one site, I would put a value on existing hospital services and let the consultants pay for them. I accept the Minister's plausible argument that bilocation releases more beds. However, it must be recognised that consultants are using State equipment paid for with taxpayers' money.

One important fact that emerged from the Minister's speech, of which I was unaware, is that 44% more patients are now treated using fewer beds, an important key performance indicator. It is important the Minister chairs a committee monitoring service delivery. I agree with Senator Fitzgerald that benchmarks of progress and key performance indicators are needed for us to buy into the Minister's policy in a practical way. I hope Professor Keane will outline the key performance indicators he hopes to achieve in the coming year. This will allow us to count them as they are delivered. If we get that, no one can object. Is a risk audit for the entire health system publically available? If so, where can I access it? Without bothering the Minister, I could then find out why a hospital in, say, Portlaoise is dirty and have an answer to both sides.

While I am not prepared to be critical of Professor Drumm, he has been somewhat unfortunate in the way he has handled some of his media outings. There needs to be a single voice for the HSE for it to give its views, leaving Professor Drumm to concentrate on running the executive.

The levels of administrative staff in the health services is an issue constantly raised in the House. Not one Member wants to see consultants answering the telephone or scheduling their diaries, and there must a certain level of administration. Earlier today on the Order of Business, I requested a debate on the review body on higher remuneration. The comments made by it on extra people in senior management in the HSE are troubling. If the HSE could not come to a conclusion as to what some of its senior management are doing, it must be reviewed. Having been involved at a senior level in the trade union movement I share some responsibility in this process. In the change from the health boards to the HSE, there was a need to accommodate many people. Like what happened elsewhere, they either had to be bought out, paid off or given jobs. There is some element of duplication but that does not mean people should not be working.