David Norris (Independent)

I thank Senator Prendergast for allowing me this time to speak. I welcome the Minister because she is a brave woman who went into Angola but I wonder if she regrets that decision now. I will not engage in partisan political attacks because I agree with those who said recently that what is needed now is a Tallaght strategy. Rather than party members knocking lumps out of each other we should consider patients' needs.

I am glad to see that in her speech the Minister said, "if you are worried about cancer, this is the best assurance we can give you that the best care will be there if you need it". When will this happen? The word "will" is the crucial verb in this sentence and it means in the future. The Minister also said, "If you live in rural Ireland or outside a major city, you deserve the same care as a person living right beside a major cancer hospital and you will get it". Again I ask the Minister, when will this happen? Can she guarantee the Susie Long case will never be repeated in this country? Can she guarantee that the Portlaoise case will never be replicated? I believe this situation has arisen due to an ideology and that the notions of competition, co-location and so on are ideologically driven. I pointed out to the Minister previously that a three page script of hers mentioned words relating to business and these practices around ten times while patients went unmentioned. I know the Minister feels strongly about patients but they must be at the forefront of health policy.

Regarding private hospitals, the Minister pointed out previously that one needs a licence to own a dog but not to run a hospital. This is because hospitals are businesses but I do not feel that the health service should be a business; it should be an entitlement of the citizens of the State. I have no medical expertise but I believe, along with many eminent medical professionals, that we need a universal, accessible health service. The Minister once said we should be closer to Boston than Berlin but I would prefer to be close to some European models of health service than the American model. Has the Minister seen the film "Sicko"? It shows that the American health system is guided by the principles of competition and profit and while the United States has excellence in its health service it also has people routinely and ruthlessly excluded from the provision of health care.

I wish to put on the record my admiration for Professor John Crown. I have never met the man and have no connection with him but I listened to him with interest and I trust a lot of what he says. The Minister may agree with some of the problems he has identified in the health service including inaccessibility, inefficiency, unfairness and an uneven quality of delivery. He agrees with the Minister that the best clinical care takes place in large, comprehensive specialist centres. One may look at examples such as the Memorial Sloan-Kettering Cancer Centre and the Netherlands Cancer Institute when considering the poor resources we have.

We, as politicians, must take some of the blame because many Senators do not see their constituents as the councillors who gave them their seats in this House but as those in the constituencies where they may seek election to Dáil Éireann and they fight for local services. Professor Donal Hollywood from Trinity College produced a report in 1995 and had to have a police escort out of Portlaoise because of people stirring things up against him. Senator Harris was right when he raised the issue of vested interests, however those with vested interests are not, primarily, consultants but managers in the health service. Managers proliferate faster than any local service and this matter must be addressed.

I was interested to read a piece by Professor Maurice Nelligan.