Frances Fitzgerald (Fine Gael)

I am pleased to have the opportunity to speak on this Private Members' motion and I commend the Labour Party Senators on submitting it and providing the time to debate it. There is urgent need to address this issue, to examine how the HSE is performing, how it delivers services and the relationship, in terms of responsibility and accountability, between the HSE and the Minister in her Department. All these issues emerged in a number of reports last year as being key to the delivery of health care services. There have been two serious investigative programmes by "Prime Time" in recent weeks, one on the delivery of services to young people at risk, the other on the pace and rate of delivery of primary care teams. Both programmes were critical of the delivery issues.

It is not, of course, only on television programmes that we hear such things. We also learn from the direct experience of clinicians and patients. One of the key issues that comes up repeatedly, which is not addressed by the Government amendment, is that clinicians feel alienated from HSE structures. This is not about bashing the staff of the HSE. I agree with Senator Feeney on this matter. A great number of people in that organisation want to do their very best. It is about how services are delivered and the experiences of people. It is clear there are major problems. I am not alone in saying this. The Fitzgerald report, which was commissioned by the Minister to analyse this, stated that doctors described the HSE as a "low trust" organisation concerning relations between clinicans and administrative officials.

We must admit this is happening if we wish to change it. I spoke to a clinician today who told me that when he goes home at night it was not the patients that are on his mind in terms of pressure, nor is it the services he is trying to deliver. He said what is on his mind is how he will deal with the bureaucratic structures within which he must work and how to get across to the administrators the needs of his front-line job. Those words came from a person who is trying to give service in a very disadvantaged area. In his experience, the relationship between clinician and administrative back up is highly problematic. A number of people to whom I spoke today said they do not believe anybody is listening to them. As clinicians, they feel very strongly that their experiences go unheard within the present structures. This is a very serious issue and I believe it is real. People are not imagining such things.

Yesterday the Joint Committee on Health and Children heard representatives of the Muscular Dystrophy Association. I found it traumatic to listen to them because their needs were so great and the lack of delivery to them was extraordinary. They talked about the need for more personal assistants in order that they might be independent. In the health service right now, despite all the money available, these people do not get what they need. To take that group alone, one would have thought that after 11 years of the Celtic tiger, it would be automatic and routine that they would have personal assistants. These people are in dire need and what they need is not available to them. We know also that patients from the National Rehabilitation Hospital cannot go home at present because they cannot get enough home-care packages. I raised this at the Joint Committee on Health and Children.

The Minister knows, I know and everybody in this House knows we could quote example after example. Something is seriously wrong. What disturbs me about this amendment is that it contains denial. There are two ways of looking at it. The Minister is asking us to welcome the review of the organisation to improve its effectiveness and efficiency by streamlining its management structures, clarifying roles and responsibilities, reporting relationships, etc. It is an indictment of the Minister, the Department of Health and Children and of the HSE that after four and a half years of an organisation that was meant to deliver, the Minister comes here to tell us a review of its basic roles and responsibilities is taking place. It is an admission of failure that such measures are needed. The reports have stated clearly that these things must be done. Every report has identified this. What has gone wrong? What is the Minister's explanation to the House that an organisation she set up is not delivering ? Why has it gone wrong? Who has been in charge? How has this been allowed to develop? Why, after four and a half years of the HSE, are such measures needed?

The other side of the coin is that for 11 years we have had a Government made up of Fianna Fáil and the Progressive Democrats which has had more money for delivery of services than any other Government. We have a population that approaches 4 million and we have not been able to organise our health services.

I have no doubt that very serious questions will emerge about the public private partnerships that have been so popular with this Government. It is clear from the experience in England, for example, that there has been huge spending over budget on many such projects. This will emerge here too. I heard somebody say at the weekend that if one wishes to know where the money has gone that should have been providing front-line services in England, he or she should look to the waste in public private partnerships. It is questionable to assume that these structures deliver the best front-line service in health. This model has been used.

I am disappointed there is a need for this debate. It is distressing for people in every sector. I could go into detail on all of them but will mention just two where delivery for the patient has failed. At the end of the day patient care is what we are here to talk about, not about structures for the sake of structures. We are here because we want the structures to deliver care to patients.

There should be an inquiry into the outbreak of the C.difficile infection in Loughlinstown Hospital where 16 people died in order that we can learn from the mistakes made. The Minister will have seen what happened in Maidstone in England. This is an incredibly serious infection with devastating results. We have had a very serious outbreak with 16 people dead.

The other area I will mention is mental health and the decision to locate the Central Mental Hospital beside a prison. This is against all international best practice. I ask the Minister to reconsider that decision, which I assume was made by her and that she will take responsibility for it.

The Government amendment shows a degree of complacency in that it does not inject any urgency into the crisis in the health service.