Mary Harney (Dublin Mid West, Progressive Democrats)

It is always a pleasure to come to the Seanad notwithstanding the fact that some of its Members think I have no accountability here. It is unusual that I do not as I am here so often. I always enjoy attending debates in this House.

If we do not get the basic facts right, we will not have an informed debate. I want to tell Senator Fitzgerald that the HSE is not four and a half years in existence, nor even three and a half years. The HSE was established in January 2005 after a prolonged period of analysis carried out by prospectors and others and after widespread consultation with a number of stakeholders. The reason for advancing a unified organisation for Ireland was that, with a population of 4.3 million, we had 11 health boards with 273 members covering very small populations. It was not possible to provide quality assured services with such a small population. I advance the view again that it would not have been possible to have implemented the cancer control programme if we still had the old health board regime. The midland health board has no cancer centre, the north east and north west are similarly without specialist cancer centres. When the health plan of former Minister for Health, Deputy Michael Noonan, was put into effect by the health boards, all the evidence backed up this point. In the midlands, for example, each hospital got a slice of the action and this meant patients did not receive a quality-assured service. Consequently, a unified service is right for Ireland. It is right in terms of delivering effective quality-assured services and ensuring that we minimise the cost associated with their delivery.

Another myth suggests that since I became Minister and the HSE was established, the level of bureaucracy increased greatly at the expense of front-line staff. Since the HSE was established, there was a reduction of 423 staff in its own corporate headquarters alone. There has been an increase in front-line hospital staff in the order of 6,000. There has been an increase of just under 6,000 staff at community and primary care level and a considerable increase in the number of therapists. This is not understood. I constantly read articles and hear references in both Houses to the effect that there has been a growth in bureaucracy since the HSE was established and since I became Minister. We have increased the number of physiotherapists by 20%, the number of occupational therapists by 45% and the number of speech and language therapists by 28%. The number of consultants has risen by 18%.

On the issue of clinical involvement, I am a strong fan of clinical leadership. The cancer control programme was recommended to the Government by a group of 23 people, 17 of whom were medics. The success of that programme is very much dependent on clinical buy-in. With a view to implementing the programme, Professor Keane, a medical oncologist, has recruited to his team Dr. Arnie Hill, a breast surgeon from Beaumont Hospital, Dr. Donal Hollywood, a radiation oncologist, and Dr. Maccon Keane, a medical oncologist from Galway. These three clinicians are working part-time with Professor Keane on the implementation of the programme and there is considerable buy-in from doctors around the country. Only recently Professor Keane addressed up to 200 surgeons in the Royal College of Surgeons in Ireland. I know from many sources that when he left that meeting, virtually nobody in the room disagreed with what is happening. Individuals in particular circumstances may not like what is happening but, by and large, there is considerable clinical buy-in, bearing in mind that there is never unanimity.

The new contract of employment for consultants, which was agreed recently by the Irish Hospital Consultants Association, which represents 80% of practising consultants, was favoured by 80% of consultants while 20% were against it. An important feature of the transformation of doctors' working practice is the idea of working on a team with a clinical director. At present, consultants work as individuals, or lone rangers, within hospitals. There are a few exceptions, as in St. James's Hospital, where there is a clinical directorate model that works very well. Some consultants tell me they work "in the hospital and not for the hospital".

Lead clinicians must work in teams to provide cover in the hospital and to provide the excellence and expertise we require. The clinical director will be responsible for ensuring there is structured cover by consultants when the hospital requires it, be it on Saturday, Sunday or in the evening. There will be two directorates — a medical directorate and a surgical directorate.

It took so long to agree on the consultants contract mainly because of the issue of access to private practice in public hospitals. Senator Fitzgerald referred to doctors not being very enthused by the problems that arise. They do not go home worrying about their patients, apparently; they go home worrying about the bureaucracy.

Irish doctors are the best paid in the world.