Déirdre de Búrca (Green Party)

As I was not aware I was sharing time, I will have to pare back what I intended to say. It is difficult to make a meaningful contribution to a debate on the health services in four minutes. However, I will do my best.

I welcome the opportunity to debate the Labour Party's motion. It is a welcome motion because it reflects most aspects of the public's concern about the Health Service Executive. Rather than merely expressing those concerns, the Labour Party has offered a series of constructive proposals for reforming the HSE. However, I also take on board the point made by the Minister for Health and Children, Deputy Harney, regarding the changes and improvements that have been achieved in the health service. The HSE has been in existence for only three years and many of the improvements that have taken place are not recognised by the media. Negative headlines always make better stories. Many of the new statutory reporting requirements have enhanced the perception that there is only bad news and problems in the system. That tends to distort the picture.

The truth is somewhere in between. The process of reform is beginning to take effect. However, many of the concerns raised by Senators in this debate are valid. The greatest problem with the HSE is the lack of accountability. It is difficult to identify individuals within the organisation who are responsible for different aspects of its functioning. The task of bringing more coherence to the HSE is probably the greatest challenge facing the Minister. The establishment of the executive involved the merging of all the previous health boards. In such cases, it always takes some years before there is a sense of coherence and orientation.

New structures will have to be put in place. I use the example of the national cancer control programme as a model of the type of coherence that can be brought to bear if a particular service is delivered with the right type of clinical governance and leadership. Professor Tom Keane, who recently briefed members of my party on the national cancer control programme, strikes me as a good example of an identifiable person heading up the process of change within a defined area of the health service. He has both clinical expertise and experience in change management. He is bringing to bear that experience in putting in place the right structures.

Regional specialist centres are recognised as the most appropriate way to deliver some of our cancer services. One of Professor Keane's greatest criticisms of our existing cancer services is the emphasis on hospital and inpatient care.