Joe O'Toole (Independent)

I am delighted to welcome the Minister to the House. In my 21 years in Leinster House I have never learnt anything in political debates on the health area. Anything I learn about the health service I learn through talking to people working in the service or through listening to experts on the radio. I find it very difficult ever to find that middle line and I tend not to involve myself in such debates. I believe this is the first one to which I have contributed in approximately two years. I wish to place on the record of the House that I feel the Minister is doing a job above and beyond what might be expected of her. That may be an unusual comment to make in these Houses in these times. However, that is my view on the matter. She has taken on an almost impossible task and I feel a huge sense of sympathy in how to get it done.

One of the biggest problems people like me have in trying to take a middle line on the matter is that we have nothing by which to measure it. At the beginning of a year I would like to have a very clear understanding of the objectives for the year, the key performance indicators and how we would assess them at the end of the year. That would allow me to say this was the objective we set out to achieve and this is how far we got in areas such as waiting lists, the number of operations performed, diagnoses or whatever. That is the information I need. I have found it very difficult over the past two years with the various things that happened in the hospitals, including misreading of X-rays etc. Given that we are talking about the running of a business with a management structure, I should be able to ask for the risk register for that particular institution, wherever it may be. I would be able to inform the Minister within one hour where responsibility lay or if someone was responsible. That is a major issue for me. I would like the risk registers of hospitals to be available. There is no reason for them not to be public documents and readily accessible. Over the course of the year the assessment of those documents should also be available.

The radio interview with Nuala O'Faolain, who, sadly, has died since, impacted on us all. In the middle of that interview she talked about the way she was treated in a New York hospital. I am sure we all listened to it in different ways. I listened to it on the basis of all we have heard about the Irish health service. We are supposed to be aspiring towards the system that is available in the United States. Even though she had adequate health cover, she was allowed to lie on a hospital trolley or some such without any counselling. Someone stuck his head in the door and told her she had terminal cancer. That is as bad a story as I have ever heard of the Irish health service.

The terms of the Fine Gael motion are not unreasonable and I look forward to hearing how the Minister responds to it. Intuitively like everyone in the House, I find it difficult to live with the fact that there is no centre of excellence in the northern half of the country. The Fine Gael motion accepts much of what already exists and seeks something which should not be beyond practical response. On the issues of travel and quality and how they relate to each other, there is no contest. It would be an abrogation of the Minister's responsibility were she to agree to establish a centre of excellence in a place where the scale, experience or amount of work being done did not reach the threshold to ensure quality. While I completely agree with the point, I do not know the figures. However, I certainly agree with that basis of making a decision.

I will give an example of what I am talking about. I spoke to a woman who was about to have minor heart surgery — some people would say there is no such thing as minor heart surgery. As she had full health insurance cover she went to a specialist in a hospital in Dublin. It was an unusual operation that involved inserting some sort of electrical impulse. Senator Quinn and I would be attracted to this. The specialist told her that the hospital had a 92% success rate, which is greater than nine out of ten. He advised her that a hospital in Bordeaux — the best hospital in Europe for the procedure — had a 99% success rate. Knowing her own situation and having received advice from the surgeon, she went home and made a decision with a full armoury of facts. In the event she decided to have the operation in Ireland, which, thankfully, was successful. That is the kind of benchmarking or quantitative detail that is not normally associated with the health service. As an Independent Senator I need more of those kinds of data to make an honest assessment.

Is the same level of scale needed in the four areas of diagnoses, surgery, chemotherapy and radiotherapy to make every centre of excellence effective? Could the surgery be in Galway and the treatment in Castlebar, for example? If we are moving, is it required to move everything?

The Fine Gael motion refers to "the proposed closures at University College Hospital Galway, where the Centre of Excellence is to be located, for the month of August this year due to severe budgetary constraints", which is utterly unacceptable. I cannot find any justification for establishing a centre of excellence and closing it down in August. The Minister has spoken previously about the comfort of people who need to travel long distances. There is no point in dealing with it in a way that politicians then complain about how much it cost us to send people in taxis in the previous year. I have no difficulty sending people in taxis during a year if they are sick and need that kind of cover, we can justify the expense and it is done on a properly tendered basis. I saw the Minister writing when I first mentioned benchmarks and I will finish by saying it again. What people like me need are the benchmarks to assess progress so at the end of a year we can say whether we have made progress towards the key performance indicators and quantify it. That would be very helpful.