Brendan Ryan (Labour)

The Labour Party has no major difficulty with the substance of this legislation but we are concerned about its results and the work carried out by the various agencies to be subsumed into the Department of Health and Children and the HSE. We must preserve the functions carried out by the agencies and ensure such functions continue while not being in any way reduced. As the Women's Health Council says, we must safeguard the knowledge or institutional memory built up by these organisations. A significant number of people work in the Department of Health and Children and that number decreased only a small amount when the HSE was set up. We strongly endorse proposals for the rationalisation of the HSE, especially in the middle and other management grades.

The Crisis Pregnancy Agency was established in 2001 following the fifth report of the Oireachtas all-party committee with a remit to offer real and positive alternatives to abortion. Contraceptive services were and still are poorly developed in this country. According to the Crisis Pregnancy Agency, crisis pregnancy is not tracked or measured internationally. Irish research indicates that 28% of women and 23% of men are affected by a crisis pregnancy in their lifetime. It is not something that just affects teenagers. Less than 1% of pregnancies end in adoption; 15% end in abortion while the remainder end in parenting the child.

Progress has been measured and is detailed as a decrease of 30% in the number of women travelling to the UK from Ireland for abortions; a 20% decrease in the rate of births to teenagers and a 43% decrease in the number of teenagers travelling from Ireland to the UK for abortions, a decrease from 6% to 3.8%.

The Crisis Pregnancy Agency has succeeded in bringing to the table services with opposing ideological viewpoints, keeping them there and encouraging them to work in collaboration on developing standards, resources and advertising. In this context, the Labour Party is concerned that the work of the agency should continue. The agency had an extremely precise brief; it promoted public awareness and brought together those with opposing points of view in its efforts to reduce the number of abortions carried out on Irish women.

The decline in front-line services is evident throughout the entire spectrum of services provided by the State. Mental health services are affected; I refer to the addiction and counselling services being cut in certain areas by as much as 50%. The HSE must honour its promises on mental health and fill all vacant nursing posts. I am aware of the very great need to save money in all sections but cutting services to children with special needs, particularly those on the autistic spectrum, is seriously flawed. It will create a considerably heavier burden in the future with a far greater cost and will do a huge disservice to these children.

I see great merit in eliminating the duplication of services throughout all Departments if the savings can be invested in vital front-line services. On this point, will there be a monitoring system to ensure the work of these agencies will continue and that top-class services will be provided? What tools will be used to measure effectiveness? Will the Bill save money?

I continue to be concerned that funding which is supposedly red circled for specific health programmes such as palliative care, physical and intellectual disability and Traveller health has been diverted to other areas of health. It is a matter of continuing regret that the €10 million announced last year for a cervical screening programme was pulled. We will continue to insist that preventive life-saving vaccines should be a priority and we feel very strongly that this screening programme should go ahead.

The National Council on Ageing and Older People is a very necessary group and I and other Members of my party have met many of its members. Its voice should continue to be heard in the Department. Better health outcomes were a positive benefit of medical cards for the over 70s as they allowed people to avail of checkups, which in turn prevented a deterioration in health. Carers have many well-founded concerns, with many people now contacting my office with concerns about a reduction in home help hours. I am informed that respite is increasingly more difficult to access and this is a retrograde step because we know how necessary it is for those who take care of people with challenging conditions.

The cancer strategy for the country has given cause for concern as a line from Galway to Dublin sees a lack of centres of excellence above it. Has any audit been done on the National Treatment Purchase Fund? What has been its effect? Since 2002, the Labour Party has been proposing a universal health insurance scheme. It is a fair system and should be re-examined. We should examine models that work in other countries and implement policies which put patients first.