Phil Prendergast (Labour)

I had hoped the Minister would give her views on the way the HSE conducts its business. My experience of the HSE matches that of many others public representatives, including Fianna Fáil Deputies and at least one of the party's former Ministers. The executive has been described by many public representatives as a monster and a bureaucratic glutton, gobbling up much-needed funds that could be used for frontline services. This is a cause of immense frustration to the public and the medical profession. It also leads to inadequate care for patients.

I accept that not everything that goes wrong with the HSE can be laid at the Minister's door, but that does not mean she can avoid accountability entirely. Yesterday in the Dáil, the Taoiseach again deployed his limited liability defence regarding his responsibility for the economic crisis. Considering the HSE's failings, which we hear about on an almost daily basis and which have been well outlined by Senator Fitzgerald, I hope to hear the Minster, who established it, today accept responsibility for its actions. It appears the HSE does whatever it wants and health Ministers assume the role of its public apologists. However, when the public wants answers from Ministers about the failings of our health service, the response is invariably: "It was not me, it was the HSE". The HSE's public accountability can only ever be limited. It is not a person who stands for election and it cannot be scrutinised in Parliament or voted out of office. Nor can its character be assessed by the electorate.

A Canadian documentary made in 2003, called "The Corporation", is potentially instructive. The film examined the conduct of corporations by applying the psychiatric diagnostics used for human beings. The diagnosis was that the firms in question behaved in the same way as a psychopath. If the same test were applied to the HSE, I believe the diagnosis would be that the patient is a pathological liar. Time and again the executive makes statements, either publicly or to stakeholders, that are demonstrably untrue. It happens so frequently that it cannot be an accident or incompetence. It is done with the deliberate intention to mislead. This reflects poorly on the Minister's political integrity.

Last year, the Minister told me and my fellow Oireachtas members in Tipperary South that we would be informed in advance of changes to our health service. However, just a month later, the HSE announced it was closing St. Michael's acute mental health unit in Clonmel, without the advance warning the Minister promised. The Minister did not break her word but the HSE did it for her. What are the Minister's views on that? What is her view on the fact the decision was made without the consultation process outlined in Vision For Change and without an option appraisal being carried out? I assume the Minister expects best practice to be observed in the administration of the health service. Does she stand over reconfiguration decisions in which consultation and option appraisal are not carried out?

Furthermore, the decision to close St. Michael's was taken without reference to the line Minister. Does she stand over this as well? If so, how many patients does it take to screw in a light bulb in the Minister's head? The welfare of over 50 patients is at stake at St. Michael's, yet the Minister saw no need to be involved in the decision over their future. Therefore, the answer is obviously not 50. Perhaps she might let us know if it is 100 or 150 before she decides to become involved.

I would also be grateful if the Minister would comment on the increase in bureaucracy since the HSE was established. Between 1999 and 2009, there was a 67% increase in the numbers working in administration and management in the health service. By comparison, the increase in nursing staff over the same period was 39%. Ten years ago there were nearly three nurses for every administrator in the health service. That ratio is now close to 2:1. The trend looks set to worsen. We already have an admission that there are not enough junior doctors in the system. Would the Minister accept that there are insufficient nurses as well?

The recruitment moratorium has led to the extraordinary situation in which the Minister is demanding that nurses carry out the cervical vaccination programme without any extra cost. That means public health nurses are being taken away from their normal duties forever. This is not like the H1N1 programme which has a prescribed lifespan. The consequence of this decision is that thousands of babies every year will not get their developmental checks at the optimum time of nine months. There was already an insufficient number of public health nurses to carry out this task to optimum level before the moratorium and the two vaccination programmes.

I pointed out the dangers of this to Professor Drumm at the time, at a health committee meeting, and he shared my concern. He will be returning to paediatrics in the near future and will no doubt be doubly concerned that there are now 120 public health nurse vacancies. These have not been filled and it is having a severe impact on the delivery of primary care. Can the Minister explain how a cervical vaccine programme, requiring the annual administration of 90,000 injections, can be run without affecting the health of babies?

Many people will find it perplexing that the HSE continues to use agency nurses, who cost 50% more than temporary and permanent staff. People could be forgiven for thinking that agency staff are hired to replace nurses on maternity, sick, compassionate or force majeure leave. They would be wrong. These nurses are rarely replaced, meaning there are fewer nurses in our system than the figures suggest. I accept the Minister might not have the figures to hand, but I would be grateful if she could provide me with an average number for nursing staff absent from duty this year when we meet at the health committee next month.

Senator Feeney stated the Opposition opposes for the sake of opposing. That could not be further from the truth. I have experience as a nurse and midwife for over 20 years in the health service in this country and for more years in another country. Our sources are of the highest integrity. The Irish Nurses and Midwives Organisation has frontline staff who feed information to the executive council and tell the absolute facts relating to the statistics. The spin from the HSE totally removes them from this. I have put questions to the Minister today and I seek answers. In particular, I ask the Minister to update the House on exactly what will happen to the patients in St. Michael's unit. When will we have an update on the reconfiguration process? What is happening with that?