Liam Twomey (Fine Gael)

Much has been said about the Croke Park agreement and a lot more will be said about it, but we should accept civil and public servants have taken a significant pay cut in the past 12 months. Some grades have seen reductions in pay of up to 15%. If we take into account what has happened in other jurisdictions where they have tried to extend pension age by two years and, essentially, seen those countries grind to a halt, it should be acknowledged that sacrifices have been made by civil and public servants. We should not demonise them for what they have been prepared to accept to this point.

The Croke Park deal is about reform and changes in work practices and there is a huge number of players involved, inlcuding the Government, the trade unions and the civil and public servants in the upper echelons of Departments who are expected to enforce the terms of the agreement. Unfortunately, what we have seen so far is the easy target approach of the Government to pay cuts. For instance, within the Health Service Executive very little regard has been had to the Croke Park agreement in terms of extended working hours for health care professionals. I am a general practitioner, yet I am not aware of any significant discussions between the Government and general practitioners to transfer some of the workload from hospitals to general practice. We are not seeing such engagement and not seeing that work being done by either the Government - the Minister of State is the driving force in this regard - or in the upper echelons of each of the Departments. What we are seeing is the pursuit of easy targets - cuts in capital spending which will prove detrimental in the long term. Another easy target is temporary staff who are being laid off. We are not seeing expenditure on upgrading medical equipment or school equipment.

There is a need for a process to be put in place to drive this agenda much harder. The Minister of State may have to walk on egg shells to get the job done, but it must be done because otherwise we will reach a stage where civil and public sector workers will see another reduction in pay, one of the options open to the Government to close the deficit. However, if there were significant reforms and greater productivity in a wide range of public services provided by the Government, there is the possibility we could avoid the worst of this. If there are tax increases or fewer benefits, they will affect every person drawing a salary, whether in the public or private sector. Unless we all face up to the changes required, we will be left with no choice in the matter.

The waste within the health service, the area I know best, is unbelievable. PPARS was a classic example. A computer system that cost €240 million was then just switched off and forgotten about. I took my child to a hospital for an outpatient appointment in recent months. I had not been in an outpatient department in the best part of the ten years since I had left the hospital system and as I sat there waiting to see the consultant, I watched clerical staff as they pulled big trolleys containing paper notes. If I am working on the on-call, out-of-hours GP service which is now used in this country - the co-operative type system, which is a radical change - and I type a consultation into the computer from the patient's bedside, it is sent directly to that patient's doctor. The idea of not using computers in general practice is considered backward, particularly when dealing with blood results and administrative work. Not only that, other changes have taken place in the amount of work done by practice nurses and in the area of secretarial work.

In the past ten years, we have radically reformed how general practice works. That is public private partnership, not just private industry, in that there is huge input from the HSE and from GPs as independent contractors. If that sort of radical change took place in hospitals, we would probably not be discussing issues like this.

These are the issues we must consider. It is the ethos we must set out for ourselves in the coming years. Otherwise, the row that takes place here about the divide between the private sector and public sector and about the cost of the public sector and the deficit we are facing will become an endemic problem that will lead to a very simplistic, blunt instrument solution within a year or two. We must face up to this reality immediately, and I hope this is how the Minister of State will approach it.

Mr. Gerry Robinson undertook several programmes in regard to change in the HSE in recent years. When he went to the hospitals, he found he could talk to the hospital managers, consultants and nurses and was able to bring about some change. However, when he was asked his view on what was the greatest impediment to change, he said it was the upper echelons of management and their refusal to engage, take responsibility or be accountable for billions of euro of taxpayers' money that was the major problem in the HSE. It is probably the same in regard to the wider public service as it is an institutional issue.

We need to throw out the old ways and become sharper, stop blaming each other and looking for excuses to blame each other and stop pointing the finger. We need to take a few risks and do things differently. That is how we will make changes. I do not want to take advice from people like the man from Topshop. I accept he can point out changes of which we are all aware, as can politicians and those who work in the service. That individual sold his company for €1.2 billion. He is not in the same world as the rest of us, so let us not quote him. There are more than enough Members in this House who can point out similar changes. I compliment Senator Harris, who comes out forcefully on these points, and perhaps I can myself be radical and fundamentalist at times. There are options for change. There is a need to listen to everybody but, most of all, there is a need to make those changes happen.