Alex White (Labour)

Maybe so. From a cursory glance of the report, the issues that emerged and were reported on in the press were much more serious for the Department of Health and Children than the Minister of State was prepared to acknowledge. Senator Ormonde got closer to what was stated in the report. The first thing we must do in all debates is be frank and put our finger on the problems. I thought that was one of the reasons the ORP reports were compiled. We can have a debate and argument in this Chamber about what to do, but we must all share the data and description of the problem and understand its nature.

The report provides a challenging critique in many areas but goes to the heart of the problem in the Department of Health and Children which is, if I may describe it as such, in an existential crisis in regard to its role. This is not surprising. Every day of the week Members on both sides stand up in the Seanad and the Dáil to vent their frustration and highlight the difficulties people have with various aspects of the HSE. This points to a continuing problem in terms of democratic accountability in the provision of health services.

Some of the public relations concerned with the setting up of the HSE related to the fact that many meetings were held throughout the country to which people travelled and for which they claimed expenses, that it was all too local with too much so-called backyard stuff and so on, and that the service needed to be professionalised and put on a proper footing, as had been done in other countries. While I do not want to express a view on whether there were abuses in local health boards, we have thrown away an amazing amount of potential democratic accountability of our health services, given that the HSE has become such an enormous monster. I hear this being said daily by colleagues on both sides of the House.

Two years ago the then head of the HSE was invited in to answer questions from Deputies and Senators, an exercise which I do not believe has been repeated. I described this as a spectacle because elected public representatives were vying, with their hands up, to ask questions of the head of the HSE about particular concerns they had in their respective constituencies. That is no way to manage health, which is still the biggest voted expenditure in the public service. Reducing public representatives to people vying to get their "spake" in, as it were, at this public meeting told a big story, namely, that we have a genuine and serious problem in dealing with our health service and matching up the need for democratic input, involvement and argument with the provision of health services

It is hardly surprising, therefore, that the ORP discovered five years on that the people working in the Department of Health and Children had yet to come to grips with managing the HSE. I know Senator Ormonde said that things do not happen overnight, but there are many nights in five years. If they have not got to grips with it yet, when will they?

Even if we park the partisan aspect for a moment, there is a genuine problem we must address, and that is what is coming out in this report. It is quite damning of the Department of Health and Children and goes much further than the Minister of State is prepared to go in what it has to say about the allocation of staff being uneven, the issue of staff morale, the confusion among staff about the role of the Department, the lack of clarity around who the Department's customers are, coupled with the feeling of being constantly under fire politically and in the media, and so on. It does not surprise me that this issue exists with the Department of Health and Children.

That brings me to the second point I want to make and to which I have referred. The real story is what we are going to do with all these reports. I am not resiling from saying the reports are important, but what happens next? I would expect this debate to be about what happens next. That is why I am mildly critical of the speech because there was virtually nothing about what happens next other than in the last couple of sentences which referred to the look back process the Minister of State, Deputy Calleary, is to initiate. If we are going to have a serious debate, by all means distribute the report. We can read the report, look at the back and see the methodology. We can find out all these things, but then we want the Minister to say what the Government will do in these matters. Sadly, we have been told very little today about what will occur as a result of these reports.

Unfortunately, I am not sufficiently well-informed about the Department of Health and Children to know whether it has produced the action plan.