John Crown (Independent)

That is just flat out wrong. With great respect to HIQA, talk about establishing a huge operation with a multimillion budget and 200 inspectors to state the blindingly obvious, namely, that there are no good hospitals in the country. I accept that there are a number of adequate hospitals. I have a quick chuckle on each occasion I hear people referring to centres of excellence. As someone who has served in the faculties of several such centres, I can inform the Minister that there is no facility in the country which is a centre of excellence. In the context of the plans being evolved, as we move deeper into the recession we will be lucky if we have centres of mediocrity or centres of competence.

There is a suggestion junior doctors are being somehow unpatriotic in leaving the country and training abroad. There are rather few medical oncologists in the country and those we do have are stunning. The other evening I met several individuals involved in research. We are privileged that a number of excellent people have left the best centres in North America, the United Kingdom and other parts of Europe to return to these shores to take up positions. These individuals are unparalleled anywhere else in the world. Of the 31 medical oncologists in the country, some 21 trained in the top five American centres - the Memorial Sloan-Kettering Cancer Centre, the MD Anderson Cancer Centre, the National Cancer Institute, the Dana-Farber Cancer Institute and Johns Hopkins Hospital. They are the top five cancer centres in the world and two thirds of our specialists trained there. The authorities in America and the United Kingdom cannot say this. They are lucky if their oncologists trained in small oncology programmes in local regional hospitals.

The Irish health care system has had one great strength during the years, namely, an extraordinarily well trained cohort of doctors and nurses. In the case of doctors, this was because they were, until recently, unofficially encouraged to travel abroad to the best centres to obtain the best training possible. They were then expected to return and compete for a tiny number of jobs. This tended to focus their minds and encourage them to work a little harder. What is happening now is a covert attempt to subvert international training by forcing our junior doctors to remain at home to plug gaps in a system which should not be relying on their services in the first instance.

I am extremely troubled by the discussions that have taken place in recent days on the closure of services in local hospitals. I am really conflicted in this regard because we have too many small hospitals. It would be better if some of these facilities were either closed or amalgamated. The degree of proposed closures is excessive. I can only speak with authority about cancer services, but I must indicate that what has been done has been handled extremely badly. The notion that we would have four cancer treatment services - not one of which could provide comprehensive care for cancer patients in the capital city - and none north of the line from Dublin to Galway spoke to something other than best international practice being the principal determinant of the way the system was configured. What is happening in this instance amounts to nothing other than a large dollop of big hospital and big medical school politics.

As someone who is a sort of political outsider and a sort of political insider, it is difficult to comprehend the way this issue has been dealt with. What has been done is so reflexive in nature. Those in opposition will always speak in favour of the maintenance of every unit, while those in government will, in general, articulate the case for closure. What always strikes me as being odd is how quickly these positions can change in the aftermath of a change in government. I am not sure how I am going to vote on this Bill. However, I am sure it is going to pass and that we will have junior doctors next Monday. A Government with a majority of the size enjoyed by the Administration will always be in position to pass legislation such as this. I am going to give consideration in the next short while to the question of whether I should register a symbolic protest vote. Somebody needs to say there should be no more Band-Aids, that we should fix the system and that we should not put off matters until they can be fixed by a mythical future Government following the next general election. In the context of all of the special delivery units, all of the tinkering with people's contracts, all of the adjustments to ER services here and there and all of the decisions to the effect that - because we want such high standards - we will ban temporary registration one day and reintroduce the next, let us hope someone will actually state we cannot fix any of these problems until we address those of a more fundamental nature.