David Cullinane (Sinn Fein)

I welcome the Minister of State to the House and agree with the Senators who expressed their disappointment that the Minister for Health is not present.

Along with previous Senators I, too, have struggled with the decision on whether to support this Bill but I will do so because in recent weeks many of us have called on the Order of Business for the Minister for Health to come into this Chamber to deal with the real problem of junior and non-consultant hospital doctors in our health services, the impact of the crisis that could develop in many regional health facilities and hospitals across this State and the potential closure of hospital wards and even more accident and emergency wards.

I join Senator Crown in describing this as a sticking-plaster solution - pardon the pun - given the Labour Party's involvement in government. It is high time that we moved away from such stopgap measures. What is proposed is precisely a stopgap measure. There is a very real problem with the system of medical staffing, training and the deployment of hospital services staff. It is absolutely appalling that a state that is still regarded as comparably very wealthy, in spite of its having gone through an economic crisis, has a crisis in its hospitals and must trawl through countries such as India and Pakistan which have their own problems and Third World countries to recruit junior doctors and non-consultant hospital doctors.

The Minister of State referred to the recruitment embargo. This is a blunt instrument and it is not working in our hospitals. I spoke recently to the clinical director of Waterford Regional Hospital about its issues associated with junior doctors, nurses and staffing provision generally. One of the problems in the hospital, which I am sure is repeated in others, is that because of the recruitment embargo, it is employing agency workers at premium rates to provide the required level of service. This is having an impact on the budgets of hospitals, putting them out of kilter. This is why the Minister has had to rein in some of the hospitals recently over their spending. It is despicable that we have these problems in the health service and that the issue of hospital consultants is not being dealt with properly. I refer also to the fact that we have a two-tier system and that many consultants can still run private practices in public hospitals using public money to do so. Many, through their contracts, are being paid exorbitant salaries and at the same time practising privately in the hospitals. Both Fine Gael and the Labour Party campaigned against this for many years and criticised the previous Government for not dealing comprehensively with the issue of consultants.

Many consultants are reluctant to change based on vested interests. If the Government were to take on the consultants, its doing so would potentially involve more costs or reducing the pay of consultants. The previous Government never grasped the nettle of reducing their pay. There are many examples in this regard. Deputy Ó Caoláin raised this issue in the Dáil yesterday with the Minister for Health. He implied that many consultants who had had their contracts renegotiated were still not fulfilling the terms of their contracts and doing the amount of public service work they should be doing.

I stated on the Order of Business recently that it was appalling and sickening to have to listen to representatives of Fianna Fáil in this House on this subject. Senator Leyden mentioned Roscommon County Hospital and stated accident and emergency services had been reduced there. I did not hear the same level of criticism from him and members of his party when accident and emergency services were axed in Dundalk, Monaghan and Ennis. Fianna Fáil is responsible for many of the problems in the health service. While I accept that the new Government must take on the problems in the service because of the failure of the previous Government, we need the revolutionary thinking evident in some of the points made by Senator Crown whose contribution was excellent.

One problem in the health service concerns accountability and the fact that we do not listen to experts. We do not even have a role for elected representatives. The talking shops set up to replace the old health partnerships are clearly not working. I would like to see proper community health partnerships with representatives of advocate groups, patient groups, elected representatives and experts who could provide information in the proper manner and exercise an oversight function with regard to what is occurring in the health service. It is appalling in the 21st century that the configuration of staffing in hospitals has led to a crisis such that we must again recruit doctors from other countries. We have still not dealt with the issue of consultants and are over-reliant on non-consultant hospital doctors in acute services. If we are to address properly the very serious problems in acute hospital services and the pressures the staff in these hospitals face, we need to invest in primary health care, a matter to which Senator Barrett referred. There is a real need to examine seriously primary health care provision. Senator Barrett referred to 24-hour supermarkets, a concept which has been raised on numerous occasions. One can go to a shop at 3 a.m., yet one cannot go to a general practitioner at that time. Twenty-four services are not available in all areas, except in emergencies. There is a lot the Government could do in this regard.

The Bill is necessary to prevent the collapse of some services in hospitals. For that reason alone, I will reluctantly support it. In supporting it, however, my party and I have very real concerns about the reconfiguration of hospital staffing, the recruitment embargo which is not working, consultants and the funding of public services generally.