John Gilroy (Labour)

I welcome the Minister for Health to the Chamber. He probably has the most difficult job in Ireland, if not the world. He has started extremely well. His decisive early decision to disband the board of the HSE sent a signal that he and the Government were serious about health service reform. The previous Government spoke about reform but, in the main, failed to deliver it. The development of cancer services is a possible exception in this regard. As the Minister said, credit must be given where credit is due. One of the problems facing the HSE is that too many people seem to be almost intractable. I have a view on this. Crisis after crisis has emerged since the formation of the HSE. We can expect more crises to emerge as time goes on.

The HSE was established on the basis of a set of assumptions that were not consistent. When it was established, it was considered that the imposition of a centralised system of management and administration onto an unwieldy set of services, without paying much attention to how this new arrangement might work, was all that was needed. A fundamental reorganisation of the services should have taken place at the time, but it did not. I am afraid the legacy of this lack of bold decision-making remains with us. I am glad the Minister has set his face towards reform. It will be a difficult road. All of us should show political courage in this regard. Difficult decisions lie ahead, not only because of this country's financial position but because the health service needs to be reformed.

It is not good enough for politicians from all parties in this and the other House and outside the Oireachtas to start raising fears among the public for narrow party political ends. We have seen too much of this. There was an example of this earlier in the summer when some of the public comments of politicians were nothing short of disgraceful. I understand that all politicians strive to protect the services of their local hospitals and fight to ensure services are not taken away from them, but surely their arguments must be evidence-based. If evidence suggests that a particular hospital needs to have its services reduced, all honest politicians have a responsibility to support such a decision.

It would be easy for me to stand up here and criticise the HSE. The temptation to do so is not easy to resist. I will not criticise it. The time has arrived — it was long overdue — for us to deliver real improvements in these services. I am aware that longer term proposals for a universal health care model are in the offing. We need to achieve real results on the ground. We cannot wait for two or three years to see these real results.

There have been some very good improvements recently. Things seem to have improved significantly at Tallaght Hospital, which had been the subject of some fairly bad or poor public comment earlier in the year. In his response, perhaps the Minister will comment on how these improvements have been achieved. He mentioned the appointment of a special delivery unit, which is a very positive step. We look forward to early results in this area. I smiled when the Minister mentioned that the director of the unit was a philosopher. I think the Minister and the director will need to be fairly philosophical in their future dealings with the health service.

The staff of the HSE are doing tremendous work. I was a front line worker until I was elected to this House. I know what it is like to hear everyone criticising the HSE and its staff. It is very demoralising for people who often work in very difficult areas, to hear constant and mostly uninformed criticism of their endeavours.

I will focus on two issues. The moratorium on staff recruitment is having a considerable impact on front-line services. I am particularly concerned about mental health services because many people, especially nursing staff, are expected to retire from those services by next February. It is feared that the exciting plans outlined in A Vision for Change will be put on hold or will not be realised in their entirety. Given that mental health services have historically been underfunded and neglected, we should show purpose and intent by considering exempting the mental health services from the worst of the cutbacks coming down the road.

I have already mentioned the universal health care model. It is vital that we end the two-tier health care system that has been allowed to evolve here. It is inequitable and downright unfair. The two-tier system is not becoming for a country that proclaims itself to be a republic. We need to drive on from here. We need to face down the powerful interests that are at work in our health services and would prefer to maintain the status quo. We need to show political courage when we do this.

Some of my colleagues will put some questions to the Minister later in this debate. I congratulate him on his good start and wish him well. I offer him my support and that of Labour Party Senators in this House. He will continue to enjoy that support as long as results are being achieved. However, I should mention that the Minister is not entitled to that support in the absence of results.