John Crown (Independent)

As we are now more than a year into the term of the Government, I ask the Leader to consider scheduling in the near future a formal broadly based debate on the fundamentals of health policy reform. This should not be another of the very worthy but piecemeal debates we have had on individual pieces of legislation, which could be broadly construed as part of an overall agenda for reform, but I believe they are not. The fundamentals of reform of our health system were contained in the programme for Government synthesised by the two parties. It was based on two quite informed individual party strategies, which together formed a nice synthetic programme which if implemented would address the core problems in our health service, which are poor quality, inefficiency and inequity.

My good friend and colleague, Dr. Gerry Burke, a consultant in Limerick, has been quoted in the press commenting on what he regards as rampant managerialism which is impeding the development of the health service. I fear somewhat that some of the first tentative steps, which we are being told are part of the reform process, are in fact steps in the direction of further managerialism and not dealing with the fundamental problems. I will give one quick example which I would like the Leader to convey to the Minister for Health regarding the National Rehabilitation Hospital in Dún Laoghaire. Any Senators who have had the privilege of visiting it will know it is an extraordinary institution which works in very difficult circumstances with some of the most challenging problems of often young people facing incurable spinal injuries as a result of trauma, cancer or sports injuries. They go through very rigorous rehabilitation with variable outcomes and get the very best care they can in an institution that is grotesquely under-provided for in two key areas.

The number of consultants is approximately 60% to 70% what it would be by UK standards and less than 10% of what it would be in France. The number of beds is approximately one fifth of what is recommended by the professional body. As a result, for some of its specialist neuro-services there is a six-month waiting list to get started with rehabilitation. This means that someone whose spine has been fractured or head badly injured may be either sitting at home or in a hospital bed losing rehabilitation time because he or she cannot move on. This causes the downstream effect of failure to admit people for other procedures that have varying degrees of urgency. This is merely one example of a system that is deeply dysfunctional and we need to have this debate in the near future.

I wish to comment on Senator Noone's - if I understand her correctly - somewhat extraordinary suggestion that the right way to deal with the widespread use of the morning-after pill is to increase its price. It would be somewhat like trying to reduce abortion by increasing the waiting list to ten months.