Marc MacSharry (Fianna Fail) | Oireachtas source

I welcome the Minister to the House. The Fianna Fáil Party will support this legislation but remains unconvinced about what it can contribute to the improvement of services and, in this context, I wish to make a few points. When I sat on the Government side of the House, I was highly critical of the establishment of the HSE in 2004. Moreover, even while on the Government side, Senator Cummins and others can confirm I thought it was wrong that such a large proportion of the State's budget and of taxpayers' money effectively would be under the control of a third-party organisation. In that context, I support the Minister's actions in bringing the budget back in, as is appropriate as it never should have left.

The origins of the HSE go back through quite a few Administrations. The initial idea may be traced as far back as the then Minister for Health, Barry Desmond. I agree that subcontracting the running of the health service to a third party organisation constitutes an abdication of the State's responsibilities in the interest of what was wrongly dressed up as this thought of political interference.

It is vital for public representatives to have the power to do work on behalf of the people. If they abuse that, there needs to be appropriate enforcement to deal with that. However, our automatic reaction should not be too subcontract the power and ensure we operate at arm's length. I would be critical of the Minister in some of his actions in that regard.

I look forward to more detail being provided on the legislation. I think of Titanicand ask myself if it were called Olympicwould it have stayed afloat? If the captain were known as the skipper, if the engineer were known as the navigator or if the master at arms were simply known as the head of security, would the ship have stayed afloat? I doubt it would have. That is why I am concerned this legislation is just the relabeling of the existing structure, albeit with the potential to be under more control by the Minister, as should be the case. Will the same individuals go from being the head of a particular directorate as it is now, to having a different title? What are the service areas that each directorate will deal with specifically? What budget will be available for this transition? In an agency as large as the HSE as we know it, I hate to think of the cost of relabelling the doors where people's names are, just to name a very small and insignificant part of it.

I know it is envisaged that this legislation will have no impact on budgets, but I disagree. What budget has been earmarked for these changes? Will there be any job losses as a result of these changes? To what service areas will the new directorates apply? It seems we are cutting down to six or seven from 12. Will there be salary increases for the new heads of these directorates? Who is earmarked for them? Will there be a public procurement process to put these people in place? Will it simply be that the person who used to be called the skipper will now be called the captain resulting in the Minister now having full responsibility and being able to tell the individual to review particular area because the service plan does not include X or Y?

Is this legislation that was thrown together based on a promise made 17 months ago about how we would transform the health service? There is no plan or blueprint for how we will implement this and how it will change. All politics is local. The HSE, the Department of Health and the Government - past and present - would point to the national cancer control programme and the approach to cardiac care and cardiac categorisation as being highly successful. I ask myself what this new structure will do to undo the discrimination in an entire region, the north west. Statistically it can be pointed out that the people are looked after with 80% of them getting stents inserted within the two-hour best international practice period, and we have our specialist cancer centres of excellence. The approach seems to be that the 20% of the people living in the north west can either move closer or die as I have often said, including to previous Ministers.

In opposition the Minister was the foremost Member in the House at highlighting these discrepancies and inequalities in our health systems. When I was on the other side of the House some of my colleagues would not speak to me because I was so vociferous at saying similar things. Now that he is in government and in command why are those things not forthcoming? The people on the street do not care whether it is called Olympicor Titanic. They just want to know how the Minister will keep it afloat because the reality is that it is sinking and all we are seeing is a haphazard approach to management. I do not doubt the Minister's capabilities medically or in business. The previous Government was rightly criticised for poor communications but, by God, the communications of the Government and the Department of Health in recent months have been shambolic in the extreme. If I were captain of a football club and the vice-captain could not express confidence in me, that person would be gone. If a fellow manager in a club used language along the lines of stroke politics in describing something I did in carrying out my duties, that person would have to go or I would be gone. That is what the people are seeing.

What do people in the north west see? They see cuts to home help and discrimination in what are supposedly the successful clinical programmes, but that is down to where in the country one lives. Some months ago this House saw the breaking of the story about Creagh House. We were assured by a Minister that there would be no cut to the services and yet today, having been warned by me and many others, the unions have announced there is a problem and the Government needs to intervene. What is the legislation doing for them? The reality is that it is doing nothing for them.

We constantly hear the rhetoric that the cupboard was bare when the Government came into office and there was no money to implement the plans it wanted to implement. The Minister when in opposition met representatives of the troika as I did. When I participate in the Fianna Fáil delegation meeting the troika, I get to question it on what we can and cannot do. The Minister and his party colleagues, including the Minister for Finance, Deputy Noonan, did so when in opposition. However, they prepared a manifesto to buy the people by lying to them about what would be done in the north west, including the provision of centres of excellence and the retention of the accident and emergency unit in Roscommon. That is just my part of the country. Every parish has a story to tell and it was disgraceful and deeply cynical.

We are now passing legislation to change the name of the fleet. While we support it, I see nothing to give the people the confidence to which they are entitled in the management of our health service. However, the reality is that free GP care is nowhere to be seen. We have cost overruns of ¤500 million. Mr. Cathal Magee has resigned as head of the HSE having back in February told the Minister - based on freedom of information requests - that this would happen. The Minister's Cabinet colleagues are running for cover in the context of expressing confidence at one level and then half-heartedly doing so in the House. There is a Minister of State who openly flaunts her feelings and undermines his authority.

Where are sections 10 and 12 of the Bill in terms of the Minister's input into selecting primary care centres? I have no doubt that Swords and Balbriggan are as entitled to have those primary care centres as are Sligo town, Ballymote or other places in my area. However, we must have rules. Those on the outside looking in see poor management and a lack of management. Everybody knows the Minister needs to find savings and cuts will be required. However, all they see are a lack of communication and haphazard management - the headless chicken approach as I called it last week. If any good news is to be announced, the Minister and his senior colleagues are wheeled out to announce it while, if there is any semblance of bad news, Mr. Tony O'Brien is wheeled out to say the Minister had nothing to do with it. However, 18 months ago he claimed to be fully in control. Who is in control? Whether it is Titanicor Olympic, who is in charge and calling the shots? Is it the Minister on this, Mr. Tony O'Brien on that and the Minister of State, Deputy Shortall, on the other? In these difficult times people need to be able to say, "You know what? Reilly is a good one. He's a medical professional with business experience and in these difficult times he's in command." They are entitled not to see the vice-captain question him or a senior Minister saying that he is involved in stroke politics. While I know we will be in opposition for some time, in the interest of the country the Minister has my full support in giving himself a good shake, bucking up and giving the people the confidence they require in their health service. This legislation does not do much to give me that confidence at this point.