Martin Conway (Fine Gael) | Oireachtas source

I welcome the Minister to the House. He is a frequent visitor at this stage and enters into debate and discussion with us in a very healthy, open and useful manner.

I commend the last speaker for his contribution. He was very positive, as always, and I look forward to helpful amendments. It will be interesting to see what they are. I particularly commend Senator Crown for his contribution. It is very telling that he stated that had he the opportunity to provide a vote of confidence in the Minister, he would have happily done so. I believe Senator Crown has credibility in this area as a distinguished consultant who has specialised in the treatment of cancer over the years in this country. He knows the health system and what the Minister has inherited and is trying to do and is somewhat in unison with the Minister's vision.

This legislation is important when it comes to implementing that vision and I welcome and support it. For too long, the HSE was too much at arm's length from the Minister. When difficult decisions were being made and correct and incorrect decisions were being made, the previous Minister regularly stated that the HSE was effectively not accountable to the Minister for Health. In any political democracy I know, the line Minister takes ultimate responsibility for his or her Department and does not kick to touch. No disrespect to anybody but that is what happened for the past number of years. There was an awful lot of kicking to touch. What I would describe as an extremely right-wing philosophy saw the whole disaster that was co-location. That philosophy is what would often be regarded as the Boston-type philosophy. One often heard the phrase "Boston or Berlin". Based on what Senator Crown said earlier, I would be much more comfortable in the Berlin model. Most elements of Irish society would support that concept and did so in the last general election when the two coalition parties had broadly similar philosophies on health. They involved universal health insurance and a fair and accessible health system for all - effectively a public health system where no matter who one is as a citizen, what one's resources were and whether one had or did not have resources, one would have access to the same high quality health care.

Unfortunately, implementing that policy is not easy, especially when one is taking over the monster which was and, to a large extent, still is the health service. The Minister must effectively dismantle a health system that is not working and incrementally reassemble a working health system which has at its core the principle of patient care and safety, what is correct for patients and, most importantly, accessible, quality and safe health care. Trying to achieve that will not be easy. The Minister will make enemies because there are vested interests. When one is trying to manage vested interests and do the right thing, one will upset people. This Minister is not interested in the perception of change, rather he is interested in change.

Unfortunately, for too long in politics we have had too much of people spinning and trying to create a perception that change is afoot when in real terms no change is afoot. When dealing with the health service, perception is very dangerous because people's lives are at risk. Every citizen should be entitled to good quality health care. Unfortunately, for too many citizens that is not happening. The Minister is making a genuine effort and he has a vision. The legislation will enable him to penetrate that vision throughout the system by introducing the necessary changes.

Staff costs will have to be examined. While we are still within the terms of the Croke Park agreement it will be reviewed. Given that 70% of the budget goes on staff costs, it is difficult to implement change. However, genuine efforts to reduce costs are being made with the remaining 30%. There is an old saying, "Rome was not built in a day", but in this scenario change will take time. There was a mention of two terms of office. I would be delighted if I could say to citizens in my area and elsewhere that in ten years time we will have a high quality health service. The majority of people are buying into that.

I attended a HSE briefing at 8 a.m. on Friday last with Anne Doherty, chief executive of the HSE in the mid-west region which is considering the joining up of Ennis hospital, the Mid-Western Regional Hospital, Dooradoyle in Limerick, St. John's Hospital, Limerick and Nenagh hospital. The concept is that they should be looked at as one campus although there are four sites. The idea of creating specialist areas in various hospitals is the correct approach where risk assessment and quality care is assured. Therefore, when a patient from County Clare is referred by a general practitioner, it may be more appropriate for him or her to go to Nenagh hospital because that is where the particular specialty is located, or it may be more appropriate for a person from Nenagh to go to Ennis hospital. This is a small country with limited resources which is part of a troika programme. We have a responsibility to do things efficiently and in the best interest of citizens.

I believe in primary care and in keeping people in their homes for as long as possible. I subscribe to the notion of primary care centres. While I am not a medical expert, I am a reasonable observer of such things. If injuries can be treated at local level, without referral to accident and emergency departments, that is a more desirable prospect. I would like to think there will be advances in primary care in the lifetime of the Government and, by the end of the next term of Government, a blossoming of primary health care throughout the country.

A value for money audit was carried out on the provision of services for people with disabilities, whether personal assistant hours or a conglomerate of services, because money was being thrown at services and we were not getting value. Certain recommendations within the value for money audit show that a better service can be provided at a cheaper rate to those in need. Difficult decisions will have to be made. In terms of the body that nominated me for the Seanad, People with Disabilities in Ireland, 92% of its funding was going on office space and administration. It was inappropriate that it should receive ¤1 million of Government money when ¤920,000 was being spent on office space and administration. I had to support the decision because it was the right decision.

I call on all representatives of the Houses, in opposition and in government, to work together to ensure the people have a quality health system. Politics will have to be put aside. Unfortunately, party politics is necessary but, when it comes to the health service, there should be a national approach for the betterment of the people.