James Reilly (Dublin North, Fine Gael) | Oireachtas source

I appreciate the intervention.

Senator Byrne referred to the same staff being in place but I already have made clear the staff has changed considerably. Many have made the point that the board of the HSE was abolished last year. However, it was not abolished - its membership changed - but this governance Bill will abolish the board.

As for talking about two terms to implement the reform, I believe that for the first time both parties in government had the political courage to state before an election that it would take two terms to carry this out and that they could not promise what they could not deliver. However, the Government will deliver it within two terms. Someone also mentioned the Dutch system, how the costs have risen and how the entire system is unaffordable. I happened to be in contact with the Dutch permanent secretary fairly recently at an informal meeting in Cyprus and he explained how the costs of course have risen because they have begun to cover dental care. Senator Moloney spoke about the muzzling of health workers and I have covered that point. It is not something with which I agree. Senator Barrett referred to the increase in the number of non-doctors in the health system from 56,000 to 96,000.

We also need to include among those non-doctors nurses, health care assistants, physiotherapists, occupational therapists and others. This brings me to a key principle in which I believe, which is treating the patient at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. I do not want consultants seeing patients whom GPs should be seeing and I do not want GPs treating patients whom their practice nurses or physiotherapists should be treating. I do not want nurses looking after patients whom the health care assistants should be looking after. Why is it that one of our major hospitals has nine nurses to one health care assistant and another hospital other similar size has three nurses per health care assistant? Through the HSE and SDU we will transpose uniformity across the system and where we find excellence of care or really efficient methodologies being used that are safe, we spread them across the system.

I often quote the example of the physiotherapists who, when screening orthopaedic referrals, found that 50% of the patients did not need to see the surgeon at all. Some of it might be because they could treat them and some of it could be because it was the only way the GP could get the patient the physiotherapy service. The same thing is happening in psychiatry with counselling services. There is considerable dysfunctionality in how our systems are organised.

A colleague of mine recently turned up at an outpatients department along with 35 other patients at 9 a.m. I find that a disgrace. That is a system that is self-serving and shows disdain for citizens and patients. There is no reason for that - it must stop and it will stop. I have asked Mr. Tony O'Brien to ensure it stops and people are given appointments. I accept we need to allow for those patients who do not arrive. Large numbers of people are not arriving and that could be a factor. If they have had to wait for a year they may have got sorted out somewhere else. There are simple things we can do and will do such as sending text messages 48 hours beforehand and asking them to reply indicating whether they are coming. We will also send a text message again on the morning of the appointment reminding them to come. Equally if those people do not reply by text, the next time they seek the appointment it will cost ¤10 or ¤20.

I wish to refer to the money being spent. Many of the things I said when in opposition have been quoted, but here is something else I said frequently when in opposition. I said we should not put another bob into the black hole that is the HSE until I find were the leak is and we are getting there. Like most things I have found out that it is like a bloody colander - pardon the language.