Sean Barrett (Independent) | Oireachtas source

I welcome the Minister to the House and wish him well in his mammoth task. It is probably the most difficult task in Irish public life to reform the health service. I note from the first page of the Minister's speech that we are on a journey to the dissolution of the HSE. Our briefing document from the Oireachtas includes the steps mentioned by Senator Crown towards more freedom for hospitals in the model to which the Minister is moving.

I was associated with one of the moves the Minister is reversing - the creation of the HSE - as I served on the Brennan commission.

I agree with what the Minister is doing today. We all learn as we go along. Health was local, then regional and then national, and now it is being devolved back to individual hospitals. I think that is the correct way to proceed. I am not trying to justify anything ex post factobut what influenced us was the fact that the old regional health boards were never able to strike budgets and annoyed a sufficient number of people to the point that their abolition was commended. Thereby hangs another tale, because there were no savings. The headquarters in places such as Kells simply transferred to something else. That is a problem. People arrive from the south and west in Dublin and see a former hospital changed into offices for health bureaucrats. When I used to go to matches in Tullamore, the relatively large building on the way into town was the headquarters of the Midlands Health Board and the relatively small building beside it was the hospital. I think that is being addressed, and the hospital has had an extension. We have a huge problem in that there are still around 8,500 medical and dental staff but nearly 16,000 management staff. My sector in education experienced the same kind of problem. A US economist called it Baumol's disease. It should not exist and does not need to exist. When I am sick, I want to see Senator Crown or, indeed, the Minister. I do not want the other 16,000 administrators doing calculations and converting hospitals into office blocks. We have the same problem in education. The basic transaction is quite low-cost. It involves a podium and lecturer and, hopefully, something happens within 50 minutes with more than 400 people listening. If one can do it that way, it is an extremely worthwhile proposition.
I hope that the dissolution of the HSE, of which this Bill is a part, will tackle the fact that we gained no administrative efficiencies from the abolition of regional health boards. I appreciate that the Minister has inherited an extremely difficult situation and that he has managed to run the health service, according to the December 2013 figures we received, with 99,959 staff, compared to as many as 111,770 in previous years. From the mid-1980s to the peak of the boom, the Minister's predecessors doubled the number of staff in the health service, from 55,000 to about 111,000. That seemed to take place without any regard to what the outcomes were and whether patients would be better off. We lost the focus. This Minister has had to try to correct that. The Bill is a step along that road.
We have problems such as the bureaucracy I mentioned and the length of stays in hospitals. A report found that a treatment that would have taken about three and a half days in other countries took more than 11 days here. Another problem is the lack of competition. I hope that under the new system, the hospitals will compete. I do not want layers of bureaucracy. I want it to be the case that hospital X performs a particular operation because it persuaded a competitive insurance industry it could do it better than anybody else and it does not carry out excessive numbers of tests or keep people in hospital too long.
In developing the GP service, there is evidence that excessive hospitalisation exists because of the de-skilling of GPs, particularly where their practices are near major hospitals. This needs to be tackled. It is an immense task. I commend the Minister on taking on a gargantuan task that has probably been made far more difficult by some of the mistakes made in the past. It needs to be reduced to the simple transaction between doctor and patient. The bureaucracy and many of the irrelevancies must be removed. If we can do that by taking the Minister's route, including the dissolution of the HSE, I support him in that regard. It is long overdue. The burden has fallen on this Minister's shoulders, and I wish him well in the task.