John Gilroy (Labour) | Oireachtas source

I will speak to amendments Nos. 9 and 10 in a moment but first I will not allow some of Senator Crown's comments to go unchallenged. He suggested the Health Service Executive has most to lose from a reorganisation.

It seems to be some sort of tautology or, at minimum, a circular argument. In the 30 years I worked with the health services, I have never been accused of being a defender of the HSE and I am one of its greatest critics. Nevertheless, Senator Crown's diagnosis of the problem at managerial level in the HSE does not really capture the entire picture. There are many other interest groups involved which have a special interest in maintaining the status quoand are required to do so by their members in many ways.
The managerial position in the HSE outlined by Senator Crown - with managers making decisions - is the reality but there are some clinicians who also make decisions. For example, in the mental health services, the clinical director rules the roost within the catchment area in which those services are delivered. I have spoken in the Seanad many times about the postcode lottery. If a person experiences mental health difficulties, he or she is required to go to the consultant in the geographical area in which that person lives. If the consultant in question is a good clinician that is great, but the consultant must also be a good manager. If the consultant is one of the two, the patient is in trouble, and if the consultant is neither, the patient is in real trouble. The postcode lottery maintains poor service within the mental health sector as there is no way to judge outcomes from one catchment area to another; the patient or service user has no choice only to avail of the services in a particular area. This is an illustration of my point about Senator Crown's analysis of the managerial problems within the health services and how the entire picture is not captured.
A legislative proposal that would provide a GP not be required to adhere to evolving and best practice would be problematic and undesirable. It is premature to put the provisions of amendment No. 9 into legislation when we are unsure of an outcome, and we do not even know the final agreement under the June framework. It would be not only premature but reckless and careless to insert a legislative provision in advance of knowing what a contract will ultimately contain.