Alex White (Dublin South, Labour) | Oireachtas source

I thank Senators for their further remarks and contributions. It is entirely a matter for Senator Crown to press the amendment but I am sorry he proposes to do so. I hope he and others have heard what I have stated in respect of what has been termed a "gagging" clause. This is in addition to what I have stated outside the House and the Minister for Health's comments about our intentions and bona fides with regard to the matter. So be it.

There was an interesting discussion about conflict of interest, which was raised by Senator Crown and picked up by Senator Gilroy. Perhaps it is an issue for another day but I must question what people believe the "interest" is of the HSE other than the public interest. Perhaps it is an academic debate. It has been determined that the HSE is to be abolished, although we will still need people to manage our health services. People in the health services come and go; some retire and others come along to do the work. I am not fully sure what is the "vested interest", which was the phrase used. Perhaps that is just a difference between us.

Everybody would recognise that historically there is tension between practitioners and managers. I would not describe Senator Crown or any of his colleagues as mere technicians but nor would I put down people who do important work in the service as mere bureaucrats. It is a little facile for us to engage in that kind of phraseology or debate as it does not get us anywhere. We need both our administrators and professionals, and the challenge is to have the correct balance between them and ensure that professional autonomy, for example, and leadership is facilitated. I was very interested in what Senator Crown said about professional leadership. I am not as fully informed about the gap he sees in professional leadership and whether the system needs to address it in a better fashion. I might discuss it with him on another occasion, as there was much sense in his comments.

There is no question of being prescriptive with, for example, a HSE manager being prescriptive as to what test a doctor should appropriately implement for a patient or illness. That would be absurd and why would anybody think it would be remotely appropriate? Why would one think it is intended that the HSE should say that a particular test should be used or a doctor should engage in a particular fashion in respect of the care and management of a patient? That could not arise.

There is another issue pertaining to the debate of who makes decisions about health services. We were criticised by some practitioners for going ahead with legislation without having agreement from the medical profession. I must respectfully repeat the point that the question of policy and the distribution of resources allied to that policy is a matter for the Oireachtas and not a matter for the profession or any other group. I do not for a moment say the profession should not have an input, and it would have an elevated input because of its expertise, which I accept. The policy making must remain a matter for the Oireachtas as the distribution of a resource - whether in health care, education, justice or social protection - is a matter for a policy makers. It should remain as such, and I therefore do not accept that the drafting of legislation should be made contingent on the agreement of any vested interest or profession.

I say that in all generosity to them. The input, however, has to be respected and taken on board.

With respect to Senator Healy Eames, to some extent she is putting the cart before the horse. I am not going to speculate as to how many doctors will sign up to this contract. It is a voluntary question for anyone in any contractual position. No party can force the other party to engage in or sign a contract. The GSM system is founded on a contract between the system and the individual general practitioner.