Other Questions.

I remind the House that supplementary questions and answers relating to ordinary questions are subject to a maximum duration of one minute.

Will the Minister be taking Question No. 98 with Question No. 94?

I am not responsible for making such decisions.

We are taking Question No. 94.

Water Fluoridation.

Phil Hogan

Question:

94 Mr. Hogan asked the Minister for Health and Children if the expert body recommended by the forum on fluoridation to advise the Minister has been set up; and, if so, the advice he has received to date. [6886/04]

The use of fluoride technology is known to manifest a positive oral health outcome. Local and national surveys and studies conducted since the introduction of fluoridation in this country attest to the reduced dental decay levels of children and teenagers in fluoridated areas compared to those residing in non-fluoridated areas. The safety and effectiveness of water fluoridation has been endorsed by a number of international and reputable bodies such as the World Health Organisation, the Centre for Disease Control and Prevention, the United States Public Health Service and the United States Surgeon General.

I established the forum on fluoridation to review the fluoridation of public piped water supplies in Ireland. The main conclusion in the forum's report was that the fluoridation of public piped water supplies should continue as a public health measure. The forum also concluded that: water fluoridation has been very effective in improving the oral health of the Irish population, especially of children, but also of adults and the elderly; the best available and most reliable scientific evidence indicates that at the maximum permitted level of fluoride in drinking water at one part per million, human health is not adversely affected; and dental fluorosis, a form of discoloration of the tooth enamel, is a well recognised condition and an indicator of overall fluoride absorption, whether from natural sources or fluoridated water, or from the inappropriate use of fluoride toothpaste at a young age. There is evidence that the prevalence of dental fluorosis is increasing in Ireland.

The forum consisted of people with expert knowledge spanning the areas of public health, biochemistry, dental health, bone health, food safety and so forth. It took an evidence-based approach to its examination of water fluoridation. In its report, the forum made 33 recommendations, including the establishment of an expert body. The latter is now well under way.

The terms of reference of the expert body are: to oversee the recommendations of the forum on fluoridation; to advise the Minister and evaluate ongoing research, including new emerging issues, on all aspects of fluoride, its delivery methods and as an established health technology; and to report to the Minister on matters of concern. The expert body will have broad representation, including from the areas of dentistry, public health medicine, toxicology, engineering, management, environment and the public, as identified within the report of the forum on fluoridation. Letters of invitation have been issued to prospective members of the body. I am pleased to say that, based on the acceptances which have been received, the body will have a strong consumer input in terms of members of the public and representatives of consumer interests, in addition to the necessary scientific, managerial and public health inputs. My Department is in discussions regarding the chairmanship of the expert body and I expect to be able to announce a decision on that matter in the near future.

Additional information not given on the floor of the House.

I am pleased to announce that the secretariat of the body will be provided by the Irish Dental Health Foundation, an independent charitable trust which has been very much to the fore in securing co-operation between private and public dentistry and the oral health care industry in relation to joint oral heath promotion initiatives. The foundation's stature and expertise place it in an excellent position to support the work of the forum in its initial stage.

As the House is aware, the forum's report envisages that the work of the expert body may be subsumed into the health information quality authority in due course. The support of the foundation allows us to press ahead now with the establishment of the expert body in advance of the establishment of the HIQA. I understand that the intention is to have an inaugural meeting of the expert body in early April.

Do I take it that 18 months after he received the report of the forum, he has not implemented any of its recommendations and that, despite the fact that he said that it is well under way, the expert body has not yet been set up? One of the most significant recommendations was to the effect that the optimal level of fluoride should be lower than that which had been added to water in the past. I do not know whether the Minister or the Minister for the Environment, Heritage and Local Government is responsible, but the Fluoridation of Water Supplies Regulation 1965 requires that a regulation be introduced to change the amount of fluoride to be added to water.

The forum clearly believed that too much fluoride was being added, particularly in light of the fact that people were obtaining fluoride from so many other sources. Does the Minister not consider that the recommendation to which I refer is absolutely critical and that it should be implemented immediately? Does he not consider that the level of fluoride is damaging to people and that he has left himself open to challenge if anyone is so damaged? Apart from anything else, adding fluoride to the water supply is costing the health service a great deal of money. In consultation with some of the health boards, I have calculated that it cost up to €750,000 over and above what it should cost to fluoridate water for a period of 18 months. Fluoride is extremely expensive and the health boards pay for that which is ordered by local authorities. Fluoridating water in the range of 0.6 to 0.8 to one part per million is costing almost €750,000. The health service could do with that money.

Is there any possibility that the Minister will move quickly to ensure that the regulations to which I refer are signed and that the level of fluoride in our water will be reduced? I know that he has no concerns but I have seen the impact of overdosing on fluoride and it is not a pretty sight.

We have already acted upon a number of the recommendations. A research project on fluoride delivery systems has been undertaken. The contract for this project was awarded by the health boards and the Department to the ERHA under the various lots of the dental epidemiology contracts. Its aim is to evaluate the quality and performance of the fluoridation of public water supplies and to develop best practice methodologies appropriate to all aspects of water fluoridation.

There has been some delay in establishing the expert group. However, in the context of the Deputy's final point regarding the reduction from 0.8 to one part per million to 0.6 to one part per million, with a target level of 0.7 to one part per million, the recommendation in question came among a number concerning the use of fluoride technology in the country. Redefining the optimal level of fluoride in drinking water was one of the recommendations as part of a long-term strategy to reduce levels of mild dental fluorosis. That existing levels of fluoride are damaging to health was not the basis of the report.

Of course the forum did not say that. How could it do so? Nevertheless, there was a recommendation and the Minister has ignored it.

It will be implemented. However, we must consider the logistics involved. It is important not to make statements about something which the forum did not do.

When? A year and a half has passed.

The forum was clear that it was not damaging to health.

It was clear that the forum recommended a reduction in the amount of fluoride in our water and the Minister has not taken action in this regard.

The Minister's reply does not inspire confidence. What inspires less confidence is that under the original fluoridation Act, health studies were to be carried out on the population. However, no such studies have ever been carried out. Would it not make sense for the Department to carry out some sort of monitoring on the public to see what is the level of fluoride in their bones and their blood? I know for a fact that he would discover that people in this country exceed the safe level of fluoride ingestion. It makes no sense to continue with fluoridation.

I also draw the Minister's attention to a recommendation on page 134 of the forum on fluoridation's report which states: "An increase in the rate of breast-feeding in this country would contribute significantly to a reduction of the occurrence of dental fluorosis."

Deputies may not quote during Question Time.

We know from the Joint Committee on Health and Children that the Food Safety Authority's original recommendation not to use fluoridated water for baby formula was overturned in mysterious circumstances. Does the Minister agree that on the basis of that development alone, the forum appears to have been a complete whitewash?

No, I do not agree with the Deputy whose consistent position has been to oppose fluoridation, irrespective of the views of the forum. It was regrettable that people who took an anti-fluoridation stance did not accept my invitation to join the forum.

That is not true. Dr. Paul Connett was a member.

He made a submission. I am referring to the membership of the forum. I invited people who had an anti-fluoridation stance to become members of the forum and they refused.

They knew it would be a whitewash.

In a democracy, people have different views on issues and decisions are taken on the basis of evidence-based research. I appointed people from different disciplines as members of the forum. They did not have pre-determined views and they were not yes men.

They were yes men. The forum did not include an expert on toxicology.

With respect, the Deputy opted out which was a deliberate weakness.

I am not opting out.

The Deputy wants to reserve the right to criticise.

The Minister should watch this space.

The local elections again.

What does this have to do with elections?

It has nothing to do with elections. The Deputy must have heard me muttering under my breath.

Services for People with Disabilities.

David Stanton

Question:

95 Mr. Stanton asked the Minister for Health and Children the progress that has been made in developing national standards for disability services; and if he will make a statement on the matter. [7003/04]

My Department, in partnership with the National Disability Authority, is developing national standards for disability services in consultation with people with disabilities, their families, carers, service providers and other stakeholders. These standards are being designed to ensure that services are provided to an agreed level of quality and that this level is consistent on a national basis. It is proposed that the standards will initially apply to day, residential, respite, training and home support services for people with disabilities, as funded by my Department.

The project began with a call for submissions on people's views on standards and quality in services. More than 500 submissions were received. These were analysed and reviewed and assisted in the development of the first draft standards. The draft standards focus primarily on attainment by service providers of generic quality standards such as governance, human resources and management information.

My Department and the NDA agreed to a pilot project to test and evaluate the application of the assessment process of the draft standards, including the use of an audit tool. The principal aim of the pilot project was to evaluate the draft standards. This evaluation process included an internal and external assessment of the services. The pilot project was undertaken in 20 participating organisations in the final quarter of 2003 and was followed by an independent evaluation of that exercise. The pilot was useful in that it raised a number of important issues which need to be further addressed. To that end, work is progressing with a view to finalising national standards for health services for people with disabilities.

When does the Minister expect the project to be completed given the promise in the national health strategy of 2001 that it would be completed in 2003? When does he propose to extend the remit of the social services inspectorate to include residential care for people with disabilities? When funding is allocated to service providers for the provision of services to people with disabilities, what checks are in place to ensure that the service being paid for is actually provided and the State receives value for money? Does the Minister and the Government intend to fully support the National Disability Authority in its efforts to establish reasonable standards for services for people with disabilities?

What is the Minister's view of reports that the draft report, the independent evaluation to which he referred, showed that 75% of services provided to people with disabilities failed to reach the standards set by his Department and the National Disability Authority? Does he have in mind a new date by which the report will be placed on a statutory footing? When will the national standards and protocols for quality, care, patient safety and risk management be drawn up?

The Deputy has asked many questions. In terms of a timeframe, the Department works with the National Disability Authority in drawing up the standards. Various reports have emerged during the process, particularly with regard to the pilot programme. The Department is not entirely happy with the recent outcome of the sector report which indicated certain inadequacies, including in key areas. It has also been in contact with some of the service providers to obtain their analyses of the evaluation.

Once the formal evaluation has been received from the consultant, it will provide useful data and the Department will work with the National Disability Authority in progressing the next phase of developing national standards, an outcome to which we are committed. It is important, however, that we get these standards right because they will ultimately constitute the template against which disability services will be benchmarked.

Contrary to the impression which recent reports may have given, the pilot project was not designed to evaluate the quality of services provided by any particular service provider, but rather to evaluate the draft standards and the monitoring tool which would help to inform the ongoing process of developing national standards. I have been asked to stress that references to services not meeting Department standards are not accurate. The 20 services involved volunteered to take part in the project and for this reason one cannot conclude that a true representation of overall services can be gleaned from the analysis of the services selected.

With regard to the expansion of the remit of the social services inspectorate, it will take some time before it is extended to cover care of the elderly and disability services. Forthcoming disability legislation may have a role to play in this regard.

When funding is allocated to a service provider, what checks are in place to ensure that the service being paid for is delivered? These funds are transferred from the Department to the health boards to the service provider. For several months, I have been trying to find out what happened to the €50 million the Minister distributed last July but have still not received a response. What checks are in place to track the money and how and where it is spent? Does the Minister agree that we are ripping people off if services for people with disabilities, for which provision is being made, are not being provided?

This is an important point. Since 1997, approximately €643 million in additional funding has been allocated for health-funded support services for people with disabilities. Of this sum, €388 million was allocated for people with intellectual disabilities and some €230 million for people with physical and sensory disabilities. The Department checks with the health boards to ensure that these allocations are used for ring-fenced projects. However, accountability legislation has consistently caused certain difficulties to arise. For example, when a chief executive officer of a health board wants to break even at the end of a year in order to comply with this legislation, does the acute service remove additionality from primary care, continuing care and care for elderly and disabled people? We have been anxious to avoid such circumstances developing?

We also work with the service providers, particularly in the non-statutory sector, with whom we meet to ensure that funding is channelled into their services. Some of the difficulties which have arisen in recent years have been in the area of pay awards, with some of the non-statutory service providers arguing that they are not often compensated for complying with the terms of benchmarking, Sustaining Progress and various agreements concluded from time to time. In terms of the Health Services Executive and primary continuing care —the non-acute side —the new reform programme is designed to ring-fence budgets for the future to ensure budgets for disability will not be eroded or redirected to other sectors.

Health Board Services.

Róisín Shortall

Question:

96 Ms Shortall asked the Minister for Health and Children the steps being taken to ensure that the Ballymun health centre will be brought into operation and made available to the people of the area, in view of the fact that it has remained unused, although completed, for a year at an estimated cost of €3.5 million; if he has received an application for funding to allow the centre to be fitted out; if he intends to make this money available; and if he will make a statement on the matter. [7060/04]

The identification, prioritisation and provision of health centres to meet the health and personal social service needs of local communities are matters for the health boards or the Eastern Regional Health Authority, ERHA. Prior to proceeding with the development of such facilities, however, a number of requirements must be satisfied. Of fundamental importance in informing a decision to allow a health board or the ERHA to proceed with a particular development is the availability of sufficient funding to meet the full cost involved. Additionally, all health boards and agencies are required to follow the Department's guidance documentation for capital projects, together with national and EU capital procurement procedures. It is a requirement, in the first instance, for the health agency involved to submit to the Department project details for agreement such as assessment of need, option appraisal, design brief, cost estimates and cashflow projections.

The former Eastern Health Board and its successors, the ERHA and the Northern Area Health Board, NAHB, in conjunction with Ballymun Regeneration Limited, a wholly-owned subsidiary of Dublin City Council established for the purpose of advancing the regeneration of the area, proceeded with the development of the project in hand, involving a new health centre and community care headquarters as part of the new civic office development which was to be the centrepiece of the redevelopment of Ballymun town centre. The project was not pursued with either the involvement or approval of my Department.

The latest estimates provided by the ERHA indicate a funding requirement in excess of €60 million for the provision of the facilities. The authority said the Northern Area Health Board intends to acquire its share of the building on a lease-purchase basis over a 14-year period. The indicative annual cost of this proposal over the 14-year period is approximately €4.02 million. The authority has further indicated that the proposed financing arrangement will mean that the Northern Area Health Board or its successors will own the relevant portion of the building after this period.

Additionally, the fit-out of the NAHB's portion of the building has been estimated at €6.35 million and the provision of furniture and fittings is estimated at an additional €2.8 million. Further clarifications to allow my Department to complete its evaluation of the project are required from the ERHA and the NAHB on various aspects of this project, in particular those relating to the overall scope of the project, funding, procurement procedures and value for money.

The fact is that 14 months after the completion of this fine facility to provide for a health centre and health board offices at a cost of €46 million, it remains idle. The Minister says he has not received all the relevant information from the Northern Area Health Board and Eastern Regional Health Authority, yet they say they have given it to him and have kept his officials up to date on developments during the past three years.

Someone is not telling the truth. A major public building has been completed without, it appears, proper approval first being sought. This matter should be referred to the Comptroller and Auditor General. A great deal was spent on this project and moneys committed are not forthcoming. I raised this matter on the Adjournment with the Minister one month ago on 3 February and he told me he was seeking information and further clarification from the ERHA and the Northern Area Health Board. Has the Minister received that information? Does he require further information? When is he likely to take a decision on the substantial amount of money committed to this project?

The Deputy hit the nail on the head when she said this matter could be one for a committee of the House or for the Comptroller and Auditor General to investigate.

Very often the Department is attacked for simply rubber-stamping such projects. I have raised this matter with my officials who are clear the project proceeded without approval or involvement by the Department of Health and Children. That issue needs to be teased out. My officials told me as late as today, during preparations on the reply to the Deputy's question, that further clarifications to allow the Department to complete its evaluation of the project are required on various aspects of it, in particular those relating to its overall scope, funding, procurement procedures and value for money.

I take the Deputy's point that the centre is ready for occupation. There is a desire among all the parties involved that the centre be put to use. The Department has, however, raised fundamental issues in terms of accountability and is proceeding with a degree of caution in that regard.

When is the Minister likely to reach a decision on this matter? Proper procedures may have been breached but the facility has been completed and has remained idle for 14 months. There is an urgent need for proper health care facilities in the Ballymun area. It is up to the Minister to take a decision on the matter. He knows what is required. The facility needs to be fitted out and the rent needs to be paid, a burden which another State agency is carrying while awaiting funding from the Department of Health and Children. The city council has paid approximately €6 million in rent during the past year. There is a sense of urgency about this matter, not least because people in the Ballymun area are awaiting the provision of decent health services. When will the Minister bring this project to fruition?

If the reason this facility is not being commissioned is that it proceeded without departmental approval, what then is the explanation for the failure to open Mullingar General Hospital; the 90-bed community unit in Birr; large parts of Blanchardstown Hospital, including the ICU and surgical blocks; and the part commissioning of the accident and emergency unit at Naas General Hospital? Do these projects remain unopened for the same reason or is there another explanation for the Minister's failure to commission them?

They are separate issues.

We have sanctioned the 90-bed development in Birr.

When was that sanction given?

Approximately one month ago.

It was a long time coming.

We work with the boards on such issues. The Department will not roll-over, accept whatever estimates it receives, pay out the money and everything will be hunky-dory. That is not the way things are done.

What about Blanchardstown Hospital?

That is a separate matter.

There are a number of issues involved, such as ongoing funding. There was a great deal of criticism of the Brennan report. My Department provided information to the Brennan commission regarding significant overexpenditure across many health boards on capital projects not approved by it. The general system came in for criticism in that regard. The Department must draw a line somewhere. I accept there is a dispute on this issue which arose under the auspices of the previous authority, the Eastern Health Board. The matter is now being dealt with the Northern Area Health Board and the ERHA. The view of the Department is that this very significant project proceeded without its approval.

A project that has received approval has not received funding.

There has been a great deal of criticism of how this project has been handled but everyone accepts there has to be accountability.

What is the Minister going to do about it now?

I do not have a date for the completion of the process but I will undertake to keep the Deputy up to date on progress. The Department is endeavouring to bring this matter to a conclusion.

Health Service Reform.

Denis Naughten

Question:

97 Mr. Naughten asked the Minister for Health and Children the structures and roles of the main groups involved in the implementation of health reform; and if he will make a statement on the matter. [6893/04]

Paul Kehoe

Question:

107 Mr. Kehoe asked the Minister for Health and Children if he will clarify the next step in moving to the new health structures; and the measures that are being taken to ensure that there is no diminution of services during the transition for either organisation or financial reasons. [6927/04]

Liz McManus

Question:

140 Ms McManus asked the Minister for Health and Children if his attention has been drawn to the potential conflict of interest arising from the appointment of the managing director of a major pharmaceutical company; the steps he intends to take to deal with this situation and ensure that the public interest is protected; and if he will make a statement on the matter. [7005/04]

Paul Nicholas Gogarty

Question:

170 Mr. Gogarty asked the Minister for Health and Children if those appointed to the interim health executive will have no conflicts of interest; the steps he will take to ensure there are no such conflicts of interest; and if he will make a statement on the matter. [7086/04]

I propose to take Questions Nos. 97, 107, 140 and 170 together.

The implementation of the Government's health service reform programme centres around a number of bodies including the programme's national steering committee, the Interim Health Service Executive, the Department of Health and Children and the existing health boards/ERHA.

I announced the establishment of the board of the Interim Health Service Executive last November and it held its first meeting in January. The members of the board were selected on the basis of their respective competencies and experience in areas which are directly relevant to the governance role to be exercised by the board. I am satisfied that all board members share a strong commitment to the successful establishment and functioning of the Health Service Executive and that they act with total integrity, motivated solely by the public interest. The membership of the board of the Interim Health Service Executive is set out later in this reply.

The interim HSE has been assigned responsibility for ensuring that all necessary measures are in place to ensure an orderly transfer from existing statutory agencies of authority, responsibility and accountability for the management and delivery of publicly-funded health services. In particular, the board of the interim HSE will have responsibility for: recommending the senior management structure for the new executive; recommending regional boundaries and location of regional headquarters for primary, community and continuing care services and appropriate management structures for consideration by the Government; and within approved parameters, selection and appointment of a chief executive officer to the HSE and subsequent appointments at senior management level.

The work to be undertaken by the interim HSE is one of four distinct but interrelated strands of activity taking place under the reform programme during 2004. The other three strands are: the legislative, mainstreaming, human resource and industrial relations aspects of the reform programme for which the Department of Health and Children will continue to have lead responsibility; the work of the Acute Hospitals Review Group chaired by Mr. David Hanly; and the ongoing management of the health system and internal preparations for the new organisation and governance arrangements being led by the chief executive officers of health boards/ERHA and the Health Boards Executive.

The Government has also appointed a national steering committee to oversee the implementation reform programme and to provide a co-ordinating forum and ensure overall consistency with the Government's decision. It will report on a regular basis to the Cabinet committee on the health strategy, ensuring that the Government is kept fully informed on all important issues. It will liaise with the health reform project office in the Department of Health and Children and the Interim Health Service Executive in the implementation process.

The membership of the national steering committee is also set out later in this reply. I am satisfied that the members of the committee reflect the appropriate mix of competencies and experience to support their role in the implementation of the health reform programme. The committee is made up of the executive chair of the interim HSE, chairman; heads of the Departments involved; the chair of the Acute Hospitals Review Group; the director of the Health Boards Executive and chief executive officer of a health board; and two external members with personal experience of large-scale change management in a private sector context.

I am satisfied that all members of the group share a strong commitment to the successful implementation of the health reform programme and act with total integrity motivated by the public interest. In particular, I am satisfied that, given the specific role of the national steering committee, no conflict of interest arises for any member of the group.

Both bodies are subject to the usual norms in regard to all public bodies, including the adoption of formal procedures to address any particular instance where a conflict of interest might arise for a particular member or members.

I would like to take this opportunity to express the Government's appreciation to the members of both bodies for their agreement to take on the demanding roles assigned to them and I look forward to working closely with both over the months and years ahead.

In regard to continuity of services in 2004, each of the health boards and the ERHA have submitted service plans to me setting out the quantum of service to be provided during 2004 for the funding received. All of the services plans were adopted by their boards/ERHA and I am assured that services will be provided in accordance with the service plans. My Department will continue to monitor performance in regard to service plans during 2004 in the usual manner.

The changes on which we are embarking put emphasis on the improvement and enhancement of patient/client experience as well as improving the experience of staff working in the health system and overall value for money. Various measures are being put in place during 2004 to ensure an orderly transition to the new structures and this will be the subject of ongoing discussions with the health boards/ERHA during 2004.

Additional information not given on the floor of the House

Board members of the Interim Health Services Executive:

1. Mr Kevin Kelly (chair)

2. Professor Niamh Brennan

3. Professor John A. Murray

4. Dr Donal de Buitleir

5. Professor Michael Murphy

6. Mr Liam Downey

7. Professor Anne Scott

8. Mr P.J. Fitzpatrick

9. Mr Michael McLoone

10. Mr Eugene McCague

11. Dr Maureen Gaffney

National Steering Committee Health Service Reform Programme Members:

Mr Kevin Kelly —Chair (Mr Kelly has also been appointed as Executive Chair of the Board of the Interim Health Service Executive)

Mr David Hanly —(Mr Hanly chairs the Acute Hospitals Review Group)

Mr Michael Kelly —Secretary General, Department of Health and Children

Mr Dermot McCarthy —Secretary General, Department of the Taoiseach

Mr David Doyle —Second Secretary General, Public Expenditure, Department of Finance

Mr Denis Doherty —Chairman, Health Boards Executive

Mr Seán Hurley —Chief Executive Officer, Southern Health Board

Mr Michael Dempsey —Managing Director, Bristol-Myers Squibb

Ms Maura McGrath —McGrath Associates, Management Consultant.

I thank the Minister for his comprehensive reply. I want to focus on one element of the Minister's response, namely, the Acute Hospitals Review Group. Does he not regard it as unusual that there is a lack of representation from small hospitals on the group, with only one representative out of the 21 members? Will the Minister not agree that the sole objective of the review group is to close the smaller accident and emergency units throughout the country such as the one in Portiuncula Hospital in Ballinasloe and the county hospital in Roscommon? In a few years from now will the pupils who are in the Gallery from Boyle, County Roscommon——

It is not in order to refer to people in the Public Gallery.

——have no service in County Roscommon or adjoining counties?

I have great respect for Deputy Naughten but he has some nerve to attack me about Roscommon because I am the one who provided the additional millions of euro to provide a decent——

The Minister might provide the staff and then we will be very happy.

——accident and emergency department in Roscommon. Let us be fair about this and stop the scaremongering. Let us forget about the doomsday scenarios. Last year we invested significantly in an accident and emergency department in Roscommon. It will not close.

It will not have staff.

We will not downgrade services and we will continue to enhance and add services to the regions. That is the bottom line. The Acute Hospitals Review Group is made up of people from a wide range of backgrounds, particularly from rural Ireland, to give a specific remit for demographic issues and rural peripherality in the consideration of the remainder of the country.

One member.

I do not know the Deputy's definition of "major hospitals" but I respectfully suggest there is a significant representation from the west in particular and the north-west because of its particular geographic topography——

Galway city is not rural Ireland.

——and a person with a remit in terms of national spatial planning. We have given clear terms of reference. For example, we have asked the group to make sure there will be continuing medical cover in acute hospitals going forward.

What does "medical cover" mean in Hanly speak?

It does not mean nurses.

The Minister should be honest. What does "medical cover" mean in Hanly speak?

What does the Deputy think it means?

It means everything except a doctor.

The Deputy is wrong. That is not what it means. We are talking about doctors.

It could include a doctor but it does not guarantee a doctor, and the Minister knows that.

That is what we have asked. We have asked them to give consideration to that because——

I call Deputy McManus.

First, does the Minister not accept that in setting up these new bodies we now have a situation which is characterised by confusion as to who is responsible, for example, for dealing with the issue of public private mix and equality in the health service? Second, on costs that are already building up we now know that it is likely that two jobs alone in these new structures —the CEO for the Health Service Executive and the chairman —will come to a total of approximately €500,000. Third, there is a conflict of interest which is inherent in the structures the Minister has created. In the national steering committee alone, apart from the chairman the only other people on the committee are civil servants. Interestingly, for the first time the Department of Finance has now got a powerful role in running the health service, but that is by the by. The only other person is the managing director of a major pharmaceutical company. How can the Minister stand over that? He has opened up a direct conflict of interest in regard to the most powerful body that will steer health reform in this country, and no explanation or justification has been given. No matter how often one protests, the reality is that in regard to a person now at the centre of the health reform programme, and I cast no aspersions on the individual involved——

That is what the Deputy is doing.

——his background, role and current job as managing director of a major pharmaceutical company, raise the issue of a conflict of interest that the Minister has not addressed.

With respect, it does not. That is a wrong assertion to make. It is ridiculous to assert that someone who happens to have significant experience in the area of change management in a particular industry is thereby debarred from any role in terms of structural reform, overseeing the Government decision and changing structures, represents a conflict of interest. The individual concerned made a significant contribution on the health strategy, for example, from a management perspective and so on.

The Minister is making people more anxious.

We should not try to create a cloud over people. That is wrong.

Written Answers follow Adjournment Debate.