Health Bill 2004: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

Last night I referred to care of the elderly. No time should be wasted by the new management of the health services delivering in that sector and the investment needed in it should be given priority. Most speakers made an issue of the fact that care of the elderly must be expanded and requires investment.

There is a provision in the Bill concerning the sale of health board property. I specifically refer to the property surrounding St. Canice's Hospital in Kilkenny and other properties owned by the health board. The new executive should consider the fact that prior to the abolition of the health boards, a clear indication was given by some health boards that if property was sold, it would be ring-fenced for the health board which owned the property prior to the introduction of the new management system. The South Eastern Health Board discussed this issue and I am pleased to note the appointment of Mr. Pat McLoughlin to the new management structure. That board identified the use of St. Canice's Hospital campus for care of the elderly because a number of beds are needed for long-term care. The current facilities at Castlecomer and St. Columba's Hospital in Kilkenny are excellent but require investment. The number of beds in that service needs to be increased.

I hope that when the incoming executive begins to look at the sale of property, it will remember the policies put in place by some health boards and will direct the spend of money generated by the sale of such property towards projects which the old health boards had in mind. In that regard, I remind the Minister that €1.2 million was being spent in St. Canice's Hospital as one part of a project for care of the elderly. When the property is sold and money becomes available, the second part of the project should receive investment. I commend the Bill and ask the Minister to take note of that aspect of my interest in it.

I wish to share time with Deputies Enright and Naughten.

This is an important Bill by any standards and I would prefer to be able to wholeheartedly welcome it. However, I cannot do that. On reflection, the public will see this is a bad deal for the health services. In my contribution, I will try to give an idea of what I believe are the main drawbacks and deficiencies in the Bill. There is a certain amount of deviousness in that this is not an honest Bill. We all know changes are needed in the health service and Fine Gael is all for the necessary changes which could, and should, be made. However, the public does not want cosmetic changes, of which there is no shortage in this Bill. People expect that changes made will provide better health care for their families and themselves and that it will be provided with dignity.

Will this Bill produce the goods? I do not believe it will because its faulty foundations are built on sand. There has been no concrete planning for the future, which I will explain in a moment. I will also explain why I believe this is a dangerous Bill. Vast powers will be vested in the Health Service Executive. I have seen many such executives since I first became a Member of this House many years ago. Taking the National Roads Authority as the prime example, it was one of the greatest side steps of all time in so far as accountability to this House was concerned. Members of the House cannot ask day to day, procedural questions about what is happening with roads. We are told it is a matter for the National Roads Authority. The same will happen with the Health Service Executive because under the Bill, the new chief executive will be the accounting officer. As a result, we will not be able to table parliamentary questions or hold emergency debates and freedom of information requests will be severely curtailed. I do not like what I have read.

It seems this huge change is being introduced on an ad hoc basis. The Government is making it up as it goes along. It could not find a chief executive even though it spent all year trying. All it could do then was push the chairman in as goalkeeper to save the day. I have nothing against the chairman but he obviously was not the Government’s first choice or it would not have gone to the trouble it did to find a chief executive.

I always believed the chief executives of the health boards were the driving force behind the delivery of health services. To my knowledge, 90% of them do not know where they will go after Christmas. There is no room for the most influential people as yet because nobody has thought this out. It is a "make it up as one goes along" strategy.

With regard to the Hanly report, the Government is pulling the fastest stroke of all time. The new executive will implement the report because its members will not be brought on to the floor of this House to be accountable to the public. The Government will merely refer the executive members to an Oireachtas committee, which could take 12 months. When they appear before a committee on technical matters, they need only attend for two or three hours. There is no accountability in the system.

If ever there were an opportunity to implement the Hanly report, it is now. The Government has silenced the entire array of political input. The provisions relating to the complaints procedure indicate that the executive members will complain to themselves and for themselves and nobody will take any notice. There is no statutory obligation on anybody to accept what they say or believe in. The public is watching this debate closely. It is clear that the Government will hide behind the skirts of the new executive and will use it as a ploy to claim that it has no responsibility in the matter and to wash its hands in a Pontius Pilate attitude. If this is the case, we are doing a bad week's work for the people. The birds will come home to roost and many people will be badly hurt at the end of the matter.

No more thought has been put into this Bill than was invested in the formulation of the decentralisation scheme, which has come undone. That was another random notion just before last year's budget. Little more effort has been expended in devising this legislation. It is change for change's sake. There is no substantial thought put into it, good or bad. The legislation has been born as a weak infant and I do not predict that it will get any stronger.

An important element of the Bill is the centralisation of power in the health service. If one considers an issue such as mental illness, a very reasonable proposal was put forward by the Western Health Board on the occasion last year when it became known that St. Brigid's Hospital in Ballinasloe was being phased out. Nobody can deny that much good can come from a centralising approach, up to a point. What was proposed in this case was that the proceeds of the substantial property attached to this hospital would be sold at public auction and allocated to the development of mental health services in north Galway. What will happen now that everything is to be centralised? It is possible that the funds from that hospital will go towards some other mental health facility elsewhere.

I have severe reservations about this Bill. I hope I am wrong but I do not believe that to be the case.

I thank Deputy Connaughton for sharing his time with me. I regret that there is such limited time to speak on this Bill and that the opportunity afforded to each Member is so brief. The Bill will be effectively finished nextFriday and it is a pity that such important legislation is rushed through in this manner.

I wish to deal briefly with certain aspects of the Bill. With regard to section 2, I am somewhat surprised that advice can only be given to the Minister if it is requested. I may be told that this is always the case but that does not mean it should always be so. The right of the executive to offer opinion or give advice is limited to those cases in which the Minister asks for it. Furthermore, section 7(5)(c) stipulates that the executive must have regard to the policies and objectives of Government or the Minister. This provision is too broad and we have seen Ministers on solo runs in the past. This section is open to two readings. If the executive must have regard to the policy of the Minister, it may be entirely different in some instances from Government policy. In such a situation, to which policy should the executive afford chief regard? This is an issue that must be reconsidered.

I have concerns regarding the proposed membership of the board, an issue I have raised with regard to other legislation also. The Minister will appoint all 11 members. From our knowledge of the interim board, there is a tendency to appoint people to run the health service from the world of business and banking. There have been some with health experience but it is an adequate number. It is clear what members cannot be. Deputies, Senators, MEPs and councillors cannot take these roles. However, the legislation does not stipulate what qualifications members should have. Guidance should be given as to how the Tánaiste and Minister for Health and Children will make her selections when the time comes. We are not told if the chief concern is a medical, administrative, accountancy, legal or education background. No guidance is given in this regard.

Section 13 tells us how somebody may be removed from the board. Some of the reasons are clear and others less so. Again, there is no indication as to how members will be appointed to the board. I am concerned that the provisions that apply to other members will also apply to the CEO. This issue must be considered.

Section 20 gives the CEO the role of accounting officer, which was previously held by the Secretary General of the Department of Health and Children. This is another concern. The CEO may be brought before an Oireachtas committee at its request to give an account of the general administration of the executive. However, the CEO cannot offer an opinion on the merits of any policy of the Government or Minister, even though the decisions he or she makes will be affected directly by those policies. If the Minister believes that the 11 board members are the experts who can run the entire show, they should surely be able to express dissenting opinions to the Government, Minister or Oireachtas committee. The ultimate decision will rest with the Minister but the board members should be able to make their views known to Members of this House.

I share Deputy Connaughton's concerns with regard to the NRA. I come from a constituency that has had plenty experience of national roads coming through, particularly in Laois but also in parts of Offaly. I can recall members of the Government parties attending many meetings to express their frustration, concern and helplessness with regard to roads issues because the power was given to the NRA. Those members will come into the House next Tuesday like turkeys voting for Christmas and effectively vote for a similar situation with regard to the HSE. I shall see these same Deputies at meetings in a few years time claiming that the Government is powerless and all blame rests with the HSE. It is they who will vote to put the HSE in place and we will remind them of that when the time comes.

The Minister of State, Deputy Brian Lenihan, was not present at a meeting I attended in Tullamore earlier this year when the Health Boards Executive was established. It was a lovely day out with presentations galore. The HeBE has rented a lovely building but one is forced to wonder what will happen to it now. Where will the staff who were put in that building at the beginning of the year go and what will be their role under this new system? Who made the decision to put this facility in place and fund it for such a short period of time in the knowledge of what would come downstream shortly after? The staff are extremely concerned about their future and about where they will be located. The staff in the Midland Health Board, who are located mainly in Tullamore, have similar concerns. They have legitimate questions that have not been answered.

I also point to the position with regard to step-down facilities. Elective surgery in the orthopaedic unit at Tullamore General Hospital was cancelled recently because of a shortage of beds. Can the Minister guarantee that the new hospital to be opened in Tullamore will be fitted, staffed and opened on schedule, unlike the situation of the nursing unit in Birr District Hospital? I am worried that the issue of step-down facilities is not addressed in the Bill. Birr District Hospital is still awaiting the 20 extra beds that have been sanctioned. There has been no word of 22 extra beds for Riada House in Tullamore even though the relevant planning permission is three years old. Likewise, there is no word of the long-awaited extension to Uibh Fháilí House in Edenderry. What are the Minister's plans with regard to the provision of facilities? Who will take responsibility in ensuring these facilities are in place? I am concerned that these issues will no longer be the responsibility of this House. It is important that Members can ask questions not only on policy but on issues of concern to individuals because we are elected to ensure their voices are heard.

Members want to speak on the single most important Bill we will debate during this Dáil, but it is farcical that the debate is being guillotined and the time allocated for it, published earlier in the week, restricted. That is typical because it does not give us the opportunity to highlight the pathetic system the Government has managed for the past seven years.

Public dissatisfaction with the health service at present is at an all time high. The perceived service is worsening with bed shortages, lengthening waiting lists and pressures in accident and emergency units, the list continues. The Government has dramatically increased the health budget during the past seven years, but its members would have been as well off to sit in front of the fire and throw the money into it for all the value we have got from it during that period. There is a lack of accountability and transparency in terms of the results of the decisions made. This legislation will compound that problem.

Most of the published health strategies paint a lovely vision of the future ideal health service but we have no realistic detailed roadmap of how we make this vision a reality. The Fine Gael Party welcomes health reform but this Bill is reform in name only. Where is the reform in the service delivery for patients? There is nothing about that in this Bill. The provision of health care should be to respond to all the people's needs in an efficient and fair manner, but sadly that is not provided in the legislation. We should focus on the issues of primary health care which can bring health services close to communities and help take the pressure off our acute services which are under such demand at present.

All the Bill does is provide for another unaccountable quango, the National Roads Authority mark two, an agency that will have billions of euro to spend but can never be called to account in this House. Neither can the Minister responsible be called to account in this House for how those funds are spent. Matters are bad enough at present and I will give an example to illustrate this. I tabled a parliamentary question in early September, to which I received a response on 29 September. The question related to quarterly cervical smear clinics held in Roscommon until earlier this year. Two and half months later I tabled a second parliamentary question and was informed by the Minister that as of this week the health board is currently preparing a reply. Matters will get worse from here on in.

What this Bill is about is a vehicle to implement the Hanly report. Health care should not be contingent on wealth or geographic location, but this Bill provides for such discrimination. The Hanly report constitutes a direct and fundamental threat to hospitals such as the County Hospital in Roscommon, Portunicula Hospital in Ballinasloe and many other similar local hospitals throughout the country. The report recommends that most local accident and emergency units should be closed or reduced to minor hospitals in each region, but the report is fundamentally flawed.

On page 70 of the report, it is suggested that many of the main life-saving measures in emergencies are not affected by the immediate proximity to a hospital. What about the issue of the golden hour? The lives of people in Roscommon and those in similar circumstances throughout the country are being put at risk by the Hanly report. Research produced byScientific American suggests that 30% of patients with major trauma die unnecessarily because of a lack of satisfactory care within one hour. Similarly, a study inMontreal showed that of 360 severely injured patients, those who failed to reach hospital within one hour had a threefold increase in the risk of dying within six days of admission compared to those who reached the hospital within one hour. What message does this send to the people of Roscommon and similar communities across the country? It is that the lives of the people of County Roscommon are worth one third of the lives of a native living in Ballsbridge. It is all well and good for the Minister and the Minister of State who live near major accident and emergency facilities, but it is difficult when one lives hours away from facilities down the country.

The Government does not have a clue about health policy. It proposed legislation for the break-up of the Eastern Health Board to form three health boards. It claimed that would bring the services closer to the communities. However, big is not better. It is now rescinding that legislation and introducing legislation to establish an even larger agency because it believes that big is better. It does not have a clue what is going on. This is just the latest experiment on the health services. It must remember this is about people's lives and lives will be lost through the implementation of this legislation.

My colleague, Deputy Enright, raised a number of queries about sections of the legislation, one being membership of the board. I will tell the House the criteria that will be used to appoint the 11 members of the board. Whether they are members of Cairde Fáil or carry membership cards of Fianna Fáil or the Progressive Democrats, that is the qualification used for every board that has been appointed in the past, and that is the one that will be used for this one.

Such membership should not disqualify one.

I wish to share time with Deputy Devins.

That is agreed.

This is a most welcome Bill. Its gestation has been long, beginning with the publication of the health strategy in 2001 and now as it faces into labour we can only hope it has a safe delivery, but the Opposition has already orphaned it. The Bill's modest size belies the strength, depth and breadth of its effect.

Who wrote that for the Deputy?

I did. The Bill aims to consolidate the fragmented structures that constitute our health service. I doubt anyone would not applaud and support such a radical approach. Few people want the health service to remain as it is, but clearly they all inhabit this House. I listened yesterday to the opening of the debate by the Opposition spokespersons and I was struck by the lack of passion in their contributions, a lack of passion combined with a lack of coherent or convincing argument in opposing the substance of the Bill. It was posturing for opposition for its own sake.

We are all too well aware of the failings of the current system, a towering edifice of bureaucracy which successive Ministers for Health have toiled in vain to contain. The system has become something so large, unwieldy and impenetrable that no Minister wanted to take on the task of reforming it and shirked the challenge. It is fortuitous that we finally have a Minister with not just the courage but the ability and determination to bring order to the nation's health care service and to do what is necessary and right by it, namely, to put the patient at the core of services. Deputy Twomey put his finger on it last night when he referred to the Minister, Deputy Harney, as the Minister for reform.

This Bill presents to an extent an enabling and enacting of the copious reports which were commissioned by the Department of Health and Children in recent times. It is high time that such reports, having been commissioned at such cost, were implemented, and that is exactly what this Bill sets out to do.

The case for reforming the structures of the health service is compelling. We need a health service that is responsive and appropriate to the needs of the 21st century, that is accessible to all and that puts the patient first. If the structures and functions of the current system are not organised or capable of delivering the ambitions of the health strategy, it is time to change them.

The measures in this Bill will provide for the consolidation and rationalisation of a multitude of agencies into the Health Service Executive. It will invest in this corporate body the authority to implement Government policy through a more streamlined system ending the fragmentation that characterises and undermines the current system. As the Prospectus report proclaims, a better planned and managed health system should deliver measurably improved health care to all its patients and consumers.

The current health system has been in existence for 30 odd years and is creaking under the strain. Its inability to cope is best demonstrated by the absence of improvement in service or output despite significant increases in investment which the service has received in recent times. The introduction of this Bill is our opportunity to make massive strides in the provision of health care, to put in place modern management systems to extract greater efficiencies from the considerable resources the Government applies to the sector and to put in place a new system where the patient will be at the centre of service and where outcomes can be measured.

The establishment of the HSE to replace the 11 health boards and bring 27 health agencies under one umbrella is welcome. Am I alone in not lamenting the passing of the health boards? Surely not. I did not enjoy the privilege of serving on a health board, and what a privilege it was. It was the most coveted of all the spoils the victors enjoyed in the post-election negotiations on the establishment of local authorities. Did a country of 4 million people really need 263 people on 11 different boards spread across the country to scrutinise policy? We do not have 11 different health systems——

We have 50.

——and our systems of governance should reflect that.

The Bill will see a streamlined system of governance and implementation of health policy. The 166 Dáil Deputies and 60 Senators will continue to scrutinise health policy and services, ensuring that they reflect the needs of constituents throughout the country.

Not if this Bill goes through.

I mean their real needs and not their parochial needs. I mean needs in the national interest.

Everything other than Dún Laoghaire is parochial.

Deputy O'Malley should explain that to Deputies Sexton and Parlon.

I and the other members of the Joint Committee on Health and Children take our responsibilities seriously in holding the Government to account. There will be no diminution of democracy and accountability with the new HSE. Every Member of this House has a role and a duty to scrutinise the workings of the system and I reject the notion that only councillors sitting on a health board could scrutinise the health service and that their removal presents a democratic deficit.

Deputy Rabbitte refers to the new general practitioner medical card in disparaging terms. The GP medical card is an imaginative response to the realisation that many families need the reassurance which a visit to the GP with a sick child can give and where cost may previously have discouraged them from making a visit. The Tánaiste reminded Deputy Rabbitte in the House of his own calls for such a service to be provided. He will have to learn to hold on to his beliefs. He has a tendency to switch parties with alarming frequency and I am sure this causes a certain amount of disquiet among his colleagues in the alternative coalition.

Like the Deputy's father.

Last night, Deputy McManus accused the Tánaiste of gross dishonesty. Such gratuitous theatrics highlight that the Labour Party has been wrong-footed by the Tánaiste taking up the health portfolio and immediately implementing a reform agenda. Deputy McManus has been so wrong-footed that now she resorts to nasty personalised attacks.

What is that about?

The Tánaiste is not just the Minster for Health and Children. She could equally claim the title of minister for reform and implementation. With the co-operation of many thousands of employees who deliver care under a jaded system, she will build a better service where the patient is central to all decision making and of which all people can be proud.

Did Deputy Fiona O'Malley read that speech before she delivered it?

It can only get better.

I am delighted to have the opportunity of speaking on this important Bill. Deputy Naughten called it one of the most important Bills to come before the House this term and I concur with that. That is probably the only thing in his speech I can agree with.

At least we agree on something.

The Bill has been a long time in gestation and has been flagged for some months. It follows from the many reports on the health service during the past number of years, particularly the Brennan, Prospectus and Hanly reports. All of these reports were commissioned because it has been obvious for some time that there are problems with the delivery of health care. The Bill is the distillation of the recommendations of those reports. I am delighted it has finally arrived in the House.

I was amazed at some of the posturing of Opposition Deputies in recent days regarding the short time they have had to read the Bill.

Will the Deputy give way on a point of order? It is not true to say——

That is not a point of order. I ask Deputy McManus to resume her seat. It is too early in Deputy Devins's address to ask him to give way.

He is not accurate in what he is saying. Does that not matter if it is Fianna Fáil?

It is entirely at his discretion whether he gives way.

The contents of the Bill have been well flagged for some months. My copy arrived at my home in Sligo last Friday. If some Dublin Deputies did not get their copies until Monday, perhaps the fault lies with the postal service. Other Dublin Deputies got their copies.

I did not get my copy untilMonday. I am not a Dublin Deputy.

The Bill was not published until 6 p.m. on Friday. Government Deputies got their copies before we did. That is very bold.

Irrespective of when the Bill arrived in the House, it is what is needed to help drive forward the reform of the health service. All Deputies will agree with this.

Ireland is not a large country and the administration of the health service we have had for the past 30 years is not suitable to the needs of the 21st century.

Who is writing their speeches for them?

Until now, the management of health has been done on a very local basis via the health boards which grew out of the old administration based on the county boundaries. When the health boards first came into being 30 years ago, they were looked on with some trepidation because people were afraid that their old intimate relationship with the county health authority would no longer exist. Over time, the health boards have proved themselves.

The board I know most about is the North Western Health Board. The pioneering work done by that health board has set a benchmark for the delivery of health care. Representing three of the counties furthest from Dublin — Donegal, Leitrim and Sligo — with an interesting mix of urban and rural populations, the problems which this health board faced in the delivery of health care are a microcosm of the problems facing the country. That the board managed to deal with these problems is testimony to the innovative methods it developed. I pay tribute to the staff who helped deliver such a fine service.

If it is so good, why change it? The answer lies in a recognition that the Ireland of today is a different place from the Ireland of the past 30 years. Health and its delivery has become much more complex and the old divisions between health board areas are becoming blurred and unnecessary. Let me give an example of what I mean. Part of Charlestown, County Mayo — the part known as Bellaghy — is in County Sligo. The people at one end of a street in Charlestown live in County Mayo and are covered by the Western Health Board while those who live 50 yards away at the other end of the street live in County Sligo and are covered by the North Western Health Board. The range of services provided in the two nearest hospitals, Mayo General Hospital and Sligo General Hospital, are roughly similar, except that Sligo hospital probably has more specialties than Mayo. Some of those are now becoming available in Mayo. The development of both hospitals, which are roughly equidistant from Charlestown, has occurred without interlinking because they are in different health board areas. Does it make sense that people who live in the same street should be served by two different hospitals whose development and subsequent range of services have occurred without interlinking? It does not.

Extrapolating my point from the local to the national scene, the development of all of our hospitals in a co-ordinated fashion is more suited to the demands of the 21st century. The establishment of national offices, whether for hospitals or for the delivery of services such as information technology, is a progressive and obvious step towards improving the service which the health agencies deliver.

In the overall development of the hospital service, it is also important that modern well equipped and progressive hospitals, such as Sligo, Letterkenny and Mayo, are allowed to continue to offer the widest range of services compatible with their population catchment and their geographical location. These three hospitals are in an unusual situation because of their geographical isolation. While the population decreases of the past 150 years are now being reversed, the full range of services offered by Sligo General Hospital must be maintained and developed. In that regard, I was delighted with the reply Mr. David Hanly, chairman of the Hanly report group, gave me during the debate on the Hanly report in the Committee on Health and Children some months ago. He acknowledged that special consideration will and must be given to those general hospitals which are geographically isolated from the nearest tertiary hospital. Sligo is 90 miles from Galway and 130 miles from Dublin. My Oireachtas colleagues and I will continue to ensure that the future development of the full range of specialist services in Sligo hospital will continue under the national hospital office.

I wish to deal with a point that has been made by some Opposition Deputies, namely, the supposed lack of local representation under the provisions of the Bill. However, in Part 8, sections 45 to 48, inclusive, it is clearly set out how the four regional health fora will operate as well as how local communities can become involved in advisory panels. In that way, the ideas of the users of the health service, that is, the patients, who are the most important people in the service, can be recognised.

Another tier was alluded to by the former Minister for Health and Children, Deputy Martin, and which Opposition spokespersons seem to shy away from. That is the increasingly important role of the Oireachtas Committee on Health and Children. I would like to see the Health Service Executive appearing regularly before that committee so it can monitor how the executive is performing its duties.

As Deputy Twomey outlined, a bureaucratic level is being removed from the health service. We will now know who is personally responsible for each of these new offices. The committee can get to the person responsible and obtain answers quickly and effectively. Perhaps the Opposition does not want that responsibility. Perhaps its members would like to sit on the sidelines and criticise without taking on the responsibility that is theirs. I assure the House, however, that Fianna Fáil Members on the Committee on Health and Children will be proactive in discharging their responsibilities. I was delighted to hear Deputy Fiona O'Malley of the Progressive Democrats saying the same thing. We all feel the same way. We will question, analyse and make constructive comments on how the health service executive is performing. If it is not doing its job, we will ensure that the views of the public are highlighted. I hope Opposition members will do the same instead of sitting on the fence and being negative.

That is all we can do.

I warmly commend this wonderful Bill to the House.

I find it hard to speak having listened to the debate for the past ten minutes.

The Deputy has been struck dumb.

I mean that.

He must not be attending the parliamentary party meetings.

The Minister of State should listen for a moment. We are being asked to support this Bill which provides nothing apart from the dissolution of health services, including seven or eight health bodies.

Is the Deputy sharing time?

I am sharing time with Deputy Moynihan-Cronin.

Is that agreed? Agreed.

The Health Act 1970 provided limited or full eligibility for health services through a declaration of means. It also provided for hospital inpatient and outpatient services along with general medical services, including services for mothers and children. There is nothing in the Bill before the House to provide for any such services. The Government is rushing this Bill through the House, having published it only seven weeks prior to the deadline for establishing the new health service executive on 1 January 2005. Thousands of health workers do not know what will happen to their jobs.

The 1970 Health Act was dealt with differently. The Second Stage debate took place in April 1969 and adequate time for it was provided by the then Minister for Health, Mr. Erskine Childers. Did the Minister of State ever hear of him? He introduced the 1970 Health Bill. Following Opposition amendments, the Bill was passed in February 1970. Over a year was then given to establishing a new health framework which began operating in April 1971. Seven weeks are being provided for the Bill before us, while the 1970 legislation took two years to implement.

The Health Bill 2004 calls for a centralisation of services. Section 9 states that there will be informal arrangements between the executive and local authorities. At one stage in Ireland, local authorities controlled the health services. The 86 sections in the 1970 Act will now to be replaced by an executive and a board consisting of 11 members. The executive will comply with any directive issued by the Minister under the legislation to be enacted. That is exactly what this Bill is about.

The new legislation will include arrangements for public representation in the operation and development of health and social services. The 1970 Act, however, established health advisory committees, although they were abolished in the mid-1990s. It is now intended that there will be regional fora to enable meaningful and sustained dialogue and consultation between the executive and the public at local level. In plain language, they will be talking-shops with no power. So much for the Government's decentralisation policy. Power will rest with the Minister and the health executives. Will these executives be paid €400,000 a year to introduce the legislative changes and supervise their implementation? As no public representatives will be on the executive, I hope that general practitioners and the Irish Medical Organisation as well as the consultants will be represented. These are people in the front line of providing health services.

Schedule 5 refers to the service plans prepared by the Eastern Regional Health Authority and the health board to be constituted as the service plan by the Health Service Executive. I presume they have already been done so will the Minister of State inform the House what the service plan for the southern region comprises?

I was a member of a local committee in Mallow established to oppose the Fitzgerald report of 1968 which proposed to downgrade general hospitals, including Mallow General Hospital. The current public consensus is for the hospital to be within easy access and it has now been established that 90% of patients can be treated in the local general hospital. A recent general practitioners' report stated that "GPs provide 90% of referrals to hospitals from a significant gateway to hospital referrals". They are well placed to echo the views of their patients and understand where best value for money is provided. Mallow General Hospital gives support to the community by providing appropriate and cost-effective services. The 24-hour accident and emergency, medical, surgical and consultant services allow people in the area to access acute care within the internationally accepted "golden hour", which gives people a realistic chance of survival.

Under Comhairle na nOspidéal the current radiology post in Mallow General Hospital is temporary and part-time, despite four years of promises. Having made a recommendation in 2001, Comhairle na nOspidéal has not followed up on the matter since then. In the past there was always a permanent radiologist at the hospital but that post has been vacant for three years. I want to record that since 2001 this great Comhairle na nOspidéal sat on its hands and allowed that post to be continued as a temporary one.

It is worth noting that the Hanly group had 50 members, of which only one was a general practitioner. The weight of expert evidence and opinion against the Hanly report's proposals on accident and emergency services is overwhelming. Rural populations will be most adversely affected by these changes since they have the longest distances to travel to major centres. The number of patients treated at Cork University Hospital was 23,000 with an average duration of stay of 6.34 days and an average cost per day of €746. However, the average duration of stay at Mallow General Hospital was 5.3 days with an average cost of €475 per day, which represents a considerable difference.

I regard the Minister of State as a very decent person and I hope he will encourage the Government to withdraw this legislation to give the people a chance of a good health service in the future.

Other speakers have dealt with the structural changes in the health boards, which will come into effect in the new year. I would like to focus on whether the changes proposed in the Bill will have any real consequences for those using the health services on a daily basis. The Bill will merely result in more quangos, more bureaucracy and anything and everything to reduce the accountability of the Minister in the House and prevent us as public representatives from getting answers about anything to do with health. I sometimes wonder whether the Government wants the Opposition to ask questions anymore. These proposals were mooted 18 months ago and now in the run-up to Christmas we have a few hours to debate this important Bill. I was elected to bring the views of the people of south Kerry to this House. I have ten minutes — and lucky to get those — to speak on the issues I want to bring from south Kerry. I do not believe we live in a democracy anymore — the sooner people realise that the better — I believe we live in a dictatorship.

Widespread concern has been expressed on all sides of the House about the decrease in the level of public accountability in the new health service structures. The Tánaiste and Minister for Health and Children has not made adequate provision for accountability and transparency in this legislation. Many Deputies on all sides of the House fear that the Minister for Health and Children will have a much reduced level of accountability in this House. While a number of Deputies have asked the following questions, they cannot be asked often enough. I hope that whoever replies at the end of this debate will answer them.

Will we, the elected representatives, be able to obtain information from the Tánaiste and her Department in response to parliamentary questions? When pressed about a matter by a Deputy, will the Tánaiste or a Minister of State adopt a new mantra of claiming the matter is one for the HSE or the hospitals agency? When I submit a health matter for debate on the Adjournment, will I receive a note from the Ceann Comhairle stating it is not a matter for the Dáil but for some other body, as happens today with issues under the remit of the National Roads Authority? Despite what Deputies on the other side of the House say, it will not be possible to give local input into the services for local people and those of us representing the local people will have no say. One wonders whether the Health Service Executive and the other bodies will bring about any improvement for the health consumer. Will the people on trolleys in accident and emergency departments get a bed sooner or will the thousands on orthodontic waiting lists get to see a consultant?

I refer to a number of deficiencies in the health services in my constituency which I hope will be addressed by the new Health Service Executive, although I doubt it. For example, Kerry General Hospital provides an outstanding level of service for the people of the county. However, it is facing underfunding and a shortage of capacity at present, particularly in the accident and emergency and maternity departments. The hospital is crying out for a new expanded accident and emergency department. The hospital submitted plans to the Department of Health and Children in 2002 but the Minister has not sanctioned the development which would provide an extension to the accident and emergency unit and a renovation of the existing unit. Regrettably, the Tánaiste chose not to include this much-needed development in her recent Estimates for 2005 under the capital programme. How much longer will we wait? Under the new proposal I believe we will wait a long time.

The maternity department at Kerry General Hospital is in acute crisis at present. Births in County Kerry have gone up from 1,010 in 1994 to 1,446 last year, a 40% increase in a decade. However, the maternity unit has not been upgraded to deal with this increase. The hospital has a major shortage of midwives and services are under extreme pressure. The consultant obstetrician in the maternity unit has described this as potentially dangerous and the management of the hospital has indicated it may have to reduce the number of planned gynaecological procedures to ensure a safe service is available to all patients. As we all know consultants very rarely make such public statements.

The Kerryman newspaper reports this morning that nurses at Kerry General Hospital with qualifications in midwifery are being asked to work extra hours to cope with staffing shortage in the maternity wards. How does the Minister respond to this totally unacceptable situation? Can she give any guarantees that the new National Hospitals Office, being established under the Health Bill, will ensure that facilities such as the maternity department at Kerry General Hospital will be adequately equipped and staffed to a level sufficient to provide fully for the needs of patients?

According to a recent reply to me in a parliamentary question, the Tánaiste and Minister for Health and Children advised me that the establishment of a project team to progress proposals for a new maternity unit at Kerry General Hospital is to be considered in the context of available funding under the capital fund for 2004-08. She is, therefore, admitting that it may be as late at 2008, four years away, before this vital project progresses. If the delays in progressing this work are as long as the delays in advancing the construction of a new hospital in Dingle or an extension to the hospital in Kenmare, the people of Kerry will be waiting a very long time.

A few weeks ago in this House, I raised the major delay in sanctioning the new community hospital for Dingle, which has been delayed by Fianna Fáil representatives in my constituency for almost a decade. I have little confidence that the Health Service Executive or the hospitals office, which will come into being in the new year, will deliver on these projects given the track record of the health boards and the Government to date.

I take this opportunity to refer to the mounting orthodontic waiting lists in County Kerry, which are not being addressed by the Government after seven long years in office. The average waiting time for orthodontic treatment in Kerry at the moment is four years. Some 875 patients are waiting to see an orthodontist in Kerry at present and 75% of those patients are waiting for more than a year. This is an absolute scandal. While orthodontics, by its very nature, requires early intervention to deal with dental deformities, especially in children, in Kerry it now takes an average of four years to get an appointment. Delays in getting orthodontic treatment represent one of the greatest problems in the modern health service, which has not received the appropriate level of funding or personnel from Government to meet demand. When the history of the modern health service is written, the scandal of the orthodontic waiting lists will go down as a major blot in the copybook.

While I could speak at length about other issues, I have insufficient time. Why, for example, are we still waiting for the BreastCheck programme to be rolled out to the south west? While the capital funding has been allocated, it will be another three years at least before the programme is operational and the Government has made no current expenditure provision for its operation.

How much time do I have left? Am I nearly finished?

The Deputy has two minutes.

The Deputy has two and a half years.

We have two and a half years to wait before we get the Government out of office.

The Government will be long gone by then.

: The service in Kerry is inundated with applications for housing aid for the elderly but one person is dealing with the applications and he has only got around to applications received in April. No Government can be proud of that.

Will the people of Kerry get the same services in ten years' time under this new executive? The only way we will get a good health service is to get the Government out of office. The quangos it will establish will not solve the problems so, while I hope there will be some improvement, I doubt it will happen.

Every Deputy has put forward the case for improved health services in his or her constituency. That demonstrates the need for a national structure to give a national perspective on the problems and I warmly welcome publication of the Health Bill 2004. Health is the biggest political issue in the State and we have a primary role in dealing with the problems in the health service. The main issues highlighted by my constituents are delays in the accident and emergency departments and hospital waiting lists, although there are other matters of concern.

I support the Government's view that the problems in the health services should be tackled by increased funding in tandem with reform — it is not a question of one or the other. The publication of the Estimates for public expenditure for 2005 clearly demonstrates the Government's commitment to funding of the health service. Current spending on health will increase next year by €950 million to €10.5 billion, an increase of 9.9%.

The public know, however, that it is not just a question of funding. The users of our hospital service witness the waste taking place every day and recognise that there is a serious problem with management. That is why I support the health service reform programme. The Government's decisions in this regard are based on the recommendation of three key reports, the Prospectus report, the Brennan report, and the Hanly report.

The key elements of the reform programme are a major rationalisation of existing health service agencies to reduce fragmentation, including the abolition of the existing health board and health authority structures, the reorganisation of the Department of Health and Children to ensure improved policy development and oversight, and the establishment of a Health Service Executive which will be the first ever body charged with managing the health service as a single entity. The executive will be organised on the basis of three core divisions, the national hospitals office, the primary community and continuing care directorate and the national shared services centre. A health information equality authority will also be established to ensure that quality of care is promoted throughout the system. Supporting processes will be modernised so they will be in line with international best practice, strengthening governance and accountability across the system. There will be a reduction in the working hours of non-consultant hospital doctors, in line with the EU directive, and a reorganisation of the acute hospitals sector. The programme's priority focuses are improved patient care, better value for taxpayers' money and improved health care management.

I welcome the Tánaiste's speech on Second Stage last night. She is a brave woman and this is historic legislation. We must make the best use of the tremendous resources we are applying in health to get clear value and results. Legislation governing the structure of the health service is outdated. We do not need 58 separate health agencies or 273 people on separate health boards in addition to the 166 TDs and 60 Senators managing and accounting for public health spending.

I am a public representative in the Eastern Regional Health Authority district. The establishment of this authority led to the creation the East Coast Area Health Board, the Northern Area Health Board and the South Western Health Board. This structure did not work, it was a failed experiment. It took months or even years to put the appropriate managers and staff in place. It was often impossible to track down the section or staff dealing with a particular issue. That is no reflection on the staff in the health boards. They were the victims of a bureaucratic and cumbersome structure. It is only now that the managerial positions and staff are in place. Unfortunately, it never functioned properly because of its bureaucratic nature.

I sat on the board of Beaumont Hospital for a number of years. Often we did not get our budget for the year from the Eastern Regional Health Authority until well into the year, a reflection of the bad management and the way in which the structure did not work for the hospital.

This Bill will allow for the creation of a single, unified health service. It will establish the Health Service Executive on a statutory basis and provide for the dissolution of the Eastern Regional Health Authority, area health boards, health boards and other identified agencies. I welcome the fact that the accounting officer for the health service will be the new chief executive of the Health Service Executive. This is a departure from the norm and will bring greater efficiency to the procedure.

I also welcome Part 9 of the Bill which puts a statutory complaints procedure in place. The public who use hospital services often have complaints to make and the structures in place at present are not adequate. The public must follow a cumbersome procedure and the outcome is not always clear. The public should be facilitated in making complaints.

I welcome the action to improve accident and emergency services announced last week as part of the Book of Estimates. I deal mostly with the Mater Hospital and Beaumont Hospital and there are problems with accident and emergency units. Last week the Tánaiste announced the development and expansion of minor injury units, a chest pain clinic and respiratory clinics in hospitals to relieve pressure on accident and emergency departments. A second MRI scanner is being provided at Beaumont Hospital and acute medical units for non-surgical patients at Tallaght, St. Vincent's and Beaumont hospitals were announced. The Tánaiste made provision for the transfer of 100 high dependency patients to suitable private nursing home care, and the scope for using greater numbers of private nursing home beds to alleviate pressure on acute hospital beds will also be actively pursued. Negotiations will take place with the private sector to meet the needs of 500 people annually for intermediate care for up to six weeks. These are older people who are awaiting discharge to nursing home care or back to their own homes with appropriate support.

Debate adjourned.