I support the amendments and reiterate my concern about the legislation's lack of accountability. While views have been expressed about over-accountability in the old system, it provided public representatives with an opportunity to present cases and raise issues at health board level. In that way they could publicly obtain a response from the executive. That possibility has now been removed. In fairness to the Tánaiste, she said on Committee Stage that she was concerned about this matter. She also said that the issue of accountability through representation would be addressed by the new executive. While we can take her remarks at face value, I would like to hear how this will operate in practice.
I envisage a situation in future where we will be refused information from the Health Service Executive that will feel it is all-powerful and that its work is not accountable to individual politicians, parties or even the Dáil. The executive will only be accountable according to the provisions of the Bill. We need to be in a position to quote the views of the Minister as regards people's aspirations and representations being heard at every level, including local level. Once accessibility, including the freedom to express views, concerns and complaints, is removed, public confidence in the health service will diminish. Regardless of the difficulties involved, including waiting lists and accident and emergency problems, there is a connection between the public and the health service in hospitals and community care centres. Will that connection be removed over time by failure to respond to public concerns about health services? If so, it would be a serious development because the Health Service Executive would be seen as inert, unconcerned and unresponsive to public needs. We must have a health system in which people's humblest concerns can be expressed and responded to.
Some people may say that waiting five hours on a trolley is of no concern because others have to wait for 20 or 30 hours. For a person whose survival is at stake, however, that five-hour period would be of extreme concern to them and their family. We should be in a position to express such concerns on behalf of patients but will the new system allow for that? To be fair, there is a certain level of response at present, depending on the attitude of the chief executive, deputy chief executive or hospital manager concerned. I accept there is a lack of consistency in such responses but at least people's names are known and information can be obtained immediately.
People need to know what is happening in the health service and understanding attitudes are required. If someone is waiting on a trolley in distress for five hours and his or her family is concerned, the hospital may have another side to the story. When the hospital's viewpoint is expressed to a patient and his or her family, while it does not remove the health problem, it provides them with a better understanding of the difficulties experienced within the hospital. This will now be removed as a result of this legislation. On Committee Stage, the Tánaiste said it would not be removed, but I see no evidence of that.
Currently, if I make inquiries concerning the future development of national primary or secondary roads in my constituency, I receive only vague information. We are told the Government has a policy on this, that or the other, but my constituents want to know when something is happening. I cannot obtain the relevant details, however, because the National Roads Authority takes its policy from the Minister and the rest of us can wait. I rarely contact the NRA because there is no point in doing so. Prior to the establishment of the NRA, councillors could obtain such information from their local authority. In 99% of cases the county manager or the executive responsible would be only too happy to communicate as much information as possible. We seem to be going in the opposite direction with this Bill. The Tánaiste has heard these concerns but it is only right to reiterate them on Report Stage.
What is the position regarding the availability of Ministers and the Health Service Executive to appear before the Joint Committee on Health and Children? Last March, the committee sought a meeting with the Minister for Health and Children. We were supposed to see him before the summer recess and again in October, but did not. In the meantime, a new Minister was appointed and we were supposed to see her this morning but we could not do so. The Minister said she had to take the Health Bill in the House, which is fair enough, but she has a team of advisers. While we have no advisers, I was prepared to be at the meeting with Deputies Twomey, Cowley and McManus. At this rate, we will probably meet the Minister on the anniversary of our request for a meeting, which is only two months away.
I want to know how concerns and complaints about administrative issues will be dealt with under the terms of the Bill. I asked a question on Committee Stage about raising concerns regarding clinical decisions, but such a process is not envisaged in the legislation. If a patient is concerned about a clinician or a clinical decision, it cannot be raised under the provisions of the legislation.
The Minister is familiar with a report that I obtained and discussed in the House, in which an independent body expressed significant concerns about clinical decisions in regard to a patient in a psychiatric unit. The patient's family had already expressed serious concerns, which were borne out by the report. One issue highlighted in the report was the failure of a clinician to read a report indicating that the patient was suicidal and in need of constant care. The report also heavily criticised the situation whereby the admitting psychiatrist, who was responsible for making decisions about the treatment of this adult patient, had only three months' experience in child psychiatry. The report also observed that the nursing staff in the hospital failed to read the patient's notes on admittance. These are only some of the issues highlighted in the report. There were ten in total and I could point to 100 more because of my contacts in this area.
Can these types of issues be raised by a concerned family in a similar situation under the provisions of this Bill? Unfortunately, we will probably not have time to discuss the relevant provisions today. It is inadequate for the Minister to say that there is a professional body, such as the Medical Council, to which patients can address their concerns. A distressed person, such as one who has lost a family member through suicide, cannot be asked to go through a complicated and remote procedure to access a body representing the medical profession. An ordinary person with a grievance wants to communicate his or her difficulty to a local public representative, community advice centre, GP or some other local person whom they trust and who can access the relevant information. In most such cases, I can obtain a response from the relevant director of services, deputy chief executive officer, hospital manager or another relevant authority. The response is generally immediate or may take two or three weeks if an issue must be investigated.
This system provides some level of satisfactory explanation. However, it seems that inquiries regarding the decisions of clinicians cannot be made under the new complaints system in which the Tánaiste has expressed such confidence and which she compared on Committee Stage to the service given by the Department of Social and Family Affairs. Such a system does offer a level of service and we will be pleased if all queries and concerns regarding the operation of hospitals, community care and all other health service provisions within our area can be addressed. However, if members of the public see that their local Deputies or other significant persons have no role in communicating their concerns and obtaining speedy and detailed responses, a situation will develop whereby people will lose confidence and understanding and become frustrated with the health service. They will conclude that it is pointless to complain and that they must suffer in silence. It is in such circumstances that grievances fester.