I am pleased to have an opportunity to contribute to the debate. The administration of health services has been a source of irritation to many of us over a long number of years. I am of the vintage who experienced the termination of the county health system and the beginning of the health board system, which was interesting. The late Erskine Childers is reputed to have said, "How can you unscramble an egg?" when asked whether he could go back to the original system. I am afraid the egg has been scrambled a few times since and the question of how the health services should be run has come into focus on numerous occasions in the past number of years. I served on the health board system and there was accountability, responsibility and action in response to the problems raised by elected public representatives regarding services. The major players, including GPs, nursing professions, psychiatric services, consultants and the chemists, were on board in the old health boards because it was felt necessary at the time in 1970 to ensure the major contributors would be in the same building at the same time with the same responsibility, answering the same questions, accountable to the same people and committed to the same vision. That was the case but, unfortunately, as time passed, it became awkward to administrate and questions were raised.
The leader of the Opposition was Minister when it was decided to abolish the health boards and to introduce a new system. I strongly opposed that at the time both within my party and anywhere else anybody would listen me. I am sure not many people wanted to listen to me still but I remained opposed to it for a good reason. One of the propositions advanced at the time as to why we should have a different system was a comparison made with the greater Manchester area, which has a similar population to this country. Management experts around this country and several from outside the country made contributions in which they opined that it should be possible to have a similar administrative structure to that which prevailed in Manchester. They were wrong because it was chalk and cheese as two entirely different geographical areas were involved. In one scenario, there was a compact urbanised population, which was easy to administer and in which it was possible to walk from one end of the area to the other in a few hours whereas in Ireland, if somebody attempted to walk from the south end of Kerry to the north end of Donegal in a few hours, he would find out after a short while that there is a difference and if he wanted to walk from there across to Carlingford, he would find another difference. If he then walked back down to Wexford and Waterford and around to Kerry again, he would find out there was a major difference.
My view at the time was the equation was wrong, the structures were not analogous and attempting to superimpose a similar structure in this jurisdiction would not work. The Acting Chairman, Deputy Wall, and I have discussed this many times in the past. I do not claim to the be only one right about this because many others had the same view. However, I was right and it did not work. I recall asking the first chief executive officer of the HSE whether he felt a single executive with the appropriate authority could administer the health service and he said, "I don't know". He knows now, as does everybody else. I emphasise we attempted to impose a structure that was seen to be in management circles as the ideal response to a situation but it was not because they did not know what was the situation.
Then Members experienced an issue which we anticipated on the Opposition benches where when we tabled questions to the Minister for Health and Children, we were told the Minister had no responsibility to the House. I recall refusal after refusal from the Ceann Comhairle's office. This was no reflection on the Ceann Comhairle because the prevailing advice at the time was that the Minister had no responsibility and eventually the Ceann Comhairle inquired as to whether any Minister had any responsibility. Earlier, Opposition Members complained about a lack of accountability and responsibility but I know all about that because I was here at the time, as was the Acting Chairman, and we learned a harsh lesson during that period.
I pay tribute to the Minister who knows me well enough to know that I do not pay tribute too readily. However, there has been a dramatic difference in the way questions to his Department are responded to as compared to the previous Administration. That is no reflection on the previous Administration because its members admitted they did know much of what was happening. I would like to acknowledge the major improvement in the ways questions are answered. However, it is not ideal nor will it ever be. Somebody can ask who do I think I am and what do I think should be done. I acknowledge I am not always right but, in this instance, it is beyond any shadow of doubt that those who held the same view as me all along were right but we did not wait until now to find out.
The second issue I would like to deal with is accountability and the composite bodies in the health boards at the time. Consultants, nurses, GPs, chemists and administrators, including three or four programme managers, were accountable to the entire board area. The Eastern Health Board was the largest in the State and it was possible to gain access at the highest level instantly. Those who opposed this concept said it was all wrong and it was too politician-oriented. What they meant was there was too much accountability and it was alleged that nothing could be done because politicians would not allow it. There are ways and means of dealing with that. I believe in responsible public representation as well as everybody else and it is important that when people are in opposition or government, they act responsibly. We learned during that period to try to act responsibly and that meant that the health board spent what it had and nothing more and stayed within budget. However, the budget was beginning to creep up and get out of hand. The same experience is repeated in the House every day. Opposition Members promote excessive expenditure we know the country cannot afford on a daily basis. This money would have to borrowed at high interest rates. We have to beg for this money on a regular basis from our colleagues in Europe yet Opposition Members want to spend it lavishly at every hand's turn and pretend to the people that it is possible to take actions that are impossible.
I also learned during that period about the need to respond to patients' requirements.
It is all very well to state we will provide a certain quality and level of service, including an after hours service. I compliment the outstanding cohort of people who provided these services over the years, including consultants, general practitioners, chemists and nurses, as well as many others in the health service structure. Many of them gave above and beyond what was required of them as they contributed to the sum total of the response of the health service at the time. They did very well and stand unheralded, unsung and largely unrecognised to this day.
General practitioners, who were represented on the health boards, worked extremely long hours providing clinics in the morning, afternoon and evening for six or seven days per week as they sought to respond to need. They showed the vocational calling that is found in education, politics, the health service and across the public service. Unfortunately, this calling is disappearing at an alarming rate. I hope it will be rediscovered in the not too distant future because it is essential and central to the delivery of health services. I acknowledge the quality and commitment of the general practitioners and consultants who worked in the period following the 1970 Act. They did very well in providing what was needed in response to the needs of people.
Time moves on, however, and we must proceed to a different scene. The entire Health Service Executive structure must be abolished and the Minister for Health held directly responsible to the House for the functioning of the health service. The Minister of the day should answer questions in the House, as the current Minister does to a large extent, although many questions are referred to the HSE for direct reply for understandable reasons. For many years, while the Acting Chairman, Deputy Jack Wall, sat alongside me and many others on the Opposition benches, we had to put up with appalling nonsense in this regard. To discover now that the current system has its critics on the Opposition benches is equally alarming.
In any event, the system should be transformed and the old health board structure reconstituted, albeit with fewer health boards. Given the different requirements and demands in urban areas, such as the greater Dublin area, and large rural areas, it is not sufficient to concentrate services in more densely populated areas. Every citizen is entitled to a fair degree of service under the Constitution and to provide for anything else would be wrong. The current HSE structure should be abolished and replaced with a new structure. The new system should be centralised with a budget that is determined on the basis of submissions received from the various constituent health boards. These boards should be given responsibility for running the health services in their respective areas. The public and private sectors must not trip over each other and become involved in turf wars or financial wars. They should focus solely on delivering services to members of the public.
Public representation should be part and parcel of the new system. Local authority members should be represented on the new boards, as should Deputies and Senators for as long as the Seanad remains in place, which is a matter for the people to decide. General practitioners, consultants and the nursing and pharmacy professions should also be represented. All the professions involved in the delivery of health services should have a role in the health boards, which should be charged with the responsibility of delivering services. The boards must be accountable and do their business in a responsible manner. This would present a serious challenge for politics, citizens and our European partners. Those of us who examine what is taking place in other EU member states will note a tendency to resile from reality and pretend that things will go away if one ignores them. Nothing goes away, which means we must accept responsibility, even if it means telling citizens that we do not have enough funds to do the job they expect of us or that we must do the job in a way they do not expect.
Major economies can be secured in the health services, especially in the area of procurement. During my time as a member of a health board, we did an exercise on generic prescribing which resulted in substantial savings. Some of the opponents of moves towards generic prescribing were Members of this House, with certain Deputies voicing in a highly loquacious manner their opposition to the proposal. While they must have had reason to be so impressed with the argument for continuing to use branded products, the basis for their position was not made clear. We proved our point and our solution was workable.
We also set about determining in which European countries prescriptions were most economical. We decided to use Spain as a template for achieving the best solution available to us for Irish citizens and it proved highly effective. Subsequently, a certain Minister, whom I will not name in the House, decided that the health services were costing too much, were too democratic and were subject to too much intervention from the various constituent bodies. As a result, it was decided to abolish the health boards and establish the Health Service Executive. What a disaster. Not alone did this decision not save money, as originally intended, and not alone was the Secretary General of the Department moved sideways during the machinations that took place at the time, but the cost of the health service subsequently increased to an unprecedented extent. I will hold the view that abolishing the health boards and replacing them with the HSE structure was an appalling disaster until the day I die. In doing so I do not mean any disrespect to those who were given responsibility for the HSE structure and the many thousands of health professionals who were condemned to work within it. It is, however, a serious condemnation of those who determined that the HSE structure was an appropriate way to run the health service.
Having exchanged views with me on the matter many times, the Acting Chairman will be aware of my strong views on the health service. The Minister is aware that some Deputies have serious concerns about the governance of the health service. I hope the current proposal will be reviewed and revised and a structure will be established similar to that which I have suggested. While I do not claim to be the only authority in this business, I spent 20 years on a health board for my sins - I must have been very sinful - during which time I learned a great deal and met many of the great people who forged the structures for the delivery of health services. They were trailblazers in medicine who did a tremendous job in addressing people's concerns.
The health board structure may have required some refinement but it was an excellent structure. The Government of the day, in an extraordinary intervention, decided to increase the number of health boards to eight and, subsequently, to 11.
