Health Service Reform: Statements
Dr. Henry: I welcome the Minister of State. I found these two reports extremely interesting reading. I have been reading reports on the health service for quite a while now - I remember when the Fitzgerald report was issued because it resulted in my having to do a great deal of extra work. Professor George Fegan, for whom I worked at the time, was involved with the report and I remember the grave disappointment when it was not implemented, despite all the work that went into it. The Fianna Fáil Party was largely responsible for its non-implementation. So much time and money would have been saved if it had been implemented. An amazing amount of what is being criticised in the health service was actually foreshadowed in the report. It was an attempt to prevent waste in some areas.
The most important conclusion that can be drawn from both reports is that there is a dreadful information deficit in the Department of Health and Children. It will be very hard to move on unless something is done about this. Since Deputy Michael Noonan was Minister for Health and Children - about eight years ago - I have been asking for a population register in order that if we introduce a scheme, we will have some idea how many people will be involved and when they will be called for screening. When I asked for the population register to be established, Deputy Noonan was establishing BreastCheck. We then had no notion of how many women should be coming forward to be screened each year. Lists were being made up from the GMS and the VHI and people are still being left out now. The most obvious example of how important it is for us to set up a population register immediately is the medical card scheme for the over-70s, in which there were twice as many eligible to apply for a medical card than had been expected, at a huge and unexpected cost to the State. I hope a register is being set up and that this dreadful information deficit is being rectified because it is one of the most important things that needs to be done.
In both reports great emphasis is put on the fact that the health boards are to be abolished. It is right that we do this, because there are too many. Like other speakers, however, I am not only interested in denigrating the health boards. I had to leave the debate for about half an hour to go to Cherish, the organisation for single mothers, of which I am president, and give out certificates. Ever since Cherish was set up 30 years ago, we could not have managed without the support of the Eastern Health Board and subsequently the Eastern Regional Health Authority. I hope the sort of personal attention that can be given - and was given - to various problems by the health boards is not lost in this great new mechanism, because it has been very important. Cherish would not have managed without it. I went over to give out certificates to people who had done computer courses and so on and were now going into employment. Initiatives such as this need to be encouraged. I hope that with whatever mechanisms are put in place, we will be able to take account of what people are trying to do on the ground.
The Prospectus report deals with the amalgamation of various organisations. Sometimes I think I have sat on every medical organisation in the country but have now found out that there are a few on which I have not sat, such as the Poisons Commission. Some of the amalgamations seem very sensible but there are others about which I wonder. For example, the Pre-Hospital Emergency Care Council is to be combined with the National Social Work Qualifications Board. I cannot see anything these two have in common, particularly in view of the fact that the Pre-Hospital Emergency Care Council is actually getting to grips with pre-hospital care, which is improving enormously - paramedics are being trained to a much higher standard. I would have thought the council would have its hands full without taking on a lot of extra work to do with social work qualifications.
I wonder whether it is wise to amalgamate organisations just for the sake of saying there is a smaller number of them. It is perfectly sensible for the Poisons Commission to amalgamate with the Irish Medicines Board, particularly in view of the fact that it has apparently met three times in the last ten years. I would suggest that a rational look should be taken. Things should not be combined just for the sake of it and because it would look better to have a smaller number of organisations.
The situation with regard to the vested interests, the consultants, will be one of the most hotly debated topics in the entire report. Professor Brennan has been pretty harsh in her criticism of my colleagues. In one part of the report she says that there should be core times when a consultant must be available to patients in the public hospital and a formal act of monitoring work commitment in respect of public patients. Absolute categorical monitoring does not take place at the moment and if she wants to bring that in fair enough- it is not in the consultants' contract. Any time we tried to monitor each other, within the various hospitals in which I have worked, it was found that 90% of people were doing far more work than they were expected to do under their contract. Of course there was the 10% who were not doing it and we all ground our teeth about them and wondered how we could do anything because others had to carry their work. That happens in every organisation.
I am more concerned about the appallingly low morale within the health service, and particularly among the consultants and more senior nurses, than the fact that people have to be monitored. I am horrified at the hours some of my consultant colleagues work, starting at 7.30 a.m. and still there until 7 p.m. Of course there are situations where people are neglected. This can include private patients also.
A general practitioner colleague told me that his child was in hospital for five days, albeit not very ill, and not once did the consultant see the child. He did not bother doing anything about it because the child was well catered for by the registrars on duty. There will be incidences like that, so it is not just public patients who are left to one side. I do realise that, as in all professions, there are some people who do not pull their weight, but the vast majority are doing a great deal.
Much of the low morale is due to work not being done that was planned, particularly elective work. When an operation is cancelled it is terrible for the patient, but it is also terrible - particularly if it is a big operation - for the surgeon who has had to organise the entire day and arrange for a particular anaesthetist and maybe a radiologist. The waste of time involving all those people is shocking. In one of the Dublin hospitals at one stage they would phone me when there was an anaesthetist on duty but no surgeon available and vice versa. They gave up eventually as there was no point in phoning me. This type of issue is most unfortunate.
I would not concentrate too much on the public-private mix, because 50% of the population is involved in private medicine. I would not like to see the House getting bogged down on that issue.
The last thing I would mention is the drugs monitoring scheme and the use of generic drugs. I am particularly glad the Minister of State, Deputy Tim O'Malley, is here because he has a professional background as a pharmacist and we have talked about it outside this House. I have read the Forfás report on embedding the pharmo-chemical industry in Ireland and wondered if the health service was not contributing to it by the fact that the Government pays very high prices to pharmaceutical companies for drugs, which are much cheaper in other countries. The Government could do much in this regard. Of course we could buy generic drugs, although they would probably have to be branded generics. The Minister is aware, I am sure, that in Brazil, a very big producer of pharmaceutical drugs, 20 patients died recently from some sort of injectable radiological compound that was being made under totally unsuitable conditions. Six patients lost their sight owing to the effects of an eye gel which was being used in operations, probably for detached retina or something like that. We do have to be sure we have proper quality medicines.
It is important to remember that the medical profession's responsibility is to the patient, first and foremost. One cannot get away from that. It is ethically at the centre of what a doctor has to do. If doctors are being asked constantly to look at the accountancy side of things, naturally they get anxious. In neither report is the question of litigation addressed and it costs the health service in Ireland a fortune. There is four times more litigation in this country than in Britain. The awards given in the courts are four times higher than on the neighbouring island. I would like this to be addressed. I realise the Minister hopes to introduce enterprise liability on 1 July.
Officials in the Department of Health should talk to Deputy Jim Glennon who set up Medisec, a medical indemnity scheme for general practitioners. The fees for that were very small when they started, but after five years the amount of money general practitioners had to pay to be part of the scheme had to be doubled. This is one area that I am particularly sorry neither report has addressed. The Minister's Department pays a fortune for that, as he well knows.
Hospital rationalisation is essential. I have argued in this House that places such as Mullingar, Tullamore and Portarlington must get some centre of excellence for breast cancer. I am told that no woman from Mullingar or wherever will have to travel. This attitude must be overcome because we cannot have MRI scans at every crossroads.
I thank the Minister. I do hope something happens as a result of these reports. I have seen so many reports which have not led to action that I am just a bit pessimistic.
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