Vol. 421 No. 5
7 Mr. Howlin asked the Minister for Health if he will make a statement on the up-to-date position in regard to the implementation of (a) the report of the Commission on Health Funding, (b) the Kennedy report, and (c) the Fox report, with particular regard to progress made in the reform of administration, and the reform of admission procedures; whether he has decided on any legislative reform arising from these matters; and if he will make a statement on the matter.
The report of the Commission on Health Funding was a very comprehensive examination of a wide range of aspects of health policy including funding issues, eligibility for services, organisational structures and accountability. The report, and the consultation process which followed its publication, provided a most important input to the Government's decisions in these areas and to the preparation of legislation on foot of these.
The Health (Amendment) Act, 1991, is already in place and has restructured eligibility for health services in line with the recommendations of the commission.
As announced in September last, legislation is now being prepared to implement the Government's decisions on the reorganisation of health services in the Eastern Health Board area and the improvement of accountability in the health services in general. It will also address the need for greater clarity in relation to the respective roles, relationships and accountability of the other health board memberships and their chief executive officers. I intend to bring the legislation before the House in the course of this year.
The Dublin Hospital Advisory Group who were established in September 1991 have been actively pursuing the implementation of the good practice recommendations contained in the Kennedy reports. The group are at present focusing on the recommendations in relation to out-patients services.
With regard to the Hospital Efficiency Review Group — Fox report — a hospital value for money steering group — who include two assistant secretaries from my Department — have been established to progress those recommendations which are amenable to immediate intervention. Appropriate action is ongoing with the full support of the relevant hospital chief executive officers, secretaries and managers.
I thank the Minister for his reply. A hallmark of his immediate predecessor was the establishment of committees to report. At one time there were 21 separate committees investigating various aspects of the health services. Surely it is now time to take direct action rather than cosmetic action.
Does the Minister accept the kernel of the report of the Commission on Health Funding — which has been on the Minister's desk since September 1989 — that the problems we face with the health services are matters to be dealt with in the manner in which those services are planned, organised and delivered? Would the Minister say what fundamental change he intends to bring about in the way our health services are planned, organised and delivered? What is the Minister's attitude to the specific recommendation of the commission for the establishment of a health services executive? Surely he has had adequate time to formulate an opinion?
My third question relates to the Minister's own proposal, one of very great importance in relation to patient's rights, that is the patient's charter. Would the Minister confirm that the patient's charter, as announced by him, will make no impact on waiting lists or the quality of care patients receive unless it is underpinned by legislation? Is it his intention to legislate for a patient's charter so that people will know where they stand and have a legal framework within which they can vindicate their rights.
The manner in which the health services are planned, organised or delivered is a question to which we are addressing ourselves with particular regard to the new structural arrangements for the Eastern Health Board area, which, in turn, will impact on the other health boards nationwide. Second, under this new proposal, the Department will shift their focus of attention from managing and involving themselves in the everyday affairs or running of the health services, to policy decisions. I and my predecessor found that the Department were overly involved in certain aspects of the health services in which they should not have been involved, resulting in policy being overlooked. As the Deputy rightly said, there is need for planning, organisation and delivery of the health services, which can be done only within the structures we propose and which was one of the recommendations of the Commission on Health Funding. I am not too sure yet about a health services executive. I wish I had an answer as to whether this constitutes the best resolution of the problem. I will be studying the matter throughout the summer months.
There has been a consultation process engaged in vis-à-vis the patient's charter which is almost completed. The Irish Congress of Trade Unions made a very important contribution when I met them a few weeks ago. The patient's charter is almost finalised and will be published very shortly. I am not too sure whether such a patient's charter should have legislative weight. Its main purpose will be to educate patients about their rights. I think there will be public pressure to ensure that that patient's charter is respected and obeyed by hospitals. I do not think it will need legislation. I did bear in mind what the Deputy said about a health ombudsman. If we observe that the patient's charter is being ignored by hospitals then we will certainly give active and serious consideration to the establishment of a health ombudsman.
I thank the Minister for reflecting on the suggestion I made when we dealt with health questions on a previous occasion in relation to the establishment of a health ombudsman, which would constitute a solution. I am disappointed at the Minister's present fundamental attitude to the re-organisation of the health services. The commission report reveals a confused, disorganised, inadequate accountability and inadequate integration of the services. The Minister suggested today that now he is going to look at the Eastern Health Board and see how that impacts on them. Will he accept that we need a comprehensive change and overview in relation to the planning, organisation and delivery of health services? That is what the commission were set up to do and what they recommended. Now, several years on, no significant changes have occurred. Is the Minister happy to tinker around with the system or is he going to take major initiatives that will change the 1970 Health Act fundamentally?
Let us not forget the need for the utmost brevity when dealing with priority questions.
I would like to answer Deputy Howlin. He will understand that the decision was made last September, that new structures would be put in place in the EHB. I have been looking at this and I have seen the results of consultations and submissions from various bodies interested in the health services. This is no mean task. I agree with what has been said and I went into the Department with that kind of thinking but now I must face up to what is happening. That is why I said I would apply myself to this throughout the summer to see what is the best course to take. I am conscious that the restructuring of the EHB is at an advanced stage, but I must look at it very closely over the summer. I hope to come back with a positive answer in the interests of the health services.
