Dáil Éireann debate -
Tuesday, 24 Jun 2003

Vol. 569 No. 3

Written Answers. - Legislative Programme.

Dan Boyle

Question:

128 Mr. Boyle asked the Minister for Health and Children his views on the fact that the structural reforms proposed within the Brennan and Prospectus reports will result in the centralisation of health services, remove them from any kind of meaningful democratic control and strengthen the tertiary level of health services at the expense of badly needed, community-based, primary health care services; and if he will make a statement on the matter. [17626/03]

Minister for Health and Children (Mr. Martin)

The health service reform programme was announced on 18 June 2003. The programme's priority focus is improved patient care, better value for taxpayers' money and improved health care management. The reform programme has drawn on the conclusions and recommendations of the two reports, the Commission on Financial Management and Control Systems in the Health Service and the Audit of Structures and Functions in the Heath System, which were also published on the same day. The Government considered the recommendations made in both reports and has decided on a number of priority actions to move forward system reform.

These key actions are: a major rationalisation of existing health service agencies to reduce fragmentation, which includes the abolition of the existing health board-authority structures; the re-organisation of the Department of Health and Children to ensure improved policy development and oversight; the establishment of a health services executive which will be the first ever body charged with managing the health service as a single national entity and will be organised on the basis of three core divisions, a national hospitals office, a primary, community and continuing care directorate, a national shared services centre; and the establishment of a health information and quality authority to ensure that quality of care is promoted throughout the system.

The new structure set out in this reform programme will provide a clear national focus on service delivery and executive management. It will achieve this through reduced fragmentation and the creation of clear and unambiguous accountability throughout the system. This is not a centralisation of services but a streamlining of the management of the system to create greater efficiencies.

I also reject the Deputy's contention that the reform programme structures will in any way damage community based services. On the contrary, Prospectus saw this structure as optimal in terms of allowing the primary care model the opportunity to develop and grow. It also saw the advantage to be gained in distinguishing between acute and primary, community and continuing care, stating that this structure provides the opportunity to "reflect the declared priorities of strengthening primary care and reforming the acute hospital sector; allow recognition of the different management demands of each sector in terms of scale, technology, organisation type and delivery mechanism".

In addition, in the areas of primary, community and continuing care, the reform programme provides for a strengthening of existing community care structures. I have already indicated on a number of occasions that services will continue to be delivered through these local health office networks but they will operate within a fundamentally realigned national management structure providing a proper framework within which all primary, community and continuing care services can be integrated.

In respect of the issue of democratic control raised by the Deputy, we have an Exchequer-funded health service with centrally determined resourcing decisions. Therefore, Oireachtas Members should have a responsibility to ensure that there is a match between funding of services and national priorities. Democratic input could best be represented at regional level through at least twice yearly meetings with the director of the regional health office and his or her senior management team, together with other members of the HSE or its offices, as appropriate. This mechanism is advanced as complementing and reinforcing the role of the Joint Oireachtas Committee on Health and Children in reflecting the views of public representatives in the ongoing oversight of the health system. The emphasis is on ensuring that democratic input at regional level should focus on the delivery of national priorities. I have agreed to bring more detailed proposals to Government on the representation arrangements following the completion of the communications process over the coming months.