Dan Neville
Question:85 Mr. Neville asked the Minister for Health and Children the democratic accountability built into the proposed health service reform programme to remove public representatives from health boards. [217858/03]
Priority Questions. - Health Service Reform.
Both the Prospectus and Brennan reports recommended considerable changes to the current governance of the health system. The Government has accepted the argument made by Prospectus regarding the complete abolition of health boards and the Eastern Regional Health Authority.
As we have an Exchequer-funded health service with centrally determined resourcing decisions, Oireachtas Members should have a responsibility to ensure that there is a match between funding of services and national priorities. Democratic input would 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 Oireachtas Joint 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.
The Deputy should also note in this context that Prospectus also emphasised the need to strengthen existing arrangements in relation to consumer panels and regional co-ordinating and advisory committees in representing the voice of service users. These groups, which include patients, clients and other users, or their advocates and families, work to provide a bottom-up approach to understanding the needs of the groups at regional planning level. These existing models are at different stages of development and will continue to be enhanced.
I thank the Minister for his informative reply. Democratic accountability is an important part of this issue. The Minister is aware of the enormous input of the two Ministers of State, Deputies Tim O'Malley and Callelly, to their health boards as representatives of their association and the people. I have worked on a health board with Deputy O'Malley and I am aware through the association of health boards of the work of Deputy Callelly.
Does the Minister accept that democratic accountability is important and that the views and concerns of ordinary people must be brought to the notice of the controllers of the delivery of the health services? However the present arrangements may be criticised, health board representatives became knowledgeable about the workings of the system and were of great help in bringing the views, concerns and difficulties of the people to the knowledge of the management of the health board system. This was an important input, despite the criticisms we have heard. Will the Minister confirm that there will be a mechanism for this important input at local level? Will local information on how patients and people experience the delivery of the service be brought to the attention of whatever body is eventually in control? Does the Minister accept that while it is important to consult the consumer panels, they are not democratically elected?
An important point I keep reiterating as I travel around the country to talk to the employees of the various health boards is that the health strategy was the basic starting point for the structural analysis and the new construct which has emerged. We did not start out, and Prospectus did not start out, with a pre-ordained notion that we must get rid of public representatives from the boards or that we must abolish certain boards. If that was the case we could have done it two years ago and carried on. What happened was that a new construct emerged of which the boards were not a part. If one agrees with the National Hospitals Office, with which most parties seem to agree, one immediately takes about 50% of the activities and budget away from the existing health board structure.
I am asking for a continuation of the democratic input in the new structures.
I will come to that. We will endeavour to facilitate the articulation of public representatives' views on the health service, both at regional and national level. It is already facilitated at national level in the form of the Oireachtas Joint Committee on Health and Children on which we will take feedback. At regional level we will facilitate the articulation of issues pertaining to health and will have a consultation process which will facilitate the presentation of plans etc. to public representatives in a given region, on an ongoing basis, regarding planning, implementation and how things are working out.
Some political representatives have a view on the consumer panels. Perhaps the wrong term was used but they are one of the better innovations of recent times where—
I do not have a problem with them.
—the users of services would have a direct say in terms of the shaping of those services and how they respond to those who need them. To be blunt, it could be better at times. The development of advocacy in mental health—
Mental health was not mentioned in either of the two reports.
The strongest voice we have heard in recent times about mental health has come from those who have used the services over the years. They disturbed us, provoked a response and were powerful. What we are trying to do with consumer panels is use people who have direct experience of disease, conditions or a particular issue such as disability, mental health and old age, and bring them in with officials and with those who administer and take decisions to guide them and give them the direct fruits of their real life experience of these situations. That is a good and positive measure. It got a bad start when the idea of consumer panels was originally launched in the health strategy. Public representatives seem to take the view that it might represent the professionals at committees, but it is primarily for those who use the services who can bring a distinct voice to the table.
Caoimhghín Ó Caoláin
Question:86 Caoimhghín Ó Caoláin asked the Minister for Health and Children when the interim health service executive board and the national hospitals office will be established. [217825/03]
The Government has already identified the need to make an early start on the reform programme and, in particular, the prioritisation of the reform of the hospital sector. Therefore, it has been agreed to establish the interim board of the Health Service Executive and its hospital wing, the National Hospitals Office, on an administrative basis in the autumn. The appointment of the interim board for the HSE will help to expedite the overall reform process and, coupled with the establishment of an interim national hospitals office, will allow particular tasks in relation to the reform of the acute hospital sector to be advanced. It is my intention to establish both interim structures in the autumn.
Deputy Neville's question touches on mine and the responses I have heard do not satisfy me or alleviate my concerns. The establishment of the Health Service Executive and the National Hospitals Office are key elements in the Government's so-called reform programme. I use the word "so-called" because all it provides for is bureaucratic change. There is, as yet, no signal led determination to challenge the real problem which is at the core of our health service, namely, the perpetuation of the two-tier delivery of health services, and particularly hospital services. Will the Minister tell us the composition of the HSE board and the National Hospitals Office and whether these boards will include democratically elected public representatives and representatives of health service users? Will there be guaranteed and effective representation for patients who are suffering because of the mismanagement of the health services or will there be a regrettable perpetuation of the dominance of health service professionals on both of these bodies?
The composition and disciplines of members of the boards have not yet been decided upon. However, the guiding principles have. We do not envisage a representational model for the Health Service Executive or the National Hospitals Office. Rather, we will fit the right calibre of person with the tasks set for both bodies. They will not be unwieldy bodies. If we went down the route of picking one representative for every particular interest group, we would end up with a large body, which would not be a good managerial model. The Health Service Executive board will be charged with management of the health services nationally and the people on it will be required to have the appropriate expertise to undertake that task successfully. The same will apply to the National Hospitals Office.
When I was talking about the input of patients and users of services, I envisaged that would happen primarily through the consumer panels that will be established at various levels throughout the structure.
The Minister's reply confirms that democratically elected public representatives will not participate on the boards of these bodies and the position in regard to the service users representatives is equally unacceptable.
What role will the HSE board and the National Hospitals Office have in regard to the drawing up of new contracts for consultants and will they have such a role in their interim designation? Does the Minister agree that new contracts for consultants are essential if we are to tackle the two-tier system which operates in our public hospitals whereby private care is delivered by piggy-backing on the public health care system? We need consultants in our public hospitals who are absolutely dedicated to providing public health care services.
On the occasions I have met the Minister on issues concerning the North-Eastern Health Board, of which I am a member, with hands outstretched, he has bemoaned the fact that he has had a restricted input in determining the configuration of health and hospital care delivery. In what he has outlined to the House today, the Minister does not appear to be grappling with that reality. The electorate returned the Government and the Minister has been democratically appointed.
An Leas-Cheann Comhairle
Does the Deputy have a question?
There is no indication from the Minister that he will retake the reins in regard to health care delivery. Rather, it looks like there will be another tier of people on boards, like those on the National Roads Authority, to whom the Minister will be able to deflect questions.
An Leas-Cheann Comhairle
I must remind the Deputy that this is Question Time.
The Minister may say that particular questions are not appropriate to him and may direct them to the boards of the Health Service Executive or the National Hospitals Office. He can claim that it is not a function of the Minister to be accountable on the floor of the House.
An Leas-Cheann Comhairle
This is Question Time, Deputy.
The Minister must be accountable on the floor of the Chamber.
An Leas-Cheann Comhairle
That concludes Priority Questions. We have exceeded the time allocated.
Will the Minister indicate what he is prepared to do?
An Leas-Cheann Comhairle
I ask the Minister to deal with Question No. 87.
I do not believe any Minister for Health and Children should be responsible for the management of every single hospital.
The Minister is accountable.
An Leas-Cheann Comhairle
The time for Priority Questions has concluded.
In response to the long question which Deputy Ó Caoláin put, the Health Service Executive will be responsible to the Minister for Health and Children and the Minister will be responsible to the Oireachtas. If the National Hospitals Office develops a comprehensive national plan in terms of the configuration of services nationally, that would have to come before the House.
An Leas-Cheann Comhairle
The Chair is now calling Question No. 87.
Will the Minister be accountable in the Chamber?
The Deputy has hogged the floor for the past five or six minutes and I have not had an opportunity to respond.
On a point of order, there was a procedure in the House whereby when Priority Questions went over time, the question under dis cussion became an ordinary question and other Deputies could contribute.
An Leas-Cheann Comhairle
That is no longer the rule. It is past tense.
It has ceased to be. The Deputy should ask Deputy Stagg about the matter.