Dáil Éireann debate -
Thursday, 9 Oct 2003

Vol. 572 No. 2

Ceisteanna – Questions. Priority Questions. - Health Reform Programme.

Liz McManus

Question:

2 Ms McManus asked the Minister for Health and Children the steps taken to date to implement the recommendations of the Commission on the Financial Management and Control Systems in the Health Service; if he has satisfied himself with the progress made to date; if his attention has been drawn to the criticism made by a person (details supplied) in regard to the failure to take speedy action on foot of a report; when the implementation body will be established; if it will have an independent chairperson, as recommended; when the HSE will be established; the way in which these bodies will be funded for 2003; and if he will make a statement on the matter. [22645/03]

Mr. Martin

The health 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 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 on system reform. 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.

The Government agreed that to succeed it would be necessary to clearly set out the Government's vision of reform to all within the existing health system, including board members, staff and staff representatives. This engagement was undertaken as a vital first step in the implementation process. This is the process on which we have been engaged in recent months.

The Secretary General and I briefed every senior manager of every agency in the system in the days after the Government's decision. There followed a visit to every health board area, meeting large numbers of staff and board members. The Department commissioned the office for health management, OHM, to conduct an information and consultation exercise to reach as many people and agencies as possible in the system. Over 20,000 staff were directly engaged with throughout the summer months and into September. The draft report of the OHM is currently with the Department and will be made public shortly.

Overall co-ordination of the change programme is supported by a project office, led at assistant secretary level, which reports to the Secretary General of the Department. Output to date from the project office includes a draft project plan for the reform programme, identifying manageable phases of implementation, and the establishment of 13 action projects to advance specific elements of the programme by end of year.

The next steps will involve the appointment of a national steering committee to oversee the implementation process as well as the establishment of a board for the interim health service executive, HSE. I am considering possible nominees for both bodies at the moment. I intend to report back to Government shortly with proposed appointees, in consultation with the Minister for Finance, Deputy McCreevy.

The reforms will require legislation to implement them. Work has commenced on the preparation of this legislation, which will provide the statutory basis for the establishment of the new health service executive and related structures. The new legislation will also incorporate other legal changes required and my aim is to introduce the necessary legislation next year. I am satisfied that the preparatory work on which we have been engaged has been undertaken with the appropriate degree of professionalism and urgency. This programme affects every aspect of the health system and everyone working in it – close to 100,000 people. If it is to have lasting impact, particularly for patients and clients, it must be professionally planned and executed. I am more than satisfied that the planning and initial consultation phase we have just completed will pay dividends in the longer run.

Ms McManus

Would the Minister not accept that the great promise presented to the Irish public with the launch of these reports has now run into the sand? Even the person who chaired the Brennan report has been strongly critical of the lack of progress. Could he comment on these criticisms in relation to the delay, the lethargy and the lack of commitment in terms of dealing with the very urgent issues relating to lack of management? Will he not recognise also that to leave it to Department officials and chief executive officers of health boards to devise the programme for reform in a sense is to leave it to the inmates in the asylum to get things right? These are the people who are criticised very strongly in both reports, not personally but in terms of management. Yet these are the people who appear to be in charge of any reform package. Does the Minister not accept that is simply a guarantee of failure?

What does he think of Professor Brennan's point that the implementation body needs to be headed up by an independent person and that anybody in that capacity within the health service would have a conflict of interest? In terms of his comments, could he deal with that particular issue and when the implementation body will be set up, when the interim HSE will be put in place? How are these to be funded this year since the Minister for Finance has made it clear that this is about cost cutting and cost saving rather than fundamental health service reform?

Mr. Martin

When the Government took its decision on 18 June, it then decided that the head of the national steering group would be an independent person. The Government also decided, at my suggestion, that the chairperson of the HSE would be an independent person, external to the health community. That has always been the position. There is nothing new there. To suggest that those who currently work at management level in the health service are the equivalent of inmates of an asylum is wrong, and possibly not fair to those operating within the system and structures and legislative framework they have been mandated to work within.

The Government has agreed to change that legislative framework but ultimately if you have 96,000 people in a service it is necessary to bring people with you. In terms of the partnership models we have developed in this country which have been good in terms of economic performance, productivity and so on, I believe part of our success to date is the enthusiasm that has followed the lengthy tour the Secretary General and I took right throughout July to every board. We spoke to meetings that had up to 600 people in attendance. People had concerns as to where they would fit, timetables, 'road maps' forward and so forth.

There was surprisingly little hostility to the reforms, however, or negativity about them. I take the view that many people working in the health service are enthusiastic about the reforms. This has been reflected in terms of the project teams we have established. The numbers applying who want to be part of the change and who want to lead it are significant and reflect a sense of people wanting to get on with it.

I do not accept the thesis that just because someone works in the service they cannot be part of a reform package. Given the complexity of the health service it is inevitable that people will have to be involved in terms of organising the change, transition processes and so on. Broadly speaking, the broad management of the health care system has accepted the reform package, which in essence means the abolition of the health board structure as we know it and the establishment of new structures.

Ms McManus

The Minister has not answered my question in relation to the interim bodies, the HSE and the implementation body. Does he not have concerns, if this is such an acceptable process, that the difficult decisions are not going to be made? There are clearly major problems in terms of the management and structures across the country. He set up two reviews to examine the problems. The impression he is now giving is that there are no difficult issues to be addressed and no hard decisions will have to be made, that the health service can meander along nicely and everything will be all right. That was not the impression he gave in July when he launched these reports. There was an impression of a dynamic that had taken off and but it would seem it has run out of steam already.

Mr. Martin

The key fundamental decision has been taken. The rest is operational process, detailed hard work which has to happen. We have said that we are going to change the structure. We are abolishing the existing health board structures. We are establishing a new national health service executive and reducing the number of agencies currently in place. Those decisions have been taken, but there is a huge amount of detail involved in bringing about the legislative and human resource changes, the merging of different offices etc. There are difficult decisions in the operational sense and in terms of processing—

An Ceann Comhairle

I must ask the Minister to conclude. We are well over time.

Mr. Martin

—the implications of the big decisions. However, the big decisions have been taken by Government. There is no going back in terms of the decision to fundamentally establish a new structure for the health services for the future. We are not going back on that and I expect to appoint members to the health service executive and the national implementation group very shortly.