Vol. 572 No. 2
4 Mr. Neville asked the Minister for Health and Children the steps he has taken to implement the reforms outlined in the reports, Audit of Structures and Functions in the Health System and the Commission on Financial Management and Control Systems in the Health Service. [22644/03]
Organisational reform was a key framework for change proposed in the national health strategy with the aim of providing a responsive, adaptable health system, which meets the needs of the population effectively and at affordable cost. To this end action 114 of the strategy provided that an independent audit of the structures and functions of the Irish health system would be carried out. Prospectus Strategy Consultants were commissioned to carry out the audit in 2002.
In his budget statement in December 2001 my colleague, the Minister for Finance, Deputy McCreevy, indicated that a commission would be established to examine, evaluate and make recommendations on the relevant financial systems, practices and procedures throughout the health services. In April 2002 the Commission on Financial Management and Control Systems in the Health Service was established. Both reports were published on 18 June and both concluded that the system was highly fragmented with overlap and uncertainty in terms of who was responsible for services delivered. This fragmentation means the system is increasingly hard to manage as a national service.
The Government made key decisions relating to reform of the health service. The key elements of the programme include a major rationalisation of existing health service agencies to reduce fragmentation, including the abolition of the existing health board and authority structures; the reorganisation 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, the executive of which will be organised on the basis of three core divisions, a national hospitals office, a primary, community and continuing care directorate and a national shared services centre; the establishment of a health information and quality authority; the modernisation of supporting processes; and the strengthening of governance and accountability across the system. In an earlier reply I detailed the steps that I have taken on the implementation of these reforms.
The Secretary General and I briefed every senior manager of every agency in the system in the days after the Government's decision. More than 20,000 staff were directly engaged over the summer months with the Office of Health Management in a very detailed consultation exercise.
Additional InformationThe 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 establishment of 13 action projects to advance specific elements of the programme by end year.
The next steps will involve the appointment of a national steering committee to oversee the implementation process and the establishment of a board for the interim health service executive. I am considering possible nominees for both bodies at the moment. I intend to report back to Government in the coming weeks with proposed appointees, in consultation with the Minister for Finance.
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 will be 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 – almost 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.
Does the Minister agree that the public have lost confidence in all reforms as they see no tangible improvements – as discussed earlier, there are disimprovements? There is a view that we will get more reports and information but no real reform. How many positions will be abolished under the health services to ensure that improvements take place? Does the Minister not agree that there is more centralisation at a time when more countries are discovering that centralisation simply does not work? Does he agree that his decision to abolish the health boards is the only decision he has taken so far?
Given the need to implement the European working time directive, Ireland's non-consultant doctors' working hours will have to reduce to an average of 58 hours per week by August 2004. If that is not done Ireland will be liable for a fine of €10,000 for each day the directive is breached. What proposal has the Minister to ensure we meet that directive?
I do not accept the Deputy's contention on the reform programme. Reform is going to happen. We have made the decisions, not just about abolition of health boards; it is a major contraction in terms of the numbers of agencies. Both reports took the view that there was a multiplicity of agencies within the health service which had grown up over the previous decade or so.
It is not just one particular dimension that is being examined, it is an integrated programme of reform. Announcing reform and organising the detail of that reform are two different things. One needs to set up a process by which the reform can happen realistically and professionally. We need realism in that.
We have put in a professional process to bring about the detailed change that will underpin the reform. I make no apology for engaging in a very wide consultation process. I said on 18 June that I would do this and that there would be three months' consultation with the stakeholders in health. If I did not do that I can guarantee that Priority Questions Nos. 1-3 today would be inquiries from Deputy Neville as to why the Minister did not consult with staff and workers in the health service and claiming it is a disgrace that he did not do so.
The workers and the stakeholders in the health service have done a very good job in terms of delivering services on the ground. They are entitled to be consulted on rolling out the reform programme, their concerns and views.
No one said otherwise.
The underlying assumption in the question is that we should not bother consulting the people on the ground.
The Minister has been six years in office with nothing to show for it.
We have no problem with the Minister consulting. Of course he should consult but at the same time he should implement the change that is necessary. He should also be consulting with the patients who are denied the service and are being treated in hospital yards and car parks. They need to be consulted too.
Hear, hear.
When will this happen? We want to know when this service will change. The Minister should do his consultation in the meantime. We want no more reports, we want action. When will these reforms happen?
The Minister may reply very briefly.
They want medical consultation, not political consultation.
These are Priority Questions.
The most recent independent survey of patients who use Irish hospitals suggested that well over 90% were satisfied with the treatment they received in hospital.
When they can get in.
Those are the ones who got in.
The Opposition Deputies always have difficulty quoting independent data about patient satisfaction.
People are vulnerable when they are in hospital.
The Minister is missing the point.
That is not to say that other people have not had difficulty and bad experiences with the service.
The Minister has been missing the point for four years.
Question No. 5.
The Minister is getting into trouble. The Ceann Comhairle had better call the next question more quickly.
We should also acknowledge that independent data show that many people have had good experiences in Irish hospitals and we should articulate that from time to time.
The Chair has called Question No. 5
5 Mr. Gormley asked the Minister for Health and Children the legislative package he intends to introduce to implement the new health reform strategy; when this legislation will come before the Cabinet and the Oireachtas; and if he will make a statement on the matter. [22744/03]
There may be some repetition here. I have outlined to this House in some detail the scale and scope of the reform programme in the health sector. This programme affects almost every aspect of the system, in terms of structures and in terms of governance, accountability, planning, monitoring and evaluation.
It has implications for every organisation in the system and, of course, there will be new structures in some cases. Inevitably, this will require a fundamental reform of the existing statutory provisions for the roles, functions, organisational structure and management of the health system.
In line with the Department's approach on the reform programme, an action project has been established to prepare this legislation, which will provide the statutory basis for the establishment of the new agencies, consistent with the Government decision on the implementation of the Brennan and Prospectus reports recommendations. The new legislation will also incorporate any other consequential changes which may be necessary to give effect to the new reformed health system. It will also incorporate legislative proposals arising from the other action projects. I envisage that I will be in a position to introduce the necessary legislation next year.
The Minister is right, the reply is somewhat repetitive. I want to know when this Bill will appear on the list of promised legislation so that we can hold him to account. It is still not on the list, as he knows. Perhaps I can be repetitive and ask the Minister, as Deputy Neville did, how this reform package will result in savings. Would he agree that the reform programme will not deal with the real problem in Irish hospitals, which is capacity? Is he aware of the recent state ment by Dr. Colm Quigley, President of the Irish Hospital Consultants' Association, that no matter how one redesigns a litre bottle it is still a litre bottle? How are he and this reform package going to deal with the capacity problem? Is it not really a matter of investment and is it not the case that he has failed to convince the Minister for Finance, Deputy McCreevy, to invest more in our health service?
I would like the Minister to react to the statement by Mr. Maurice Neligan that the services are now in such a state of chaos that the Minister should resign.
That is not going to happen. Like a Buddhist monk, he will go into the woods and burn himself.
Since Deputy John Bruton's arrival I am having great difficulty trying to speak but I admire his enthusiasm. In the context of the reform package—
It goes with youth.
These are Priority Questions.
Eternal youth.
Hope springs eternal.
As a man of great experience, Deputy Bruton knows that in a matter—
This question is in the name of Deputy John Gormley.
A matter so fundamental as a new health Act is not produced in a matter of three months. There is fundamental change in the legislative underpinning of health for the future. That is envisaged by the health reform package, and as I said in my reply, it will be next year before the full outline of that new Act will be ready. We have appointed people specifically to look at the legislative framework because when one dissolves some organisations one creates others and one has to look at the sets of relationships between them and the Oireachtas and the Executive, and the remaining agencies within the service.
If the Deputy reads the Prospectus Report he will see that it points to the complexities in any health system globally. It says in particular that this is a major undertaking in terms of reform of this health package. It cannot be understated and therefore needs a considered, detailed and planned approach to its execution. That is what is in hand. Prior to the drafting of the legislation we will appoint an interim health services executive board which will prepare the ground for the appointment of a chief executive officer and other officers and will put out the fledgling board itself. In tandem with that, the legislative work will continue.
No one ever said we would achieve this under a new health Act in four or five months. We all have enough experience in this House to know that even legislation far less significant than this has taken a considerable time to prepare, draft and pass through the Oireachtas.
Whether the issue is investment or capacity—
Capacity.
—no one can argue with the fact that in recent years we have secured very significant additional funding for health, particularly since 1997, rates far above those of any other country's annual rates of increase and investment. Health covers much more than acute hospitals. It includes disability, child care services, the elderly and homelessness. That said, the increase has been staggering by any yardstick and has brought significant improvements in service.
Capacity is still a problem.
Capacity has also increased in many areas. We need both investment and reform. It would be wrong to say—
What about the James Connolly Memorial Hospital?
This is a Priority Question.
It is wrong to say that it is just investment. We need to reform the way we do things in the health service. It is a combination of both. We need ongoing investment. Of course, we also need economic growth conditions to facilitate and supply that investment.
I am concerned that the Minister is not addressing the capacity problem. I also have another concern which I ask him to address: Will this result in less accountability? Will questions be disallowed on the basis that they are not a matter for the Minister for Health and Children but for the health services executive? Is this a way of passing the buck?
Already, the stock reply to questions on operational matters or health board policy or strategy is that the Minister has written to the chief executive officer of the relevant health board with a request to communicate directly with the Deputy concerned.
Will it not go even further in future?
No. In the operation of the health services, the health services executive will be responsible, but will be accountable to the Minister of the day and, through the Minister, to the Oireachtas. The legislation will have to reflect this. In addition, we have signalled in our reform programme that the Oireachtas Joint Committee on Health and Children should have certain oversight roles in relation to accountability of the health services executive.
