Other Questions.

Contamination of Blood Products.

Jan O'Sullivan


140 Ms O'Sullivan asked the Minister for Health and Children his views on whether there will be an inquiry into the role of multinational drug companies in the contamination of blood products; if it is the Government's position that no decision will be taken on this matter until the proposed committees of investigation Bill has been enacted; and if he will make a statement on the matter. [1901/04]

As the House is aware, I appointed Mr. Paul Gardiner, senior counsel, to produce a situation report about the position in Ireland and in the United States in respect of a possible investigation into the actions of the multinational pharmaceutical companies whose products are implicated in the HIV and hepatitis C infection of persons with haemophilia.

As part of his investigations, Mr. Gardiner liaised with solicitors acting for the Irish Haemophilia Society. He travelled to the United States and spoke to a number of relevant experts, including the lead counsel in the HIV haemophiliac litigation in the United States. Mr. Gardiner also received legal advice from a major New York law firm on the matters relevant to his investigations.

Mr. Gardiner furnished a report to me which consisted of a 60-page opinion and a number of appendices, one of which comprised over 50 pages of legal advice from the US lawyers. The report drew attention to the fact that there is no guarantee that the US authorities would provide judicial assistance to an Irish tribunal, either in enforcing the discovery of documents or compelling the attendance of witnesses. I briefed my Cabinet colleagues on the content of the report and I provided the Irish Haemophilia Society with a copy of it.

Notwithstanding the difficulties identified, it would be possible to mount a useful investigation which would access publicly available material and seek the assistance of persons and bodies willing to co-operate with such investigation. The committees of investigation Bill may provide an appropriate mechanism for this inquiry. Other legal avenues are also being explored in consultation with the Attorney General and the legal representatives of the Irish Haemophilia Society.

I intend to maintain contact with the Irish Haemophilia Society on this issue.

I thank the Minister for his reply. Unfortunately, it bears a remarkable similarity to the answers to questions on the same issue which I have been asking for some time. We all understand the difficulties. At the end of the debate on the Lindsay tribunal report more than two years ago, the Minister stated that in his view it was possible to carry out an investigation and that he was consulting with the Attorney General. Since then there does not appear to have been any progress in that regard. To be fair to those who have suffered so much, it is important that real progress is made and that there is some firm commitment, even if it is for a limited investigation, that this will be carried out and a timeframe attached to it.

We all understand that it may be difficult to access the full information because people have a lot to hide. However, that should not deter the Minister. The longer this goes on, the more likely it is that it will simply fade and people will not remember the importance of the issue.

I appreciate the Deputy's concern. I said at the conclusion of my reply that other legal avenues are being explored. Other issues arose in the past year, to which I am not privy, which legal representatives brought to our attention in regard to the HIV potential alternative route. This issue is still under consideration.

National Health Information Strategy.

Seymour Crawford


141 Mr. Crawford asked the Minister for Health and Children when the information health strategy promised for 2001 will be published. [1549/04]

The draft memorandum for Government for the national health information strategy was circulated to Departments for observations in December 2003. My Department is currently considering the observations received with a view to an early submission to the Government of the national health information strategy.

I am a bit concerned about this issue. The reason the question was tabled is that the health information strategy is now three years overdue. Following the strategy, I presume some sort of a plan for its implementation must be drawn up, yet there is neither strategy nor plan in place. I welcome the fact that a considerable sum of money has been allocated this year for investment in an information strategy for the health service. As the Minister is aware, this has been grossly lacking and it has resulted in very expensive mistakes being made in regard to the absence of data.

Has a decision been made on how to spend the money allocated for this year? Has it been made in the absence of an overall plan, given that this is a once-off investment which will determine how the system can be administered and the kind of information that will be available for making decisions in the future? It is vital to have a coherent plan in place for the spending of the money. Have tenders been sought for a contract? What is the brief? Where is it intended to spend the money? Have outstanding issues regarding privacy, human rights and so on been resolved? How and when does he expect the money to be spent?

It is not three years. The health strategy was concluded in November 2001, which amounts to a year.

It is now 2004.

If something ends at the end of one year and is moved to the first month of the next year, it becomes three years.

Widespread consultation was necessary with various Government Departments, hospitals and the health system generally. There were significant issues in regard to the Data Protection Office such as the utilisation of the PPS number which still requires a resolution. That necessitated a certain amount of work. The work is done on the strategy. We ringfenced significant additional funding for the implementation of the health information strategy, beginning in 2004. It is not once-off funding. Significant ongoing funding will be required.

On the Deputy's question, although it does not affect the national health information strategy, tenders went out for a specific software package in terms of the collection of information on hospital activities. No decision has been taken on accepting or spending the money. I can supply the Deputy with further information.

I would appreciate that.

Health Reform Programme.

Billy Timmins


142 Mr. Timmins asked the Minister for Health and Children when the legislation establishing the bodies responsible for implementing the health reform programme will be published. [1539/04]

John Gormley


164 Mr. Gormley asked the Minister for Health and Children the legislative programme required to implement his health reform and when we can expect to see this legislation; and if he will make a statement on the matter. [2024/04]

Michael D. Higgins


210 Mr. M. Higgins asked the Minister for Health and Children the legislation planned arising from the health reform programme and the status of the Bills listed in the legislative programme; and if he will make a statement on the matter. [1894/04]

I propose to take Questions Nos. 142, 164 and 210 together.

The health sector reform programme has implications for all organisations in the health sector in terms of structures, governance, accountability, planning, monitoring and evaluation. Fundamental reform of the existing statutory provisions on the roles, organisation structure and management of the health system will be required to give effect to the proposals contained in the reform programme.

The Government's legislation programme makes provision for the enactment of legislation to give statutory effect where required to implement the proposals in the reform programme. The first element of the programme is the preparation of an establishment order under the Health (Corporate Bodies) Act 1961, as amended, establishing the interim health services executive on a statutory basis. The order is being finalised at present and I expect to be in a position to sign it shortly. This will empower the interim executive to carry out the set up tasks and preparations necessary to enable an orderly transfer of functions to the health service executive when permanently established by new legislation in January 2005.

It will be necessary to introduce new legislation to provide the main legislative basis for the implementation of the health sector reform programme. It will establish the new health service executive to replace the Eastern Regional Health Authority and the health boards. It will also provide the legislative basis for other aspects of the reform programme such as improved governance and accountability, planning and monitoring and evaluation. The establishment of the health information and quality authority on a legislative basis will also be provided for. It is also my intention that the new legislation will include provision for a statutory framework for complaints procedures in the health services as proposed in the health strategy. My intention is to have this legislation introduced by December 2004 so as to have the health services executive in place in January 2005.

The Government has also indicated its intention in the legislative programme for the spring session to introduce a Health (Amendment) Bill to cope with the situation which will arise following the local elections in June 2004. Given the impending establishment of and formal transfer of functions to the health service executive, the Government has considered whether it would be appropriate to proceed in the normal way with the appointment of local representatives to the health boards after the local elections. I intend discussing the matter further with the Association of Health Boards at a meeting to be arranged in the near future. Following that meeting, I will make a public announcement on the Government's intentions in this regard.

Can I ask about the Health (Amendment) Act which will do away with councillors and professionals from health boards? It causes me a great deal of concern that we are doing away with accountability in the service and not replacing it with any other form of accountability. The Minister said he would set up user groups and so on under the new legislation. That is a long way off. I do not think user groups will provide accountability. Who will run the health service between the time the professionals and councillors are taken away from the health boards and the health executive will be set up in 2005? Who will be accountable and who will ask the difficult questions?

The Bill will be an enabling measure to be given effect by the Minister in terms of dates and so on. There is a real issue around the immediate aftermath of the local elections where one is looking at a six month window between this and the establishment of the HSE. It is a time when members are appointed to a whole range of different bodies.

I have been on councils and there was a genuine issue to be met. When we met the Association of Health Boards in Ireland before Christmas, we said we would revert back to it in terms of alternative proposals to facilitate the articulation by public representatives in a given region of their views on the health service. I intend to meet the Association of Health Boards in Ireland shortly to discuss this issue further.

Given that the Minister is embarking on a major health programme such as the one under discussion, does he not accept that his failure to sort out his own smoking ban does not really inspire confidence? Furthermore, does he not accept that confidence is further eroded by the fact that he is abolishing a very important democratic input by local councillors into the health service and its management without having the faintest idea how he will ensure there is some democratic input in the future? Will he not acknowledge that user groups, regardless of their benefits, have no mandate or authority to speak on behalf of others and that the only people on health boards who have such a mandate are those who are democratically elected?

Will the Minister publish the terms of reference for the interim Health Services Executive? How will he ensure that the democratic deficit he is now introducing at local level will not be introduced at national level in terms of accountability to this House?

First, there is an Oireachtas Committee on Health and Children, which is a very significant facility at national level in terms of accountability to the Legislature——

What about the Minister answering questions regarding the HSE?

Yes. As we said, the CEO and board of the HSE will be accountable to the Minister for Health and Children, who will be accountable to Dáil Éireann in respect of its duties.

We do not have that information.

I said this already——

I know, but in terms of the operation——

Time is running out and a number of Deputies are offering.

Likewise, the HSE will also be brought before the Oireachtas Committee on Health and Children to account for itself and its stewardship. I envisage an enhanced role for this committee regarding accountability in terms of the new health structures.

Although many Members of this House urged for a long time that these reforms be made, I always predicted that, once they were announced, there would be 180° turns on the part of some, who would say, "Do not do this and do not do it now."

The Minister should not be silly.

I am not. The bottom line is——

The Minister is being silly.

I thought Deputy McManus was being relatively silly in advance by asking what hope the health reform programme has——

Let us have a decent debate.

Suffice it to say that this is the most substantive health reform programme in over 30 years. Many others have talked the talk but it seems, increasingly, that as the local elections approach the only agenda in town concerns how we can create political advantage by raising certain issues regarding the health reform programme.


For the past 50 years——

The Minister appointed a consultant in Mallow——

I want the Minister to be quite specific. If we come into this House and question him on the formation of the Health Services Executive, is there not a possibility that he or the Ceann Comhairle will say it is not a matter for the Minister but for the Health Services Executive?

That happens now.

Regarding services——

Will we have less accountability?

The organisational structure we now have for the delivery——

A Deputy

Like the National Roads Authority.

That is right.

——of services comprises the health board structure and a range of other——

There is local accountability.

——statutory bodies. When parliamentary questions are tabled — I read them — they imply that we have written to the CEO of the relevant health board and that the CEO has been asked to revert to the Deputy directly.

That was never the way to answer questions.

With respect to Deputy Durkan, he did it often enough himself——

I call on Deputy Crawford to put his question.

Let the Minister answer.

Could I make my point?

The Deputy has raised a legitimate issue in terms of the dividing line. In the context of the new health Act, a decision should be made in terms of the areas in which the Health Services Executive would be competent to reply and the areas in which the Minister would be competent to reply. Ideally, the Minister should be concerned with policy and strategic issues. The delivery of services is a matter for the executive body. I have had many parliamentary questions and I know why people tabled them — it is a democracy — but many of them concern individual ailments, etc. Nearly all of them are referred to the CEO of the health board.

We will not get replies.

Maybe there is a need for the executives and those in the health boards to address how they liaise with public representatives to avoid unnecessary duplication in the House. The new legislation——

That concludes questions for today——

The Minister will be answering fewer questions.

I doubt it.

Written Answers follow Adjournment Debate.