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Dáil Éireann debate -
Tuesday, 25 May 2004

Vol. 586 No. 2

Health (Amendment) Bill 2004: Motion to Recommit.

I move:

That Dáil Éireann, pursuant to Standing Order 128(1) of the Standing Orders relative to Public Business, directs that the Health (Amendment) Bill 2004 in whole be recommitted to a committee of the whole House.

I propose that the Bill be recommitted because what has happened here is grossly unsatisfactory. Important democratic accountability is being withdrawn in legislation without any alternative being provided, despite the fact that the Minister promised accountability would be retained in the system. The legislation will have an extraordinary impact in terms of decisions being made by unelected persons who will also now be unaccountable. Despite the fact that the Minister continues to make assurances, he has not brought forward any system of accountability in the Bill, either as published or as amended on Committee Stage, commensurate with what is in place.

I brought forward a Committee Stage amendment seeking that this alternative be presented to us but it was ruled out of order. We now have a Report Stage amendment being tabled by the Minister which may not be discussed as it is last in the list of amendments. It should have been tabled on Committee Stage.

I do not believe the issue of democratic accountability has been adequately dealt with by Parliament. For many years people have depended on the fact that there was accountability in the system to protect their interests. The protection provided for the people, not just by their public representatives being members for health boards, but also through professional representation is being withdrawn without proper consideration or debate. The Government is pursuing an intensely contentious set of reforms. We have been told doctors will replace nurses. Frankly——

This is a very narrow motion. We cannot have a widescale debate on the issue.

I accept that.

We are merely discussing whether the Bill should be recommitted.

I accept that but it is a good example of how decisions will be made after 11 June, which we will not be able either to know about or comment on as they will be done in secret. The Minister does not even bother to come to the House. I urge the Minister of State, Deputy Brian Lenihan, to recognise the problems we have on this side of the House which reflect those in the wider community.

I agree with what my colleague said. We are appalled at the prospect of a low turnout in the local elections but should not be surprised when at every turn accountability at local level is being eroded. Not alone have we declared councillors superfluous to the whole system but we have used them as scapegoats for everything that is wrong in the health service.

The reality is that the health service and the health boards functioned well up to the arrival of the Government. Only a couple of years ago the trend in reform was to break up health boards and make them smaller to allow for greater local accountability. This year the approach is to have no local accountability whatsoever. What faith can anybody have in a system like this? This is a matter that needs to be discussed before we wipe away everything that has been tried and trusted over the years.

I made the point on Committee Stage that the decentralised model of health care was the one that worked most effectively in other countries that have a health service we would envy. The Government claims to be decentralising but what it means by decentralisation is the movement of civil servants who do not want to be moved down the country.

We have not yet reached Fifth Stage. We are discussing the recommittal of the Bill, to which the Deputy should confine his brief remarks.

I am taking up points made by previous speakers. It is extremely important that we discuss the proposed change in far greater detail. I believe we are making a false turning here and introducing retrograde changes that will result in less accountability and a worse health service.

I spoke last night to a staunch Fianna Fáil supporter who will not be voting for the party on this occasion because of the terrible crisis in the health service. The legislation will make a bad situation far worse. There will be less accountability, less democracy——

The Deputy will have an opportunity to make those points in the course of the debate on the Bill. As I pointed out, this is a very narrow motion.

I made a contribution on a similar motion last week when Deputy Richard Bruton wanted to recommit a Bill. We should recommit this Bill as it is important that we have a far more thorough investigation.

I support the proposal to recommit. The Bill is designed to remove democratic accountability from the delivery of the health service. As a former member of a health board, I can say that for all their faults the health boards had at least some semblance of democratic accountability in terms of the nominees of the respective county council participants.

As stated on Second Stage, at the very least this Bill should not have come before the Dáil except in tandem with the health Bill in order that we would be able to see what we are facing in terms of the future configuration of health service delivery in the State. What we are being presented with is a perpetuation of the bureaucracy of the health boards without any democratic accountability and with CEOs who will hold most elevated positions and who will not be open to question. There is no guarantee this will all come to an end on 31 December because the Bill does not contain a sunset clause.

I received notification from the Ceann Comhairle that five of my amendments have been ruled out of order. I wish to refer to one because it relates directly——

That matter does not arise at this stage. We will come to it later.

——to the reason for recommittal. The communication I received from the Ceann Comhairle's office states that amendment No. 3 is outside the scope of the Bill. However, it merely seeks that the Minister be accountable to the Dáil for all matters relating to his functions as provided for under the Bill. That is incredible and we should recommit.

The motion tabled by Deputy McManus seeks to recommit the Bill to a committee of the entire House. The Bill was approved by the House, in principle, on Second Stage and it was considered in detail by the Select Committee on Health and Children.

It was not. The Minister of State was present at that meeting. It was a farce.

The time allocated for consideration of the Bill on Committee Stage was not used up.

On a motion to recommit, the fundamental issue is that some grave defect of detail has been identified on Committee Stage which would justify the Dáil not proceeding with Report Stage and recommitting the Bill to a committee of the entire House. No basis exists for such a motion. I commend Deputy McManus on her technical ingenuity in tabling the motion which other Deputies have used to try to rehearse the issues that were already decided upon by the House on Second Stage.

This is a transitional measure. The House has debated the principle of the Bill and the wider issues concerning the health service reform programme. The select committee dealt with the Bill when it considered the amendments tabled on Committee Stage. On Second Stage, the Minister indicated this is an interim measure which is being put in place pending the completion of legislation, later this year, that will establish the health service executive which will replace the health boards and the Eastern Regional Health Authority.

Deputy Olivia Mitchell canvassed the question of the local government elections and the issue of accountability. I do not want to re-enter the Second Stage debate but accountability and financial responsibility must be linked. Funding for the health service is voted through this House and not through local authorities.

Deputy Gormley referred to decentralisation and the question of less democracy. The same issue applies. Democracy involves responsibilities as well as powers. We take the responsibility of raising moneys for the health service. Opposition Deputies, understandably in my opinion, continually raise pertinent questions about the administration of the health service in the House but they appear to harbour grave reluctance about a measure which will make the health service accountable to the House.

Question put and declared lost.
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