Health Service Executive (Governance) Bill 2012 [Seanad]: Report Stage

Amendment No. a1 not moved.

Amendment No. 1 is in the name of Deputy Ó Caoláin and arises out of committee proceedings. Amendments Nos. 1 and 21 are related and may be discussed together.

I think amendment No. 1 is in the name of Deputy Boyd Barrett but it was ruled out of order.

Amendment No. a1 was ruled out of order.

I move amendment No. 1:

In page 5, between lines 8 and 9, to insert the following:

"(3) Before specifying priorities or performance targets under this section the Minister shall consult with the Joint Oireachtas Committee on Health and Children.".

Amendment No. 1 is good to go; it was amendment No. a1 to which the Minister of State referred. I have every confidence she will adopt amendments Nos. 1 and 21.

We are proposing this amendment in order to enhance accountability and the role of Oireachtas Members. Having been a Member of this House for 16 years, I believe this is something that needs to be achieved, particularly with regard to the committee system and to that committee on which I currently serve, the Oireachtas Joint Committee on Health and Children.

The executive is being abolished and the proposition in the Bill is that more power and responsibility be vested in the Minister. I will refrain from blessing myself at this point but that is something that I might have been tempted to do. There needs to be a balance and there also needs to be openness and transparency. The explanatory memorandum to the Bill, which I appear to have left behind me, states that it is essential that the HSE be properly accountable to the Minister for its performance, and I agree with that. My question, as I highlighted on Second Stage, is this: what about the accountability of the Minister for Health to the Oireachtas, in the first instance, and to the people of this State?

The engagements we have not only in this Chamber but on a quarterly basis at the health committee and during Dáil questions - including recent occasions on which Deputy Kelleher and I both strongly objected when, as Opposition voices, we were seriously curtailed in the opportunity to perform our role of holding this Minister to account - are all after the fact. Policies, priorities and performance targets are already set and, as we have discovered only in the recent past, these performance reports by the HSE have been somewhat dickied up in order to present a more favourable picture of performance on the part of the HSE and the services over which it is responsible, as exposed earlier this year in correspondence between the offices of the Secretary General and the director designate of the HSE. We are playing catch-up as elected Members in terms of actual performance and trying to see behind the PR smoke-screen that is often put up by the Department and the HSE, of which we have had ample experience. With respect to the Minister of State, Deputy Lynch, she noted all of that when she was an Opposition voice in this Chamber over many years, and, sadly, the situation has not changed one iota since this Government took up office and the Minister, Deputy Reilly, took the helm of the health services.

The health committee should have a direct input. It should be consulted. The members of the Oireachtas Joint Committee on Health and Children, as it is designated, work very well together in an earnest effort to address issues collegially and in the interest of the wider public whom we are elected to serve, and, as best as we can, we leave our respective political differences aside in seeking to address matters in the most serious and effective way.

Amendment No. 1 contains a very simple formula and its purpose is as I have described - to provide that "[b]efore specifying priorities or performance targets under this section the Minister shall consult with the Joint Oireachtas Committee on Health and Children". It is simple but appropriate, and worthy of the Minister of State's support. I commend the amendment to the Minister of State.

I thank the Deputy for his amendment. The Bill provides for the abolition of the board of the HSE - not the HSE itself - and the establishment of a new governance structure, namely, a directorate, which will be headed by a director general. Second, it provides for further accountability arrangements for the HSE. The Bill is a transitional measure and it is intended to help prepare the health system for the changes ahead. It does not provide for the abolition of the HSE and I am sure the Deputy fully understands that.

The Minister appreciates the views expressed on Committee Stage on the value of real engagement between public representatives and the HSE. He does not, however, believe that amendments No. 1 and 21 reflect an appropriate approach to such engagement. He remains of the view expressed on Committee Stage in regard to these amendments. The purpose of section 10A is to enable the Minister to specify priorities, to which the HSE must have regard in preparing its service plan, and also to establish performance targets in respect of those priorities.

Amendment No. 1 seeks to amend section 10A of the Health Act 2004 to give a role to the Joint Committee on Health and Children where the Minister is determining priorities and setting performance targets for the HSE. However, as the Minister stated on Committee Stage, priorities and target-setting for the HSE are issues for the Minister in line with Government policy, not matters for the joint committee, the role of which, in the Minister's view, is to monitor how Government policies affect people using the health service and bring concerns to the attention of the Minister. Accordingly, therefore, the Minister does not propose to accept the amendment.

I have seen it now from both sides of the fence. It is not as if the quarterly review or scrutiny that takes place with the joint committee does not have an impact on policy; clearly, it does. Deputy Caoimhghín Ó Caoláin's contribution on the cochlear implants issue is recent proof of this. That will be taken into account and impact on what we intend to do on that issue. I would not dismiss those engagements in any way. However, we could not possibly have a committee of the Oireachtas setting the priorities of all new Governments. It may change as time passes, but all new Governments come with a clearly stated policy on health issues.

I support the amendment. The difficulty we have is that we adjudicate retrospectively. Let us consider the service plan. It is published and often consultation takes place after the event. Although we have quarterly meetings with the Minister, the HSE and the Minister of State, they are often on the basis of reaction. The purpose of the amendment is clear. It would not force the Minister to comply with what the Joint Committee on Health and Children suggested, but it represents a consultation process. We often refer to the need for transparency and accountability and involving as many people and stakeholders as possible in the decision-making process. This would be an ideal platform, whereby the priorities the Joint Committee on Health and Children believes should be included in the service plan could be presented in advance of its completion. That is really what it is about.

I accept that the Government has the right to set policy and that the Minister has the right to pursue and implement that policy. However, giving the Oireachtas committee an opportunity to have an input into the process prior to decisions on the service plan being cast in stone which we subsequently scrutinise is something worth considering. Let us broaden the debate to include Dáil reform and the discussion on committees being involved in the detailed scrutiny of legislation prior to publishing the heads of a Bill. This amendment would represent another positive step to ensure Oireachtas committees would play a meaningful role in advance of decisions being taken, as opposed to reacting to decisions already made. It is a worthy amendment from that point of view.

I have no wish to labour the point, but we oppose the Bill because of our concerns about it vesting vast powers in the Minister directly. The Minister will argue that this provides for greater democratic accountability. I have no wish to personalise the issue, but affording any Minister such authority is not good. Health issues should be de-politicised. We saw what happened in the case of primary care centres and, let us be clear, they were political decisions. The decisions on the funding of accident and emergency services in various places were also political. That is the right and entitlement of the Minister, but I do not believe health issues should be politicised to that extent.

Section 7 confers supreme authority on the Minister of the day not only in the context of accountability but also in the context of decision-making. This is a matter of concern to me. It is the reason we opposed the Bill on Second Stage and why we will be opposing it at the end of Report Stage. If the amendment were to be accepted, it would at least allow some opportunity for a meaningful input from the elected Members of Dáil Éireann and Seanad Éireann, for the time being. The Minister could decide to accept, reject, amend or ignore any input, but at least it would give us an opportunity to advocate on behalf of stakeholders in advance of decisions being made. On the cochlear implants issue and many others there are a plethora of stakeholders who are keen for their views to be put forward. Ultimately, it is up to the Minister to accept or reject them, as is his right, but at least we would have had the opportunity to present cases made by advocacy groups and political parties that might have a particular view on how health services should be delivered.

I have no wish to labour the point, but in the case of the reconfiguration of hospitals, the Higgins report was presented to the Cabinet and published. All the discussions since have been on the basis of reaction and there was no input from elected Members in discussing policy. Ultimately, the Minister will make the decision, but having an input in advance could be better than the Minister deciding that accepting arguments made by elected Members about reconfiguration or any other policy would be seen as a climb-down. However, if a matter is discussed in advance of a decision being made, it could be included in the decision rather than have us claim the Minister has done a U-turn on policy. That would be good for democracy and would bring decision-making nearer the people. Oireachtas committees meet advocacy groups day in, day out and highlight issues. Groups come to discuss their needs and wants and deficiencies in services. All of this should feed into the process before a decision is made, as opposed to hounding the Minister of the day afterwards for not including things and then, if the Minister makes a change, there are the usual political shenanigans in claiming he has done a U-turn. This is a worthy amendment which could avoid all of this.

From the point of view of my party, the Bill will confer absolute power on the Minister, in whom we proposed a motion of no confidence last year. I cannot say I have confidence in him now when I did not have confidence in him last September. I have no wish to personalise the matter, but the Minister has given me no reason to believe anything has changed. We are now proposing to confer considerable powers on him without any accountability, other than asking him questions in the Dáil. As Deputy Caoimhghín Ó Caoláin noted, this limits the ability of the Opposition to have meaningful engagement or to hold the Minister to account.

The Minister of State has referred to seeing it from both sides, but the lessons from this side should be brought into the Government experience and they have not been. The lead Minister has totally and absolutely set aside all of what he learned as an Opposition voice and adopted the same approach as his predecessors, whom he condemned consistently from these benches.

What are we asking? We are trying to improve the workings of this institution and its various component parts and the Government suggests it is also seeking to improve them. The committee system needs to have its game upped, about which there is no question. We are not asking that members of the Joint Committee on Health and Children have a veto, a right to direct or a final say but to consult. The Minister will appoint advisers by the new-time and consult all and sundry. The only people with whom there is little consultation, or none in some instances, particularly on the service plan, are the elected members who act as health spokespersons for the various parties. The Minister of State may find herself in such a role again at some point in the future. It is an investment for any of us to make political interaction in the House better, with an eye on results. We should always try to reach the best possible place with legislation and measures to be introduced and implemented and service plans et al. Consultation does not strap the Minister at any point.

In amendment No. 21, as in the case of amendment No. 1, we are seeking a role for the Oireachtas Joint Committee on Health and Children.

There is no question that the HSE service plan requires serious scrutiny; of course, it does. The 2013 service plan was short on detail - I have never seen anything like it - compared to the plans for all previous years I have known. Many of the cuts contained in it are coming to light as the weeks and months go by.

I will come back to the Deputy after the Minister of State has responded. He will have the right to wrap up the debate.

The 2013 service plan was a plan to slash services. That is what it has been. The health committee could have offered better advice, guidance and steering and such efforts can always be rejected. Surely the word "consult" should be embraced. I commend both amendments to the Minister of State.

I would like to respond to Deputy Billy Kelleher by referring to my experience on the Opposition benches. Any of us who comes back into this House is very lucky. I have always viewed being elected or not being elected in that way. The voice of the people is genuinely supreme. Fianna Fáil is opposed to the Bill because it vests too much power in the Minister. For ten years we said the Minister of the day was putting the health service at arm's length. I did not personalise the matter when the Minister in question was in office and do not intend to start now. Her hands-off approach meant that every time we asked a question, she said she was not responsible. We were told the matter in question was the responsibility of the HSE. We have changed that approach entirely. The Minister is assuming these powers for himself because he is determined to be the accountable person for the health service. In opposing this Deputy Billy Kelleher is saying he wants the old regime to return. As we all know, the old regime was not very successful, even though enormous amounts of money were thrown at it. The Deputy really needs to think about this issue and I am a little surprised he has made that argument.

I will respond to Deputy Caoimhghín Ó Caoláin's suggestion that the role of the committee with regard to the service plan is reactive. I look at it on the basis that we consult the committee four times a year. I have referred to my time in opposition. The introduction of the BreastCheck and cervical screening programmes resulted from contributions made at meetings of the Joint Committee on Health and Children. It is a matter of persuading Ministers that certain matters should be included in service plans. If we were to consider putting the service plan before the committee, rather than engaging in serious consultations on them in advance, that would be a reactive measure. I remind the Deputy that the cochlear ear implant issue is a clear case in point. It is not included in the current service plan, but it will be included in the next one. We most definitely listen to health spokespersons because we know they have acquired a degree of expertise along the way.

I welcome the Minister of State's acknowledgment of our persistent-----

I apologise for interrupting the Deputy, but Deputy Billy Kelleher wants to come in. I will come back to Deputy Caoimhghín Ó Caoláin to wrap up.

Amendment No. 1, in the name of Deputy Caoimhghín Ó Caoláin, calls for consultation with the Joint Committee on Health and Children. I will explain why I oppose the Minister of State's position. While the Minister of the day is obliged to set policy, its implementation is clearly a different issue. As we are aware, ministerial decisions on hospital funding, for example, can be influenced by lobbying at the Cabinet table. The Minister decides where resources are allocated for capital projects, etc. I do not accept that such decisions should be fully vested in the Minister without some accountability to an agency. A project should not be considered a priority just because it is in the Minister's or somebody else's constituency. The allocation of our scarce resources should be based on need rather than on political lobbying at Cabinet level. There was clear evidence of such lobbying in the case of the funding of hospitals in Kilkenny and Wexford. The Minister will set policy and will be accountable in the Dáil, but there must be some oversight to ensure he or she does not politicise the delivery of health care. This clearly is the issue. We have grave concerns about the Bill because it gives absolute power to the Minister of the day. A small brake could be put on this by requiring the Minister to come before the health committee and listen to the various views of members before a service plan is fully adopted.

He goes to the committee four times a year.

I accept that the Minister for Health attends the quarterly meetings and we welcome that engagement very much. The point I am making is that the service plan is cast in stone in January every year. It is traditional for the Minister to refer it back to the HSE after scrutinising it. He will issue a press release saying it has been amended before the final plan is published. It is cast in stone at that stage. It is very hard for the Oireachtas committee to have an input in the delivery of services in that calendar year. The Minister might listen to what it has to say in advance of the following year's report. The committee's role in the delivery of health services in the current year does not extend beyond scrutinising how the plan is being implemented. There is no discussion about what should be in it in the first place. Clearly, that is the issue about which we are concerned.

The consultation takes place in advance. It has taken place by the time the report is drawn up. It is not the case that we do not listen. We have quarterly meetings with the committee and it is clear that we listen and take note. The things on which we agree with the committee appear in the service plan. Is the Deputy suggesting the service plan should not be set in stone and that it should be a flexible document that may change as the year goes on?

One cannot plan a health service on that basis. A health service has to be planned in a clear way. The Minister is not supreme and has to account to his Cabinet colleagues. Equally, he has to account to this Chamber. I find it difficult to take a lecture from the Deputy on political manoeuvrings.

I have not lectured the Minister of State. It is not in my nature to lecture.

I will restore order. I acknowledge the Minister of State's recognition of the important contributions made by Opposition Deputies on a variety of issues, including the cochlear implant issue. We look forward to the provision of funding for its introduction in the 2014 programme, as that is hugely important. This is about consultation. I could cite many other instances in which we hope to excite interest in what more we might have to say. Consultation could be very useful. If Deputy Billy Kelleher or I have an opportunity to serve as Minister or Minister of State in the future, I hope we will appreciate the experience and listen to the views of other elected representatives. We are all elected and have the same mandate when we come here to give service. We are dealing with issues with the Government after the fact, which is not the best way to do business. I appreciate and understand how the system works, or does not work as the case might be. These amendments are about consultation. The role of the Dáil committee system needs to be upgraded as part of the reform of the Houses of the Oireachtas. I do not believe the single opportunity we have every quarter is enough because, therefore, much has to be addressed. The Minister of State and her colleagues in the Department have set their minds against what we are proposing, which I regret very much. I suspect that members of all parties and none who serve on the Joint Committee on Health and Children would welcome the acceptance of these common-sense amendments. They would provide for a greater purpose for the committee and, as a consequence, increase the potential to achieve better results. It is regrettable that they are not being accepted.

Amendment put and declared lost.

I move amendment No. 2:

In page 6, line 26, after “Act” to insert the following:

“, one of whom shall be a Director of Mental Health”.

I note this is being taken as a stand-alone amendment. I would have foreseen it being taken in the context of amendment No. 4 but, as amendments Nos. 3 and 4 are being grouped together, I will speak just to amendment No. 2 at this stage.

The amendment is proposed in order to emphasise the importance of the role of director of mental health. When I raised this first on Committee Stage, we did not then have such a designated office holder. I know Mr. Stephen Mulvany going back a number of years and this is not in any way reflective on him as a person who now has this responsibility, given that happened after the fact in this instance. That said, I believe the Bill still needs that address in terms of future consideration of appointments and it is a view that is shared by many who have a concern in regard to mental health. I know the Minister of State herself will be very strong on this given she has a proven record of concern in regard to mental health issues.

I welcome the Government's intention to improve accountability of the HSE, which I have already reflected. However, the organisation Mental Health Reform has stated that - as it sees it and I am also of such a mind - the Bill does not ensure that a director of mental health has the competence to drive implementation of mental health policy. The Bill is not specific in regard to this position. Mental Health Reform is concerned that the Bill limits the recruitment of new directors of the HSE to those who already hold the position of national director within the HSE. Mental Health Reform, I and other voices believe it is vital to have the opportunity to appoint the best person, whether that person is serving within the HSE or is external to it. It is about somebody coming in, not only with the competence and drive but, in regard to the catch-up that is necessary in mental health, the person also has to have something else, something very special indeed, that voices here in this Chamber, and the Minister of State, have certainly demonstrated in the past.

While I again wish Mr. Stephen Mulvany well in his new position as director of mental health, as I did at the recent quarterly hearing of the health committee, I believe what Mental Health Reform, I and other voices have argued for should still be written into the Bill in order that this is clearly understood into the future. I commend amendment No. 2 to the Minister of State for all of the reasons I have explained.

When performing their functions as members of the directorate, appointed directors will act collectively as part of the governing body of the HSE. This is distinct from their individual responsibilities as senior employees in the grade of national director relating to a particular service area. As the Minister indicated on Committee Stage, therefore, it is not feasible for him to accept this amendment with the specificity it involves in singling out one service area, however vital. I am sure the Deputy will agree with that.

On behalf of the Minister, I am of course happy to put on the record today that his intention is to appoint the new national director of mental health as a member of the HSE directorate. As the Minister said in committee, he fully understands the good intention behind this amendment and he and I both share the Deputy's view on the importance of mental health services. However, for the reasons which have been explained, the Minister will not be in a position to accept the amendment and would ask the Deputy to consider withdrawing it.

The process that ensued in order to get these four directors was a very open one. The Bill clearly states it has to be an employee of the HSE but anyone who gets the job will then naturally become an employee of the HSE. The Bill is not stating that in order to apply for or get the job, one has to be an employee of the HSE. It does not rule that out, but it most definitely does not demand that in the first instance.

As the Deputy will know, I listen very carefully to various mental health groups, particularly groups outside the Houses. They have a particular view and, while I do not always agree with them, I always listen. The point I have noticed is that various groups that have an interest in mental health, and I would include Mental Health Reform in this, have pushed out the boat in regard to mental health and have forced us to think of it in a different way. I believe this is all very good. I would never dismiss anyone that has the experience of any of the four people who have been recruited as the new directors of the HSE. They are very competent people, they know the system and the service, and I know they will all bring to the table very unique qualities. We will be making significant progress and we need someone very specific to carry forward that progress.

I understand that when the amendment was put down, it was not very clear whether a director of mental health was about to be appointed or would have been appointed as quickly as has happened. However, I know we are all of one mind on this, and I know the Deputy, the Minister and I would wish the new director in this area only the very best. Whatever help any of us can give him, I am sure we will be prepared to do that.

In any other situation, I would accept the view that one would not be making a special case, but I make no apology at all for being that particular in regard to mental health. It requires every support and assistance to catch up after decades of abject neglect. I do not attribute that only to those in government over the years as I think it is a reflection of society that there was not an appreciation of how fundamental and important to each and every one of us was the requirement for best practice in regard to mental health services. I again hold very strongly to the view that there is a special and necessary case to be made in regard to the director of mental health.

There was a vote earlier on the housing legislation. I was 16 years in the House last week and I can remember when I first came in. It was wildly difficult to follow how this House worked when I was the only member of my party and the first to be here. The proposition on the last piece of legislation turned around the proposal from what the mover of the amendment sought, which was that the word would remain. It was very confusing to follow and one was actually voting "Níl" when one thought one should have been voting "Tá".

This is where the language becomes incredible. With respect to what the Minister of State has just said, she tried to tell us that the Bill does not seek to limit those who will be appointed to these roles to those who are already in the service of the HSE at either national directorate level or in another comparable grade within the HSE. Yet, that is exactly what it says. The Bill, under section 7, at section 16A(3), states, "A person may not be appointed as an appointed director unless he or she is a person who is an employee of the Executive holding the grade of national director or other grade in the Executive which is not less senior than the grade of national director." It is clear a person cannot be appointed unless he or she is an employee. I expect this was a requirement before the event of his or her consideration and appointment-----

I must interrupt. I can see this debate will continue but we have reached 1.30 p.m. and I ask the Deputy to move that consideration of the Bill be adjourned.

Perhaps the Minister of State will acknowledge that the Bill is quite specific in regard to what it requires.

Debate adjourned.
Sitting suspended at 1.30 p.m. and resumed at 2.30 p.m.