Health (Amendment) Bill 2004: Second Stage.

Question proposed: "That the Bill be now read a Second Time."

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

The Health (Amendment) Bill 2004 represents a further step in the implementation of the Government's health service reform programme, which it announced last June. It is very much interim in nature and is being enacted pending the introduction by the Minister for Health and Children of legislation later in the year to give legislative effect to the other proposals in the reform programme.

As Senators will be aware, the reform programme is one of the most ambitious change management programmes undertaken in the health service. It has its origins in the national health strategy, Quality and Fairness — A Health System for You. The strategy forms a blueprint for the further development of our health system to meet the needs of patients and deliver high quality care in the years ahead. While the current structures have served us well over the past 30 years, the strategy recognised the need to review them to ensure they were appropriate and responsive to the needs and challenges of delivering health services in the changing environment of the 21st century.

The four principles of equity and fairness, the need for a people-centred service, quality of care and clear accountability underpinned the development of the strategy. On the basis of these principles, four goals were identified to guide and shape the strategic direction of the development of health services. These were better health for all, fair access, responsive and appropriate care delivery and high performance. The strategy recognises that the health service of the future must be co-ordinated and integrated with a consistent, national approach to delivery based on clear and agreed national objectives.

Arising from the strategy commitment, three reviews of the health system were undertaken. These included the Prospectus review, an audit of structures and functions in the health system, and a review commissioned by the Minister for Finance and carried out by the commission on financial management and control systems in the health system. The reform of the acute hospital sector was being advanced at the same time by the national task force on medical staffing which issued the Hanly report. This report set out recommendations on how to plan the reduction of average working hours of non-consultant hospital doctors by 1 August 2004 to meet the requirements of the European working time directive. Its recommendations also covered planning for the implementation of a consultant-driven service and the medical education and training needs associated with the working time directive.

A main finding of the review of the health system was that the number of agencies involved in the provision of health services caused the delivery to be very fragmented. This fragmentation resulted in an overlap in the delivery of certain services and, in some instances, a lack of clarity as to who was responsible for the delivery of the service. The Government announced the health service reform programme based on the recommendations of the Brennan and Prospectus reports in June 2003. The programme's priorities are improved patient care, better value for taxpayers' money and improved health care management. The reform programme centres on an organisation of approximately 100,000 staff and a budget in excess of €10 billion. I am sure Senators can recall me pointing these figures out before.

Key elements of the programme include a major rationalisation of existing health service agencies, including the abolition of the existing health board and authority structures and the establishment of a health service executive, which will be the first ever body charged with managing the health service as a single national entity. Furthermore, a health information and quality authority will be established to ensure that safety and quality of care are promoted throughout the system while the reorganisation of the Department of Health and Children will take place to ensure improved policy development and oversight. It is also necessary to modernise the health system's supporting processes of service planning, management reporting, etc, to bring them into line with recognised international best practice and to strengthen governance and accountability across the system. The establishment of a health service executive as the first ever body charged with managing the health service as a single national entity is the cornerstone of the reform programme. On its establishment and following the abolition of the health boards and the Eastern Regional Health Authority, the executive will be responsible for the delivery of health services on a national basis.

The responsibilities of the proposed health information and quality authority will include assisting the health service executive in the development of high-quality health information systems to enable it to plan and arrange the delivery of health services based on evidence-supported best practice.

The HIQA will also provide an independent review of quality and performance and it will be involved in promoting and implementing quality assurance programmes nationally. Its analysis will support and inform the Department in its policy development role.

The HIQA will be established as an independent statutory agency, directly accountable to the Minister for Health and Children. The reorganisation of the Department of Health and Children to allow it to support the Minister in focusing more on strategic and policy matters is also proposed in the reform programme. Following its restructuring, one of the Department's fundamental roles will be responsibility for holding the service delivery system to account for its performance. The reform programme also involves a programme of consolidation and rationalisation of 27 existing agencies, which will be subsumed by the HSE, HIQA or the restructured Department. This consolidation of service providers will help reduce the fragmentation of services in the health system and make services more integrated and easier to access for the public.

The implementation of the reform programme is now well under way. Phase 1 included a communication and consultation process; the establishment of the national project office within the Department of Health and Children; the establishment, work and output of 13 action projects; the establishment of the interim health service executive and appointment of the chairman and board of the interim executive; and the development of a high-level programme plan identifying key milestones for 2004.

A national steering committee, whose role is to oversee, monitor and steer the reform programme, has been appointed. It reports to the Minister and to the Cabinet committee on health and children on progress achieved on implementation. Its task is to drive the overall reform programme in a co-ordinated manner, involving the interim health service executive, the Department and the Hanly group, and to ensure that direction and progress are in line with the Government's decisions.

The interim health service executive, which has been established as a corporate body, has begun its work of drawing up a plan, for the approval of the Minister, for the establishment of a unified management structure for the proposed new health service executive. It will also need to plan for the smooth transition from the current structures to the new HSE structure. The interim executive is also required to put procedures in place for the development of a national service plan for the delivery of health services on a national basis and for the establishment of appropriate structures and procedures to ensure proper governance and accountability arrangements for the proposed health service executive.

As I mentioned earlier, the Minister will be bringing forward legislation later in the year which will provide for the establishment of the health service executive to replace the Eastern Regional Health Authority and the health boards. That legislation will also provide for the establishment of the health information and quality authority. It will make provision for improved governance and accountability as well as planning, monitoring and evaluation. It will provide for the establishment of a statutory complaints framework for handling of complaints in the health services, as recommended in the health strategy. The framework will provide for greater clarity and uniformity of approach in dealing with complaints and will also provide for structured local resolution processes with an opportunity for independent review.

The Minister is conscious of the concerns expressed regarding the lack of public participation in the restructured health system. This Government takes the issue of democratic accountability seriously. The Minister has, therefore, given much consideration to the appropriate mechanisms to be put in place to facilitate opportunities for input at both regional and local level between locally elected representatives and the health service executive.

The provisions in the legislation are likely to include the establishment of a series of regional forums to facilitate local representatives in raising issues of concern to do with health services within their regions with the executive. Membership of the forums would be based on the participation of a number of nominees from each local authority. Putting such arrangements in place would ensure that the voice of local public representatives would continue to be heard in the matter of the development of health services. These arrangements will be designed to complement and reinforce the role of the Oireachtas Joint Committee on Health and Children in reflecting the views of public representatives in the ongoing oversight of the health system.

The health strategy identified the need for a more structured approach to community participation in decisions about the delivery of health services. In furthering this objective, the health boards executive, in association with the Department, issued guidelines to the health boards on community participation. These guidelines set out the principles and framework for structures for such participation. Most health boards have established consumer panels that deal with a wide range of issues such as the development and delivery of services. Two boards have also established regional advisory panels for older consumers and their carers. The Minister intends to establish these structures on a legislative basis in the next Bill. It is the Minister's intention that these structures will be in place from January 2005.

As I said at the outset, this is interim legislation pending the introduction of legislation establishing the new structures which the Minister will be bringing forward later in the year.

The Bill provides for the abolition of the membership of the Eastern Regional Health Authority, area health boards and health boards, while retaining the authority and boards as legal entities; the termination of office of all members of the health boards and the authority from the date on which an order is made bringing the Act into operation; the assignment of the authority or boards' reserved functions to the chief executive officers or the Minister for Health and Children, as appropriate; and the amendment of existing legislative provisions regarding the acquisition and disposal of property by the health boards and the Eastern Regional Health Authority by re-introducing the need for ministerial consent prior to the acquisition and disposal of property.

The Bill amends the Health Act 1970, which established the health boards, the Health (Amendment) (No. 3) Act 1996, which deals with accountability issues and defines "reserved" and "executive" functions, and the Health (Eastern Regional Health Authority) Act 1999, which established the Eastern Regional Health Authority and the area health boards. It also amends the provision of the Local Government Act 2001 which provides for the nomination by local authorities of members to the health boards and the Eastern Regional Health Authority. I will now deal with the main provisions of the Bill.

Section 1 deals with the Title of the Bill, its collective citation and its construction. It is a normal type of section. It provides for the commencement of the provisions of the Bill by order of the Minister and it provides that different provisions may come into force on different dates. Section 2 deals with the definitions used in the Bill. Section 3 provides for the repeal of sections of previous Acts detailed in the Schedule.

Section 4 of the Bill amends section 4(1) of the 1970 Act by deleting the reference in that Act which enabled the Minister to specify the membership of health boards. The provisions specifying the membership of the boards, the application of certain rules in the nomination of members by county or city councils and the obligation to consult such councils before making regulations defining functional boundaries of the boards are being repealed.

Section 5 of the 1970 Act deals with the rules that apply in regard to membership and meetings of health boards and authentication of the board's seal. These provisions, subsections 1(d) and (e), 2 and 3 and the Second Schedule, are being repealed. Currently, the signature of the chairman or that of another member of the board is required to authenticate the seal. As a result of the removal of the membership of the board, section 5 of the Bill provides that the board’s seal shall be authenticated by the signature of the chief executive officer and another officer authorised to do so.

Sections 6 to 8, inclusive, delete the requirements of the chief executive officer to consult or agree with the chairman or vice-chairman of a health board on any matter. These are necessary to take account of the fact that there will no longer be a chairman or vice-chairman of health boards in this interim period.

Sections 9 to 14, inclusive, make amendments to the Health (Amendment) (No. 3) Act 1996. Currently, under the 1996 Act, reserved functions of a health board are functions exercised directly by the board and the authority, while executive functions are those exercised by the chief executive officer. Section 9 of this Bill assigns all functions of health boards to the chief executive officer. Section 10 provides that the CEO must provide the Minister with any information in regard to the performance of his or her functions which he or she may request from him or her.

Sections 11, 12 and 14 make amendments to the provisions relating to the adoption of service plans by health boards and the authority and to the provisions relating to the submission of accounts to the Comptroller and Auditor General and the publication of the annual report. Section 13 assigns the board's function in regard to the appointment and removal of the CEO to the Minister.

Section 15 amends the Health Act 1947. It provides that the board and the authority must obtain the consent of the Minister prior to the acquisition or disposal of property. This reverts the legal position to the state of affairs which obtained before the enactment of the 1996 Act, which introduced an amendment permitting the boards and the authority to acquire and dispose of land subject only to general directions by the Minister. In the absence of appointed boards, there is a need for control in this area in the interim period.

Sections 16 to 24, inclusive, make the necessary amendments to the Health (Eastern Regional Health Authority) Act 1999 to abolish the membership of the ERHA and the area health boards. Sections 18 and 21 deal with the authentication of the seals of the authority and the area health boards. Section 20 assigns the functions relating to the appointment of the regional chief executive to the Minister. The functions relating to the appointment and removal of an area chief executive are assigned to the Minister in section 23. Section 25(a) assigns the functions of the authority to the regional chief executive and section 25(b) assigns the functions of an area health board to an area chief executive.

Under section 220 of the Local Government Act 2001, local authority members are empowered to nominate members to specified linked bodies. Section 220 is amended by section 26 of this Bill by deleting the inclusion of a health board, the Eastern Regional Health Authority or an area health board from the definition of "linked body". The effect of this amendment is that local authority members will no longer have nominating rights to health boards, the authority or to area health boards.

Section 27 of the Bill terminates the membership of all members of the boards, the authority and the area health boards from the date on which an order bringing the section into operation is made. As the terms of office of the members vary for the different categories, the purpose of this section is to ensure that the terms of office of all members is terminated at the same time.

Section 28 makes provision for work commenced by the members of the boards, the authority or an area health board to be carried on by the CEO without having to begin the process again.

Section 29 of the Bill was inserted at Report Stage in Dáil Éireann. A similar amendment was tabled on Committee Stage by Fine Gael and the Minister provided his own amendment which is now in the form of this section. This was voted on last night by the Dáil. It provides that the Oireachtas Committee on Health and Children may require the chief executive officer of a health board, the regional chief executive of the authority, or an area chief executive of an area health board to appear before it to give account for the general administration of the board or the authority. Similar provisions are included in other legislation establishing State bodies, such as the Courts Service.

As I said at the outset, this interim Bill marks a further step in the process of the implementation of the health service reform programme. Its enactment is a further indication of the Government's commitment to the delivery of a reformed health service which has as its objective the maximisation of the level and quality of care provided to patients and clients in the years ahead. It is obvious the Minister has undertaken an ambitious programme of fundamental reform on health structures in the State.

This Bill is necessitated by the fact the local elections are now due. In the absence of this legislation, the new authorities would begin the process of appointing new members to health boards. It would be pointless to do so when the Government is committed to introduce legislation to abolish these boards within the year. That is why the Bill is before the House. I commend the Bill to the House and I look forward to hearing the views of Senators.

Mr. Feighan

I welcome the Minister. He stated that the enactment of this Bill is a further indication of the Government's commitment to the delivery of a reformed health service, which has as its objective the maximisation of the level and quality of care provided to patients and clients in the years ahead. He went on to state that he looked forward to hearing the views of Senators.

Mr. B. Lenihan

I did not use the word "client". I did not deliver that speech.

Mr. Feighan

It is in the leaflet handed out to us.

Mr. B. Lenihan

I did not use those words. I used the word "patient". I did not use the word "client".

Mr. Feighan

"Patient" is much more appropriate, but "client" is here in the leaflet.

Mr. B. Lenihan

That speech was delivered by the Minister for Health and Children.

Mr. Feighan

The Minister of State claimed he was looking forward to hearing the views of Senators. I do not think the Minister will be too keen to hear my views. Fine Gael is opposed to this legislation and I have problems with the manner in which Government legislation and reform is carried out, especially the Hanly report. In the past year there has been much confusion, bitterness and division. The Minister decided to close Ennis hospital and Nenagh hospital, but has granted them a reprieve as the local and European elections approach. What kind of Opposition does he think exists? He stated he was going full-steam ahead with all the reforms, but wavered for political expediency. People have a right to change their minds, but the Government is wrong, and it is completely wrong regarding the Hanly report. One Senator on the Government benches has already called for the report to be binned. That call should go to the Minister as the report is dead in the water.

As someone who was not involved in politics until relatively recently, I was part of that public mood that wanted to get rid of all politicians from health boards, VECs and so on. I felt politicians did not have the expertise or professionalism, or might have had an agenda, when making very serious decisions. However, when I was elected to Roscommon County Council, I sat on VECs and the county enterprise board. I took my job with great pride, enthusiasm and even impartiality. I later found out on an interview board that there were people within the system who made the decisions because they had worked with or knew a candidate, or were repaying a political candidate.

Once again with these reforms, we are leaving decisions to people within the health boards to repay favours to those who wish to climb the ladder. I do not think that is acceptable. The Minister, in trying to capture the public mood, is getting rid of politicians and I think he is wrong. We are replacing politicians with bureaucrats. Why should anyone bother to go for election any more? Should seats on a health board be given to some doctor's secretary to speak on his behalf? Since I have seen the system from the inside, my mind has changed on this issue and I feel very strongly about it. Politics is part of everything, but the Minister ignores the fact that there is politics in VECs and in the areas of health and education. Without an elected representative on a health board standing up for the rights of patients, we are on a downward spiral to a less efficient health system with less accountability.

There is much debate on decentralisation, while CIE and Aer Rianta are to be broken up. Many years ago, county health boards existed and were an effective model, but it was decided to abandon these and develop regional health boards such as those in the west. Now there will only be four regional health boards. I do not think that bigger is better, I prefer small, accountable health boards. We have an ombudsman for the insurance sector. We should have the same for the health sector, particularly in a system where everyone is represented. Every trade and profession has an association, union, consultants and public relations. Yet the patients and the health boards do not have anyone on their side. Unless accountability is put back into the system, these reforms will fail.

Every day I deal with constituents who are some of the 27,000 people on waiting lists for an operation or the 46,000 who have lost their medical cards. Who will speak for the people on the hospital trolleys? Who do I talk to as an elected representative? Should I tell these people not to come to see me but to go to some bureaucrat the Minister has appointed who has worked his or her way up through the health system to that position? The Minister is getting rid of democracy, and that is a dangerous route to travel.

There are 100,000 people working in the health system, which has a budget of €10 billion. The Minister is playing with people's lives and careers and, most importantly, he is putting the patient in danger. I ask him to ensure that public representatives have a say in the health system. We are going down a very dangerous road. Fine Gael will oppose this legislation. Accountability is being lost in this legislation and in view of this it, like the Hanly report, should be abandoned.

Labhrás Ó Murchú

Cuirim fáilte roimh an Aire Stáit agus gabhaim buíochas leis mar gheall ar an soiléiriú a thug sé dúinn maidir leis an mBille seo. I welcome the Minister and thank him for the clarifications he has given us. He mentioned that what we are dealing with is interim legislation, the first of two Bills which will be coming before the House. The purpose of these Bills is to give legislative effect to the proposals of the reform package the Government is bringing forward on the health services.

It is right also to make the point that the health service has served us well over the past 30 years and we should salute all those who made a contribution to that service. The health boards in particular should be given credit for the work they did. They were the conduit between the service and the community, and we all realise the importance of that in this age of transparency and accountability. The local authority members who served on those boards were in touch with the needs of the community. They were often able to undertake fire brigade action where that was required. The people on those boards were very committed, and they had a good knowledge of the way the service worked. Anybody who studied any of the boards over the years will realise that without them we may not have had the same observance in regard to the delivery, quality and accessibility of service, which is particularly important.

When the Minister is considering the new fora which are intended to allow input by public representatives I ask that he ensures they have teeth and that they are not merely advisory bodies which exist to question the executive. They should be given a status, which in many ways they deserve, and their expertise and experience should be availed of. In view of what the Minister of State said in his speech it is clear an opportunity exists to closely examine this proposal before we deal with the further development of the new structures being brought forward.

It is not an exaggeration to say that good health and a good health service are fundamental requirements to any society, particularly a progressive society. The health service is always a priority in public debate, as it is with the Government. However, we sometimes make the mistake of equating money with service. Over the years we have seen that irrespective of the amount of money that has been invested, there is not a commensurate return for that expenditure on the ground. It behoves a Government to ensure we get value for money, particularly when such a large amount of the total budget is expended on health. That has been a consistent demand of media commentators and public representatives over the years.

There has been much confusion in trying to analyse value for money. There are many demarcation lines within the service where people take a particular stance and where consultants, hospital management or whatever have their own agendas. I do not say that in a critical way. It is understandable but it is important that there is cohesion among all the interests because the patient, like the pupil in school, is the most important person in this debate.

We should also give credit to the religious orders which played a central role in the delivery of the health service in this country. There is not a person in this House who, over the years, has not remarked on the excellent management, including the overseeing of a medical input structure, provided by the nuns. Many would bemoan the fact that they are no longer available to us but society moves on. In any hospital I have had the opportunity of visiting, particularly in the early part of the 30 years under review, we got value for money and a professional approach. Compassion was also always provided, an important element which should not be overlooked.

To return to the issue of quality, what we are dealing with today is totally different from what we dealt with 30 years ago. Those of us who are old enough to look back on the history of Dr. Christian Barnard will remember his work in the area of heart surgery. Many people felt at the time that he was indulging in a form of black magic yet what is happening in that area today is almost like cosmetic surgery. We all see the wonderful results which have been achieved as a result of progress in medical science but it also puts pressure on the health service because what is being offered today is many times greater than what was being offered years ago. We have to bear that in mind when we try to assess progress and what still needs to be done. It is like saying that An Post provided a much better service 20 or 25 years ago in that one could send a letter to some area of the country and it would arrive the following morning. Even in that case one has to acknowledge there is a much greater volume of mail than there was in those years. The first action we must take, therefore, is to examine the services now being provided.

Second, we have to be particularly careful in our criticism. While there must be criticism it should be balanced. Often a controversial approach is taken to many issues, particularly health. One would imagine that no hospital was delivering a good health service and yet when one talks to patients — this has been my experience throughout this debate — they invariably say that when they went to a hospital they were well looked after. They praise the medical staff and the structure. When we make reforms we must not throw the baby out with the bath water. We must look at what has delivered the service and at the commitment of those who work in it.

People have different expectations within the health service today. Nurses now take a different approach and it is not for us to say they are wrong in considering their job to be a career rather than a vocation. Everyone else has moved also. A good service is being provided but if we want to have transparency, quality and accessibility, which are the aims of Government and of the public, we must put the necessary structure in place. No service can be delivered without a proper structure and that is the position at present.

Senator Feighan was correct when he referred to confusion with regard to the Hanly report. That confusion arose when people rushed to comment on the report before they had a full understanding of what it set out to do. I am not sure that we fully understand it yet. However, as the debate proceeded people got a greater understanding of the report, alarmist headlines disappeared and the attitude of political point scoring became less prevalent. I do not blame a particular political party for that. Politicians are right to look after their own functional areas with regard to any service, particularly the health service. Those who are proactive in a debate make a positive contribution to it. As the debate proceeded people gained a clearer understanding of what was being proposed and of the need to provide acute and specialist services where and when they are needed for all people and not just those who have insurance cover. If the Hanly report had received that type of attention early on we could have sought information, analysed the report in greater detail and indicated where corrections, if necessary, might have been made. Senator Feighan was right to say we started from a base of confusion which clouded all opportunity of extending the debate in the future.

The strengthening of governance and accountability is vital. If we continue to allocate State resources to health but cannot see a net result of that, we will have this debate all over again. The Government is right to be courageous and strong in its approach to this issue and the Opposition is right to tease the matter out and to question where we are going. However, the health system must not become bureaucratic to the point where common sense, local knowledge and individual concerns can not find accessibility.

That is why I return to the question of the proposed fora. It has been suggested to me that they might be like the advisory committees which existed in the past. Nothing which existed in the past should be revived simply for the sake of saying we have local democracy in the new system. The Minister must examine this issue very closely. There remains an opportunity for flexibility. I recently attended a seminar on this issue in Tipperary where the issue of local authority representation in the health service was discussed. It was clear that local authority members were not interested in jobs for the boys or in holding on to what they had. They were principally concerned with having the necessary expertise and with delivering on their responsibilities exceptionally well. They were determined that local representation would be an ingredient in any future reform.

I wish the Minister well in what he is trying to achieve and reiterate the four points which have been mentioned: better health for everyone; fair access; responsive and appropriate delivery; and high performance. If we keep within those four guidelines it will be possible, with the constructive and positive help of everyone, to get this right once and for all.

Dr. Mansergh

I welcome the Minister of State. We all have an interest in the successful implementation of the national health strategy. I agree with my colleague, Senator Ó Murchú. Despite what I read about problems in the health service, the experience of those close to me has been, on the whole, good. They have not experienced the health service as the lurid disaster area depicted in the media. Nonetheless, I accept there are serious problems and pressures, which are particularly heavily concentrated in the greater Dublin area. We need to remember that the population of the country has increased from little over 3 million in 1971 to almost 4 million today.

I have mixed feelings about the abolition of the health boards. Their establishment was one of the pieces of genuine decentralisation, in the sense of devolution, we have had. We are now saying that has not worked efficiently and we must have a centralised delivery system. I have concerns about that. Some of the controversies which have arisen are due, in part, to a resistance to centralisation. This is so in the case of Cavan/Monaghan/Dundalk and of radiotherapy services in Waterford, for example.

When we talk about the health services we talk in terms of delivery but we must also think about the people who are in receipt and need of services. We must not simply consider efficient management from the point of view of the providers of the services. We must also look at the service from the point of view of the patients who need care. I recently attended a meeting in Carrick-on-Suir which discussed the pressing need for a radiotherapy centre in Waterford to serve the south east region. Today's newspapers contain a report of the very different outcomes for cancer patients in different parts of the country. This must have something to do with proximity and access to services. The journey from Waterford to Dublin takes a minimum of three or four hours by car. A patient must spend an entire day coming to Dublin for a radiotherapy treatment which takes between a few minutes and an hour. Cancer patients are not, in the main, particularly well and this journey puts considerable strain on them.

From the point of view of efficiency of delivery and throughput, I can see why this service should be centralised in two or three places. However, we must look at the service from the point of view of the patient. The south-east regional authority has suggested that a new look needs to be taken at the Waterford radiotherapy issue and I am totally in support of that suggestion. When I was still working in Government Buildings but heading in the electoral direction, I had an argument with a former adviser to the Minister for Health and Children. When I told him I supported the Waterford radiotherapy centre he replied that I was sounding like a county councillor. I respect county councillors and so did not take that as the insult that was, perhaps, intended.

There is a disadvantage in downgrading democratically elected representatives. I agree with Senator Feighan that local representatives have not treated decision-making on a highly partisan or biased basis. My experience has been — I can only speak for the South Eastern Health Board area — that public representatives want to do the best job for people in their area. Obviously, there are sometimes arguments about what should be prioritised and where best to locate facilities. I am not happy about moving elected representatives from a co-decision making function to a purely advisory one. I agree with Senator Ó Murchú and others that the issue needs further consideration.

A particular problem for health boards has been the issue of resources. A lively debate is currently ongoing in Tipperary regarding the allocation of resources for the completion of Clonmel hospital and the knock-on effects of that for Cashel. It is easy to believe, when one has a problem in any area of Government, that if one changes the structures or the name of the Department, one is somehow solving the problem. Sometimes that works. However, if something is not working one may have to try another way of dealing with the problem including trying new structures. Very often changing structures is a cosmetic panacea which does not get at the real problem.

I am a little sceptical about what is being proposed. We have to try it because the current system is not working. I implore Ministers not to accept uncritically the mania for centralisation. Patients want facilities that are reasonably close and accessible to them. Cancer patients, in particular, are entitled to such services. We must rethink the issue of providing only a few centralised facilities which deal too much from the point of view of the medical professionals and not enough from the point of view of the patients who need the services.

Mr. P. Burke

I, too, welcome the Minister of State. The Government is losing the run of itself in terms of this legislation. The Government has, over the past number of years, completely changed how local authorities perform and should take a closer look at what happened in that regard. The new systems introduced were to make local authorities transparent and more accountable. I do not believe they are any more transparent. The new systems created more tiers of bureaucracy which make it harder for the public to find out where to go, what is being done and how it is being done. The legislation before us is, in my view, more of the same.

I cannot understand the logic of a Minister giving the go ahead to legislation to be implemented in 2005 to radically overhaul the health services. In that regard, what the Government is actually saying is that the Department of Health and Children, which has overall responsibility for the health boards, has not performed its duties over the past number of years and that health boards have not been accountable for the past 30 years. Health boards have performed well and have carried out their duties. However, some tightening up is required and better structures could be put in place for health boards by way of resources. Many health board problems arise due to a lack of resources.

The health system in Ireland is one of the least resourced in the European Union. The Government will say it is investing billions of euro every year in the health service, that it is a black hole, is eating up all the money and that something has to be done. We know something has to be done. Waiting lists have increased and now stand at 27,000 and rising. What the Minister intends to do will not alleviate the waiting lists.

This legislation is window dressing. The Bill proposes the establishment of local area advisory committees. Who will they advise? Who will listen to them? Members of the previously established SPCs were frustrated because advice or decisions made by them were not taken on board. The same will be true of the proposed local area committees which will not be able to make decisions but will only give advice, 90% to 100% of which will not be taken on board because the system, when commenced, will be run by bureaucrats. The Bill proposes the putting in place of a bureaucratic system.

I cannot understand why the Minister wishes to remove public representatives from health boards. In all the years in which I have served in public life, I have not come across a case of a public representative putting his or her interests first. The Minister is, in that regard, handing over the making of decisions to vested interests. He proposes to appoint people involved in health care areas, many of whom may have vested interests. Currently, many doctors who are members of health boards put forward their interests. I have never witnessed local authority members putting their own interests before those of the public. They have always put the public first. The Minister should take another look at this issue. Nobody will listen to the proposed advisory committees. The previous system included public representatives who were at the heart of the decision-making process. Unless those appointed by the Minister are involved in that process, they will lose interest and will not put any enthusiasm or drive into the work they are supposed to do. I ask the Minister to take another look at this issue.

The vast majority of appointees to health boards by various Governments over the past 30 years were public representatives. One has to ask why that is the case. Obviously, the Minister of the day correctly believed such people had a contribution to make to health boards. Such people did have contributions to make. I am sure if one looks back on health board records one will find that in many cases public representatives made huge contributions to their particular health board.

This is window dressing by the Government to buy time. I ask the Minister to examine this legislation. We all appreciate that something must be done to alleviate the crisis in the health service. The Department has not carried out its duties. Proper resources should be put in place as the management exists within the health board system. The strengthening and resourcing of the current system along with a little rationalisation would go a long way to help solve the problems.

Mr. J. Walsh

Ba mhaith liom fáilte a chur roimh an Aire Stáit don díospóireacht tábhachtach seo. There is no topic that has been given such attention over the last decade as health and much ink has been used on the subject of health issues. This is not just an Irish phenomenon. It occurs in our neighbouring island and countries in mainland Europe. It is obvious for many reasons that where there is an ageing population, such as in Europe, people have a greater interest in ensuring health sector services are of the highest standard.

There has been a significant investment in the Irish health services since 1997. Expenditure has increased from €3.5 billion in 1997 to €10.2 billion this year. Not everybody would agree that the improvements in the service have been commensurate with the very significant increase in expenditure. Some of the criticisms are unduly focused on hard cases. The comments made by a number of Senators reflect the general opinions of those who use the health services. In general there is an overwhelming satisfaction with the service provided, particularly in the hospitals. That is not to say there is not the occasional criticism. Last year over 1 million in-patients were treated in our hospitals and the number of those treated since 1997 has increased by 200,000.

The numbers employed in the health services have increased significantly, from 68,000 in 1997 to 95,800 last year, a 40% increase. Much of the problem stems from the many vested interests in the health services and in the administration of the health services. This was a structural fault in the regional health boards.

The national treatment purchase fund is a very worthwhile initiative by the Minister for Health and Children. Approximately 11,000 patients who were on the waiting list since 2002 have been treated under the scheme.

Seanad Éireann debate - Wednesday, 26 May 2004

Health (Amendment) Bill 2004: Second Stage.

Tá

Níl

Seanad Éireann debate -
Wednesday, 26 May 2004