Frank Lane, who has been the deputy head usher of Leinster House for a considerable length of time, is retiring this evening. I wish to avail of this opportunity to pay tribute to him for the outstanding service he has given to Members on all sides of the House throughout his 40 years working here. I wish him every success in his retirement and hope he is moving from the busy life of Leinster House to the quieter life of retirement, but I equally hope that it is as fulfilling as was his life here for the past 40 years.
I thank the Seanad for facilitating an early discussion on Second Stage of the Health Bill 2004 and, I hope, its smooth, albeit speedy, passage through the Oireachtas next week. I am very pleased to have the opportunity to speak to the Bill in the House. As the House will be aware, the legislative basis for the structures and organisation of the health services has been in place since 1970, with the passing of the Heath Act 1970. Since that time, there have been many developments in the area of health care. New treatments have been developed to treat and cure previously incurable illnesses and treatments are available to improve the quality of life of ill patients and to help extend their lives. We are also experiencing for the first time in over a century a growth in our population and, as with other countries, an increase in our ageing population. We are now investing very large sums of money in our health services, more than €11 billion next year, which puts an added onus on us to ensure that this funding is used wisely.
It is time to reorganise the management of our health services to ensure that it meets the demands of the 21st century We must ensure that the patient is at the centre of health care. This reorganisation must ensure that effective management is in place to make the best use of the tremendous resources we are applying to health and to get clear value and results for that money. The legislation we are considering today has developed from the Government's health service reform programme. That programme is based on the findings and recommendations of two reports, namely, the Commission on Financial Management and Control Systems in the Health Service, otherwise known as the Brennan report, and the Audit of Structures and Functions in the Health System, otherwise known as the Prospectus report. The Government announced the reform programme on 18 June 2003.
The central proposal of the programme was the establishment of a single health service executive which would assume responsibility for the management of the health services and which would replace the health boards and 27 other agencies. The Government also stated that it was committed to the establishment of a health information and quality authority and to re-focus the role of the Department of Health and Children. A clear message emanating from the reports was the need for clarity of responsibility and accountability. We undertook to provide that under the reform programme. This Bill provides for the first time that clarity of roles and responsibilities within the health system. The lines of responsibility and accountability are very clear in this legislation. Political responsibility rests with the Minister while operational responsibility rests with the executive.
A wide-ranging communications process with those employed in the health services and with the general public was undertaken and has continued throughout this preparation period up to today. This legislation is the result of a long deliberative process undertaken by many people both before and after June 2003. Its success will be measured in three ways, namely, better outcomes for patients, better value for taxpayers' money and a better working environment for the 120,000 people employed in the health services.
The purpose of the Bill is to provide the legislative basis for the new organisation and accountability structures proposed in the health service reform programme. The Bill provides for the establishment of a health service executive on a statutory basis which will take over responsibility for the management and delivery of health services from the Eastern Regional Health Authority, the health boards and a number of other specified agencies. It also provides for the establishment of a national health consultative forum, regional health forums, advisory panels and a statutory complaints framework.
Owing to time constraints, provision is not made in the Bill for the establishment of the health information and quality authority, but this will be provided for in legislation which I will introduce in early 2005, which will also address issues arising from the national health information strategy.
Section 6 provides that the Health Service Executive will be established on a day to be appointed as the establishment day. It is my intention that establishment day will be 1 January 2005. Section 7 clearly sets out the object and functions of the executive so that its responsibilities are clear to all, as is its accountability for delivering on those responsibilities. The objective of the executive is to use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public. The executive is required to perform the functions under the enactments listed in Schedule 3 which, prior to establishment day, were performed by the health boards and the other bodies dissolved on that day. A review of these enactments gives an indication of the very broad scope of the functions and responsibilities performed at present by the health boards and being taken on by the executive.
The executive is required to manage and deliver health services or arrange for the delivery on its behalf in accordance with the provisions of the Bill. In managing the health services, we are requiring the executive to integrate the delivery of those services. I consider this requirement essential. Frequently we hear of patients being unable to access services when moving from one health care setting to another because of the lack of integration between the various settings. The reorganisation of the management of health services must put an end to this and the movement of the patient through the health system must be a seamless process. The executive is also being required to facilitate the education and training of students in health professions and its employees and the employees of service providers to the extent practicable and necessary to enable it to carry on its functions.
With regard to the accountability of the executive, a key objective of reform in the health system, as identified in both the Prospectus and Brennan reports, involves the separation of policy and operational responsibilities. It is my firm view that the executive should be as widely and directly accountable as possible for its decisions, plans and actions in regard to the discharge of its statutory functions. Such an approach is central to ensuring that the highest standards of service are achieved and maintained. This approach should be reflected in the quality of service it provides to all its clients and customers, including the service it will provide to Members of the Oireachtas in responding to queries and providing information about the management and delivery of health and personal social services whether at national, regional or local level.
The executive must establish an effective system of rapid response to inquiries from the public and public representatives, establishing systems capable of reaching into the organisation and rapidly retrieving the necessary information from the authoritative source. This is one of the many potential benefits of having streamlined administrative arrangements in place and is one in which all of us here, as public representatives, have a particular interest. The IHSE is aware that it has responsibilities in this area and has been making plans to ensure that arrangements are put in place to meet them. It has already announced that the function of managing parliamentary affairs would be assigned by the chief executive officer to one of the central governance areas.
I am aware of, and strongly support, the important role played by the voluntary and community sector within the overall health system. In recognition of that role, the Executive is required to have regard to the services similar or ancillary to its own provided by that sector when performing its functions. As the activities of other public authorities can also impact on the health of the public, the Executive is required to co-ordinate its activities and co-operate with those other authorities. It must also have regard to the policies and objectives of the Government or of any Minister to the extent that those policies may impact on the functions of the executive.
Section 10 provides that the Minister may issue general directions in writing to the executive for any purpose in this Act or any other enactment. This provision is necessary as it enables the Minister to inform the executive of policy decisions made by the Government and to direct it to perform its functions in compliance with Government policy. The Minister is also empowered to issue directions regarding the provision by the executive of information and statistics which relate to its performance. The executive is required to comply with any directions issued by the Minister under this section. As part of the structures to underpin the accountability of the executive, Ministers in future will be obliged to lay copies of any such directions before the Houses of the Oireachtas.
Part 3 of the Bill deals with the board of the executive. The board will consist of a chairperson and 11 members appointed by the Minister, along with the chief executive officer, who will be anex officio member.
The Minister will appoint persons to the board whom he or she considers have sufficient experience and expertise on matters connected with the executive's functions so as to enable them to make a substantial contribution to the work of the executive. Members of the Houses of the Oireachtas, the European Parliament or a local authority will not be eligible for appointment to the board.
The provisions relating to the operation of the board are set out in Schedule 2. The term of office of a board member is five years and members can serve a maximum of two terms. Five members of the first board will serve for a period of five years and five will serve for three years. This ensures that not all of the board members leave office at the same time with the consequent loss of experience and expertise.
Section 14 provides that the Minister may remove all of the board members in the event of the board failing to meet any one of a number of specified obligations including failure to comply with a direction of the Minister or any other requirement under this Act. The Minister may also appoint an independent person to review any matters related to the board's performance of its functions, if he or she is of the opinion that they are not being performed effectively. In the event of this independent review being undertaken, the executive is required to co-operate with the person undertaking the review and provide him or her with all reasonable assistance.
To further provide clarity regarding responsibility and accountability, the Bill provides in section 12 that the board is to be the governing body of the executive. Provision is made for the delegation by the executive of some or all of its functions to the chief executive officer, who has operational responsibility for the day-to-day running of the executive under section 18.
We recognise that in order to enable it to perform its many functions effectively, the executive will require expertise in specific areas. Section 15 therefore allows the executive to establish committees to provide it with assistance and advice. The persons appointed to these committees need not be members of the board, but may be persons who have the experience and knowledge required to advise the board.
The Minister will appoint the first chief executive officer on the recommendation of the board of the executive. After that, the CEO will be appointed by the appointed members of the board following a recruitment process carried out in accordance with the Public Service Management (Recruitment and Appointments) Act 2004.
Section 17 provides that the Minister may appoint an interim CEO of the executive on the recommendation of the board of the interim health service executive. This is to address the current situation where the board has appointed Mr. Kevin Kelly to be acting CEO of the executive pending the appointment of a permanent CEO.
As I said earlier, the CEO is responsible for the day-to-day operations of the executive. He or she will be responsible to the board for the performance of his or her functions and for the implementation of the board's policies. The board is empowered to appoint a deputy CEO in the absence of a CEO or if the position is vacant for any reason.
We are providing for a formal system of delegation of functions. This again reflects the emphasis we are placing on clarifying the lines of responsibility and accountability within the executive. Section 19 provides for the delegation by the CEO of some or all of his or her functions to other employees within the organisation and their subsequent sub-delegation by those employees. This system of delegation will also provide employees of the executive with clarity regarding their roles and responsibilities within the organisation.
Section 20 provides that the CEO will be the Accounting Officer of the executive within the meaning of the Comptroller and Auditor General Acts 1866 to 1998. Appointing the CEO as the Accounting Officer requires the establishment of a Vote for the executive. This is provided for in paragraph 7 of Schedule 5. The Vote will be established on establishment day. This move ensures that the executive will operate as a separate entity with the CEO accountable for that Vote. The CEO will be responsible for the preparation of the appropriation accounts and the Vote of the executive in the same way as a Secretary General of a Department. This role is central to the system of accountability for public money. It is designed to be an open and transparent system for scrutinising the manner in which funds are used having regard to the principles of regularity, propriety and value for money. This is a very strong form of accountability for public funds and will give much greater clarity than before as to where responsibility for the management of public funds lies. The key element in the accountability framework is the Committee of Public Accounts, which will examine the expenditure of public funds and report to the Dáil on its findings.
As well as the CEO being required to appear before the Committee of Public Accounts in his or her role as Accounting Officer, provision is also made under section 21 to require the CEO to appear before Oireachtas committees when requested by those committees to account for the performance of the executive.
Under the provisions of section 22, the executive is allowed to recruit its employees subject to the terms of the Public Service Management (Recruitment and Appointments) Act 2004. The overall numbers, grades and terms and conditions will be determined by the executive with the approval of the Minister for Health and Children and with the consent of the Minister for Finance.
The transfer of those staff currently employed by the ERHA, area health boards and health boards and the other dissolved bodies is provided for in section 63. These employees will transfer on establishment day on terms and conditions no less favourable than those enjoyed prior to the transfer. Staff of bodies which will be dissolved at a later stage by order of the Minister will also transfer under similar terms. The executive may change the terms and conditions of such staff, but only on an agreed basis following negotiations with the trade unions representing staff interests.
The 1970 Health Act contained provisions which provided an employee with access to appeal to the Minister in the event of a proposal to dismiss him or her. This provision is being repealed. It is considered more appropriate that the employees of the executive have the protection of the employment legislation, for example the Unfair Dismissals Act 1977 to 2001. The provisions of this legislation were extended to local authority employees in the Local Government Act 2001.
Under section 23 the executive is required to prepare an employee superannuation scheme which it must submit to the Minister for Health and Children for approval, with the consent of the Minister for Finance. Regarding staff transferring to the executive from the dissolved bodies, section 60 provides that superannuation benefits of staff transferring to the executive will be no less favourable than those applying to them in their current employment.
Members of the Houses of the Oireachtas or of the European Parliament are not eligible for employment with the executive and where employees of the executive are elected to any of those institutions, they will immediately be seconded from employment with the executive. Provision is made by way of amendment to the Local Government Act 2001 to allow the Minister to designate certain grades or classes of employees who may not become members of a local authority. The executive and its employees will have a very important role to play in the lives of all Irish people in terms of the services they provide to the public. As a result, we have made provision in section 25 to require that the board, the employees and any advisers engaged by the executive maintain proper standards of integrity, conduct and concern for the public interest. The members of the board and the senior management will be subject to a code of conduct under section 10 of the Standards in Public Office Act 2001. The executive must prepare a code of conduct which it must make available to all its employees and advisers. This code of conduct must indicate the standards of integrity and conduct to be maintained by these persons in the performance of their functions and will form part of the terms and conditions under which a person is employed by the executive or engaged as an adviser. Part 7 sets out the requirements placed on the executive in respect of its accountability.
The executive will be required by section 35 to prepare a corporate plan which will set out its key objectives for the three-year period concerned, the manner in which it proposes to measure its achievement of these objectives and how it intends to use its resources. This plan will set out the executive's key objectives and its plans for their achievement for the following three-year period for all to see. The corporate plan will be laid before both Houses of the Oireachtas once it is approved by the Minister and will be published on the Internet or in accordance with any other arrangement specified by the Minister. The Minister will also be able to monitor the executive's progress in achieving the objectives it has set for itself as it will be required to report on progress in this regard in its annual report and at such other intervals as the Minister may decide.
On an annual basis, the executive will be required under the provisions of section 31 to prepare and submit a service plan to the Minister for his or her approval. The service plan must indicate the period to which the plan relates, the type and volume of health and personal social services it intends to provide and estimate of the number of employees for the period in question. It must comply with any directions issued by the Minister and accord with the policies and objectives of the Minister and the Government. It will also be required to submit an estimate of its income and expenditure relating to the plan.
Provision is made to allow the Minister to direct the executive to amend the service plan if it does not comply with the requirements set out section 31. The executive is permitted to amend an approved service plan, but this must be resubmitted to the Minister for approval. The approved service plan will be laid before the Houses of the Oireachtas and made publicly available by the executive. The provisions of section 33 require the executive to manage the delivery of the services indicated in an approved service plan to ensure they are delivered in accordance with the plan.
The Bill requires the executive to obtain the Minister's prior written approval before entering into any arrangement or committing itself to major capital spending in excess of a figure to be set by the Minister.
The Government considers it very important that the executive sets out clearly the governance arrangements within which it will operate. This provides direction for its employees and reassurance to the public that the organisation is aware of and committed to adhering to its responsibilities in this area. The provisions of section 35 require the executive to prepare a code of governance which outlines the guiding principles applying to the executive in its performance of its duties, its structure and the responsibilities of its board and the CEO; the processes and guidelines used to ensure compliance with the requirements of this Act; and its internal controls, including procedures relating to internal audits, risk management, public procurement and financial reporting.
The code will also outline how the executive intends to integrate the delivery of health and personal social services and the nature and quality of services persons can expect when receiving those services. The executive is required to submit the code to the Minister for approval and to make it publicly available. It must give an account in its annual report on its arrangements for implementing and adhering to the code.
As the House will be aware, under current legislation the health boards are permitted to enter into arrangements with providers for the delivery of services on its behalf. It is intended that the executive should also have such an ability. The arrangements between the executive and the service provider will be on such terms and conditions as the executive may determine and will be subject to the resources available to it and any directions issued by the Minister. The service providers entering into these arrangements will be required to keep all proper and usual accounts and records of income and expenditure as specified by the executive and to submit accounts annually for audit. To reinforce the accountability role of the executive in respect of expending its funds, it is enabled to make whatever arrangements it considers necessary to monitor the expenditure incurred and the services provided under these arrangements and to request any information from the service providers it considers material to the provision of those services.
Section 65 of the Health Act 1953 which is being repealed by this Act, was the basis on which many voluntary groups were funded for services which are similar or ancillary to the services provided by the health boards. These can range from large bodies providing a service in the disability area to very small groups providing a local service such as home helps, meals-on-wheels services, friends of the disabled groups and so forth. As it would not be appropriate to have most of these groups funded in accordance with an arrangement under section 38, the executive will be enabled to fund and support in a flexible way the range of community and voluntary groups which are currently funded under what are commonly known as section 65 grants.
The board will be responsible for adopting the income and expenditure accounts. These will have to be reconciled with the appropriation accounts which will be submitted by the Accounting Officer to the Comptroller and Auditor General.
The executive's annual report will provide the executive with an opportunity to report on its activities during the previous year. It will be a very informative document for the public as it will be a method of measuring the executive's progress on implementation of its corporate plan. It will also contain a report on the operation of the complaints framework.
One of the central themes of the debates concerning this Bill is the need for the involvement of public representatives and the users of the services. The Government recognises the necessity for such involvement. The Government is providing for the establishment of four regional health forums which will comprise members of city and county councils within the functional area of the forum. This will give local public representatives an opportunity to make representations to the executive on the delivery and operation of health and personal social services within their area. The health strategy recommended the establishment of consumer panels on a more structured basis so as to involve the local community more in the decisions about the delivery of health services which affect them. The provision for the establishment of advisory panels in this legislation is designed to address this recommendation.
The executive is permitted to establish whatever mechanisms it considers appropriate, including advisory panels, to assist it in seeking the views of local communities or other groups in respect of health and personal social services. These panels may consist of users of a particular service or a mix of users, providers and community groups.
Many people and groups have been calling for the establishment of a statutory framework for complaints. In the health strategy, the Government committed to putting in place such a framework. Part 9 of the Bill provides for the establishment of a statutory complaints framework which initially seeks to resolve the complaint at local level but with access to independent review if the complainant is dissatisfied with the outcome of the complaint. It also provides for access to the Office of the Ombudsman or the Office of the Ombudsman for Children if the complainant is still dissatisfied following the outcome of a review. This statutory framework will also apply to all service providers providing services on behalf of the executive. They can either avail of the executive's complaints system or establish their own if the executive is satisfied that its standards are comparable to that of the executive. If a person is unable to make a complaint because of illness or age or disability, a complaint may be made on his or her behalf by certain specified persons. Complaints must be made within 12 months of the actions giving rise to the complaint. Complaints cannot be made about certain issues which include matters which are or have been the subject of legal proceedings, matters relating to clinical judgment and matters relating to the recruitment and appointment of employees. The procedures relating to the operation of the statutory framework will be set out by way of regulations made by the Minister.
Part 10 of the Bill sets out the provisions dealing with the dissolution of the specified bodies and the issues arising as a consequence. The bodies to be dissolved on establishment day include the health boards, the Eastern Regional Health Authority, the area health boards, the General Medical Services (Payments) Board and the Health Service Employers Agency. Comhairle na n-Ospidéal is also being dissolved on establishment day. All property, liabilities, contracts, etc., of these agencies will transfer to the new executive. Section 59 provides for the transfer on establishment day of all the functions of the specified bodies listed under Acts listed in Schedule 3, to the executive. Section 60 provides for the transfer of staff and, as I have already stated, this will be on terms and conditions no less favourable than those enjoyed under the current system. The executive will be responsible for the preparation of the final annual accounts and annual report for each of these agencies. Prospectus identified a number of bodies for dissolution and the transfer of the functions, staff, assets and liabilities to the executive. A number of these bodies were established under the Health (Corporate Bodies) Act 1961 and while it is not intended to dissolve them immediately, it is necessary to provide the Minister with the power to do so at a later stage.
Schedule 5 contains a number of transitional provisions to assist in the smooth transition from the regional health board structure to a single executive structure. As the health boards are involved in many diverse and extremely important areas, it is important that the functions undertaken by their employees immediately prior to establishment day can continue seamlessly, on and from establishment day, under the remit of the executive. For this reason, we have included provisions to ensure that delegations of functions and appointments of authorised officers can continue until varied by the executive.
Schedules 6 and 7 contain amendments to other legislation arising from the abolition of the health boards. The Office of the Attorney General advised that these amendments are required to ensure that with the dissolution of the health boards and the transfer of their functions to the health service executive on its establishment, no difficulties should arise from this in discharging responsibilities and carrying out functions under or in connection with the Acts.
As Senators will note, while this is comprehensive and complex legislation, its thrust and purpose are simple. It will establish a single organisation with a clear mandate to manage and deliver health services which put the patient at the centre of the system. The lines of accountability are clear and unambiguous. The legislation begins the process of reform. While much work remains to make the reform a reality, I am convinced the patient will be the real winner when he or she sees that the system is delivering quality, front line services to him or her when they are needed. I commend the Bill to the House and look forward to hearing the views of Senators.