Health Bill 2004: Second Stage.

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

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.

I welcome the Minister and her officials to the House. Her concluding remarks were somewhat ironic as she indicated that patients would be the winners. She also admitted the legislation is simple in one respect but complex in others. Why was the Bill rushed through the Dáil? The events in the other House yesterday, when amendments were accepted on Committee Stage and overturned on Report Stage, gives politics and politicians a bad name. I understand only 30 of 150 amendments tabled on Report Stage were discussed before the guillotine was applied. It is regrettable the other House did not get time to fully debate the Bill because the legislation brought before the Seanad has not been properly debated and the House will suffer as a consequence.

The exercise in which the House is participating today and next week is futile because the Bill will not be amended. The Minister has made up her mind and while she may listen to our views, they will not be incorporated in the legislation. This is in direct contrast to the previous Bill from the Department to come before the House, the Health and Social Care Professionals Bill 2004. The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, accepted some genuine amendments to the legislation during a fantastic debate, during which Senators debated the issues. This, rather than the shambolic events in the Dáil this week, which will no doubt be followed in the Seanad next week, is how Parliament should operate.

The Fine Gael Party broadly welcomes the Bill but it has two difficulties, namely, the absence of real reform and the lack of accountability. Although the Minister referred to reform on numerous occasions, the Bill does little to effect it. According to recent figures, administrative staff numbers have increased by 98% in recent years, whereas nursing numbers have increased by only 22%. The Minister did not indicate whether there will be job losses or redeployments, which does not make sense. While it is fine to reduce the number of health boards from 11 to four, if no structural changes occur subsequently and matters continue as normal, one must wonder whether reform is taking place.

I was amazed the Minister indicated the Bill would be enacted on 1 January 2005 because this directly contradicts a report in today's issue ofThe Irish Times. During a briefing given by officials from the South Eastern Health Board this week, Oireachtas Members from the south east were informed that the chief executive officer of the board will remain in situ for a further six months.

The CEO in question will be the head of the hospitals office.

There is considerable ambiguity in this regard. Despite holding no meetings since last June, the health boards will remain in place for some time. The public is confused. Having initially been told the boards would be abolished as of 1 January 2005, we are now informed they will continue to operate for another six months.

The date is 1 January.

That is definite.

That brings some clarity to the matter. The Minister spoke about consulting widely but has not done so. I have been contacted by many groups which are appalled at the manner in which the Bill was rushed through the Dáil. They suggested that some amendments which, incidentally, reflected Government policy, were not accepted or even properly debated. The Irish Nurses Organisation, the trade unions, including SIPTU and IMPACT, and others have grave concern about the pace at which the legislation is proceeding through the Houses. The Minister has not consulted as widely as she should have.

The public is cynical. I was appalled to read in newspaper reports recently about a survey, of which none of us can be proud, in which the public gave all politicians a thumbs down on health. People believe we cannot do anything in health. We have had report after report in recent years but little action.

The Bill is action.

That remains to be seen. We learned recently that the previous Minister for Health and Children spent €30 million on commissioning reports. We have still not received the full figure but I understand approximately 150 reports were commissioned during his five year tenure during which approximately €2 million was spent on public relations and spin. This damages the perception of the role of politicians, although I accept that some politicians make a positive contribution to the health service.

The Minister must accept some responsibility given that she is a member of the Cabinet and the concept of collective responsibility applies. We have seen Government splits emerge recently on several issues, which casts doubt on the operation of collective responsibility. I will not dwell on the position as regards the North but the headlines in today's newspapers——

The Senator should stick to the topic.

Trust and integrity are important.

I assure the Senator that the Government is at one on the North.

The House is discussing the Health Bill.

One of the Government parties appears to be retreating from a deal agreed unanimously by the Government on Tuesday.

The Senator does not know what he is talking about.

I am merely referring to the issue. The main issue is that we will not have real reform of the health service. When I asked members of staff of the South Eastern Health Board the areas to which they would be redeployed, they were uncertain about where they would end up. Higher ranking officials in the health boards are concerned that they may lose out. All health board staff need to know where they will end up.

Following enactment of the legislation, I wonder whether in six or 12 months the system will have been reformed or the name of one organisation replaced by another. Will we have done nothing more than confer substantial powers on 11 people with a budget of €11 billion at their disposal or will we have introduced genuine reform? The pace at which the Bill was rushed through the Dáil indicates the Government is not genuinely seeking the public's confidence that it will deliver a good health service.

It is worth repeating that the main purpose of the Bill is to improve, promote and protect the health and welfare of the population. This will be the ultimate test of whether the legislation has been successful. I note also that the 2001 health strategy, Quality and Fairness — A Health System for You, provided for an independent audit of structures and functions in the health system. A similar report was published in 2003, yet we are rushing through this legislation as this late stage, which is regrettable.

Under the Health Act 1970 employees have an option to appeal directly to the Minister in the event of a proposal to dismiss him or her. While this may make sense in the context of current labour law, it strikes me that the Minister is keen to wash her hands of any difficult decisions down the line. This is a major concern of the Fine Gael Party. Who will ultimately be held accountable? Will the Health Service Executive be blamed for everything? I saw this approach at work in my previous position as spokesman on transport.

I doubt if the Fine Gael Party will blame the HSE. It will still blame me.

It is not a question of us blaming the Minister but one of whether she will accept blame on behalf of the Government.

The Senator need not worry.

In transport, it is frustrating that when one tables a parliamentary question on roads, one is told the issue has nothing to do with the Minister and is a matter for the NRA. We have created a new layer of bureaucracy in that area. Fine Gael worries the same will happen in health. We all know it is difficult under the current system to get replies to questions from the health boards with such a process often taking weeks. The danger is that the system will worsen under the provisions of the Bill.

I wonder if the provision which precludes Members of the Oireachtas from sitting on the executive would, if appealed, stand up in court. I believe it is discriminatory. I am not aware of any reason Members should be precluded from holding another job. Many Members of both Houses have experience in this area and should not be precluded from being a member of the executive. I would like to see the provision challenged in court. This is an issue on which Senator O'Toole also has strong views.

The Senator should speak to Deputy Ring about that matter.

I will do so. This aspect needs further consideration. Section 29 sets out requirements on the drawing up of a corporate plan by the health executive. Section 32 provides for a service plan. However, these plans are nothing new; they existed under the old system but have not been effective. The Bill makes no mention of targets for improved service delivery and better value for money. The service plans must not become paper exercises. They must be dynamic and relevant showing proposals for clear reform with targets on service delivery and service evaluation for patients.

Under the old system, 263 members — 140 from local authorities, 90 from the medical professions and 24 ministerial appointments to the ERHA — represented the health interests of the population. The HSE will consist of 11 members to be appointed by the Minister. There is a clear democratic deficit in that regard. Like us or loathe us as politicians, we, at least, are accountable. We face the electorate every four or five years and they give their verdict on us. There will be no accountability under the new system.

Part 8 provides for public representation and user participation by way of a national health consultative forum, four regional health forums and the establishment of an advisory panel to consult with local communities or other groups on health and personal social services. Public representatives are to be allowed membership of these fora. However, the number of public representatives and from where they will come is not specified. There is grave concern that they will ultimately become talking shops. They will, as far as I am aware, have no executive role. That may look good on paper but it will not provide a better service.

Section 20 provides that the new chief executive officer of the HSE, not the Secretary General at the Department of Health and Children, shall be the Accounting Officer. We are concerned about the effect these new structures will have in terms of the lack of accountability by the Minister to the Dáil regarding service delivery to patients. The HSE could well become the NRA of the transport arena. The Minister stated that the HSE will be compelled to attend the Joint Oireachtas Committee on Health and Children. That sounds find in theory but the Minister will be aware she was due to attend that committee twice in recent weeks but was unable to do for genuine reasons. We will be lucky if they attend the committee once a year.

No, there is a legislative requirement on them to attend.

I know they are compelled to attend but in reality we will be doing well if they attend once or twice a year. That fact will be borne out in years to come.

Fine Gael has particular concerns about section 55 which restricts a complaints officer from making a recommendation which would require an amendment of the executive service plan or of another body's arrangement with the executive for service provision on its behalf. Should such a recommendation be made, arrangements must be requested by the executive or other body to amend, reject or suspend implementation of the recommendation. This effectively ties the hands of the complaints officer and stymies any chance of improving the service to the patient. Fine Gael queries whether reform is taking place when a complaints officer, who has examined a complaint in detail, is prevented from making recommendations to the service plan. A problem never highlighted is, in our view, a problem that never existed.

The Bill also precludes the making of a complaint on a matter relating to the Social Welfare Acts. This preclusion could have dire consequences for complaints regarding the supplementary welfare allowance administered by the health services on behalf of the Department of Social, Community and Family Affairs. Also, the complaints officer is designated by either the HSE or by a service provider. It will be important to ensure that complaint officers can act with the necessary degree of independence. The members of staff of the existing structures are gravely concerned about the Bill. The pace of reform was slowed down last week when IMPACT, which represents 15,000 administrative staff in the health boards, voted for industrial action from Monday, 13 December. According to the unions the decision will block the introduction of administrative structures due to come into force on 1 January 2005 and results in concern among staff regarding work locations, job security and working conditions. This is a reflection of the lack of consultation on the part of the Government.

The ballot from unions came just one week after the proposed CEO of the new HSE pulled out at the last minute due to personal circumstances, an issue on which, regrettably, the Government party put a different spin. Perhaps the person to be appointed felt he would not be able, under current structures, to do his job properly.

The Senator is putting his spin on it now. What he says is not true.

The Senator is spinning it.

The person concerned may not have believed he was in a position to carry out his duties.

The Senator does not know what he is talking about. The person concerned does not have such a responsibility in the UK.

I have qualified my remarks by saying that is my personal view.

The Senator should get his facts right.

Please allow Senator Browne to conclude his contribution without interruption.

I have, perhaps, said enough at this stage. I may also have said too much.

That is true.

Fine Gael has grave concerns about this legislation. I appealed to the Leader of the House this morning to ensure that when debating Committee Stage we are not afforded the same treatment as that given to the Dáil where many of the amendments tabled where not dealt with in detail. The issue of health is too serious to mess with. There is an onus on us as parliamentarians to ensure the legislation is debated in detail. I look forward to contributing on Committee Stage.

I wish to share my time with Senator Daly.

Is that agreed? Agreed.

I, too, welcome the Minister to the House. I envied the Minister having half an hour to make her speech which she delivered so well. Anyone who had never read the Bill would have gained a clear understanding of it from her speech.

Since we commenced this debate under an hour ago, almost €1.5 million has been spent in the delivery of the health service. We spend €13 million per day on the service or almost €1.5 million per hour. We will have spent almost €2 million when we reach 3 p.m. That is incredible.

It is incredible.

I am pleased to have an opportunity to contribute on this important Bill. The Minister said there is an onus on us to obtain value for money on behalf of the taxpayer. I am sure all Members will refer to this legislation as important. It is possibly the most important Bill to come before the House this session. It was a long time in gestation and has been flagged for many months, possibly a year or 18 months. It follows from many reports on the health service over the past years, in particular, the Brennan, Prospectus and Hanly reports, all of which were debated in this House.

Senator Browne has little faith in the system. I have heard other members of his party, when debating those reports, suggest they would be left on a shelf to gather dust. Far from gathering dust, we are now putting their recommendations through this House. The Bill will be the distillation of recommendations contained in those reports and I am pleased to be involved in the passing of it through the House. It will be the tool to drive forward the much-need reform of the health service. Ireland is a small country and the administrative system of the health services, used over the past 30 years, is no longer suitable. The demands and challenges of the 21st century that must be met will be well served by the Bill. Until now, the health services have been managed on a local basis via the health boards. These grew out of the old administration set on the county basis. When the health boards were established 30 years ago they were met with great disdain. Senator Browne looks too young to have been around then.

That is nice.

That is a compliment to Senator Browne.

Compliments are not allowed on Second Stage.

A Chathaoirligh, it is the Christmas season.

Am I not even allowed a little flirtation at Christmas time?

At the time of the establishment of the health boards, people feared they would lose the old intimate relationship they had with their county health authorities. It is fear that makes people not want change. If fear can be overcome and we can move on, we will get a better system. Some 30 years after the establishment of the health boards, the Opposition wants to hold on to the old structures.

That is not true.

If the Opposition knocks it so much, why can it not come up with an alternative? I have yet to hear anything constructive come from that side of the House.

I make constructive comments but Senator Feeny does not listen.

Over time, the health board system proved itself. I grew up in the Midland Health Board area and have lived for the last 25 years in the North Western Health Board area. I take my hat off to pay tribute to those who have worked in the North Western Health Board, particularly the chief executive officer, Mr. Pat Harvey and his predecessors. I pay tribute to the staff of the board and board members. I am delighted that the Bill allows public representatives to have an input.

The County Sligo town of Bellahy borders the County Mayo town of Charlestown. The two towns are virtually joined by one continuous street with the people of Bellahy living alongside the people of Charlestown. However, both towns fall under different health board areas. Patients from Charlestown are sent to Mayo General Hospital in Castlebar, while patients from Bellahy are sent to Sligo General Hospital. It makes no sense as Castlebar is the same distance from Bellahy-Charlestown as Sligo. For specialist treatment, patients from Charlestown must travel 90 miles to Galway when they could travel 20 miles to Sligo. I am glad such practices will be tidied up by the Bill.

The choice of 1 January for the implementation of these proposals is an excellent one. This date, along with the end of July, is when the biggest changes in the health service occur with the changeover of junior hospital doctor positions. I compliment the Tánaiste on her comprehensive speech which she put across in a lovely way in plain and simple English. The Bill will ensure a better outcome for patients. The Opposition will, depending on when it gets its head around it in six or 18 months, eventually wake up to see patients will be better served by the Bill.

How will this be benchmarked for us to know it is a better service? What targets have been established?

It will lead to better value for taxpayers. Opposition Members may be a little slow but we can give them a little shake to wake them up earlier. The Bill will result in a better working environment for health service employees, who have given us diligent service, which they deserve.

The level of information that will come about when the legislation is enacted will be excellent and better than we have ever had. I am, delighted that membership of the executive will see a continuation of experience, with some members serving for five years and others for three. It is not an arrangement we often see on State-appointed boards and one which should be examined for all as it is important to keep experience on board. I am pleased that funding will be made available for meals on wheels and other such organisations. The regional health fora and the advisory panel are other important developments.

The most important development is the complaints procedure, giving people a constructive process. I was confused about the provision whereby complaints cannot be touched when they are of the nature of legal proceedings or matters relating to clinical judgment. Does that mean where there has been a court case one cannot take a complaint if one does not agree with the original clinical judgment and one had received a second opinion? I am delighted to assist the Bill in its passage through the House and look forward to debating the next Stages.

I thank Senator Feeny for sharing her time with me. I welcome the Tánaiste to the House and compliment her speech on this complex legislation. I wish her well as Minister for Health and Children. She has taken on a mammoth task but I know she has the energy, drive and enthusiasm to deal effectively with the issues in the health area. I wish her every success in dealing with these during her term of office.

This mammoth Bill will take over the operation of the health services. A new system of administration will be put in place and replace one that was established in the 1970s. At that time, the health boards took over running the health services from the local authorities. It was often felt that some responsibilities should not have been transferred from the county councils to the health boards. In some jurisdictions, local authorities have responsibility for local issues, such as elderly care and physiotherapy patients, dealing with them in local health offices. In this regard, we are replacing a system which was very fragmented and heavily burdened with administration.

It is not advisable for the Tánaiste to put a further fragmented administration in place when we have an opportunity to deal effectively with the changeover. It is necessary to avoid overlapping and duplication as much as possible in the committees and fora which are established. We must avoid establishing bodies which people see as mere talking shops, do not have decision-making powers and further delay the investment of human and financial resources required in this area of the health service. We must speedily process the legislation.

I appeal to unions, some of which are apprehensive about what the changes in the legislation mean. There is no need for anyone to be apprehensive about changes which will be for the betterment of the service and the personnel who work in it. I appeal to the unions to discuss their apprehensions about how the legislation will work in practice with the Department of Health and Children and the interim executive. They must help to plan and construct a service which is capable of responding to their needs and wishes while also meeting those of the public. The unions have nothing to fear from the process and everything to gain.

I record my appreciation of the achievements of the Mid-Western Health Board in my local area and of the personnel and professionals who have worked in the health service generally. While there has been severe criticism of the system from time to time, we have been very lucky to have such a dedicated professional team delivering health services to the people of this country. The Health Bill will further strengthen the service and in the long term the new arrangements will lead to a more satisfactory and administratively effective system. I encourage the Minister to press ahead with change and appeal to those people who have expressed reservations and apprehensions to set them aside and enter negotiations in a spirit of co-operation. They must help to achieve the best legislative provisions it is possible to put in place to give effect to the decisions which need to be made in the health service. The legislation will in no way delay the development of Ennis General Hospital and other important health service investments.

I welcome the Minister to the House and very much welcome her Bill. I support Senator Browne's comments about the reports which have been issued by the Department of Health and Children over the past seven years. Approximately 130 reports have been produced at a cost of approximately €30 million but there has been very little action on any of them. While I welcome warmly the Minister's decision to take action, I remain concerned that the legislation will constitute a process of rebranding rather than of real reform.

Health boards have been in place for a long time and have had varying success over the years. Those involved in them have lost a certain amount of their enthusiasm. It is not wholly the fault of those who work within the health boards. I have seen brave initiatives by some boards receive very little support from the Department. The pilot scheme for cervical screening in the Mid-Western Health Board has been a recognised success for almost a decade but despite the efforts of the board has not been extended to the rest of the country. There have been disasters in some places where health board management appears to have completely lost control. In that context, I will be pleased to see the establishment of the executive.

I was a member of a the Eastern Health Board a long time ago when services were less complex and we could keep some sort of eye on them. I was a Member of the House when we agreed to split up the health board area, a process everyone must now recognise was not a success. While it was not intended thus, I found myself in scenarios in which I was dealing with a consultant psychiatrist in one area who was treating people from another on an inpatient basis in a third. It was completely out of hand and unsuccessful.

There are some interesting revivals provided for in the Bill. I was a member of the National Health Consultative Forum 30 years ago, which is approximately when Senator Browne was born. It is interesting to see it return. It was a pretty useful body and while I do not know if anyone took any notice of us, I was pleased to be on it. While the city and county council area local fora provided for in the legislation are a positive idea, discussion of the need also to recognise town councils in the context of the Garda Síochána Bill should be borne in mind. Perhaps we could consider the matter on Committee Stage. Comhairle na nOspidéal, another body on which I served, is being dissolved. It is correct to place it in a more mainstream position.

All Members must be aware that representatives of the voluntary and community sector are not best pleased that it has not been positioned more prominently in the Bill. They would like the sector to be recognised on a statutory basis. While an advisory role has been provided for in section 47, the failure to include the community and voluntary sector further has disappointed people in the context of the endorsement of the Minister for Finance in his budget speech of the role it plays in Irish life.

In establishing the executive, the Minister should be careful to ensure medical interests are not over-represented. While the Irish Nurses Organisation will want to ensure a nurse is appointed and I am quite sure the Minister will appoint one if not two doctors, running a health service requires the advice not just of those working in it, but also of people with a great deal of managerial experience. Given that this Bill is about the management of the service, it is not only its medical aspects which should be considered. We also need people with experience in personnel and information technology. This is the context of my concerns that the legislation may simply represent a process of rebranding. There do not appear to be enough provisions regarding management.

There have been examples of disastrous health service management over the years, some of which were interrelated. There have been continual complaints about the accident and emergency department at the Mater Hospital, which is in a dire state. It is always grossly overcrowded and people end up on trolleys for days. The same is true at all the other major hospitals in Dublin. What annoys me most is the fact that up the road in Ballymun the new health centre, which was completed two and a half years ago, has still not been equipped and opened. The old Ballymun health centre is completely incapable of dealing with the population in the area. It is unsafe at times due to the interference of water with its electricity supply and there is no heating. It must be shut down frequently.

If we tell people constantly not to attend accident and emergency units when they should more appropriately attend a general practitioner, we must ask who is responsible for the fact that one such unit which is significantly overcrowded is situated at most one mile from a new health centre which has not been opened. It is ridiculous carry-on and typical of the circumstances which obtain nationally. Staff have yet to be recruited to operate the surgical wards in South Tipperary General Hospital in Clonmel which have existed for approximately a year and have yet to be commissioned. Patients at the hospital who require surgical procedures are transported across country to Cashel. Who is responsible for this ridiculous carry-on? I do not know how long the wards at Mullingar General Hospital have remained unopened. When I last raised the matter in the House, Senator Glynn said progress was being made, but one would like to see a great deal of it.

We must do something about information technology. The extension of medical cards to people over 70 was an unbelievable debacle with 30% more people than expected being found to be eligible for them. How can one plan a health service if one does not have the statistics one needs? The Scandinavian countries and some others also have a personal identification number which people are given at birth. That number remains with that person for whatever service they are availing of. They have population registers as well which gives an idea of where people are at any time. Information like that is needed when trying to plan services.

I have been talking about an identification number since we brought forward the legislation regarding BreastCheck. The other day Senator Cox brought up the delay in extending the BreastCheck programmes to the west. One of the major problems is the difficulty in making up the lists of those who are eligible. When the lists were being made up initially we had to get them from the GMS and the VHI; we now have to get them from BUPA also. We then have to correlate those and tell anyone who had been left off them to get on to the service. We are moving towards some process with PRSI numbers but it is not the same as having a personal identification number. That is something the new board should examine immediately because we cannot plan if we do not know the number of people for whom we should plan.

There is a major problem with people attending accident and emergency departments who should be going to see their general practitioner. Apparently, 40% of people should be going to see their general practitioner. Rather than bringing general practitioners into the hospitals we should start training members of the general public to see general practitioners. Frequently in this House I am asked a question by people who are feeling sick and I tell them they should go to see their general practitioner. They reply that they have not got one. I tell them that if they go in one direction there is the Albany Clinic, in the other there is the Grafton Street Clinic in Anne Street or if they want to go a little further they should go to the Radcliffe Clinic on Fitzwilliam Square. Several GPs have their plates up, one on Merrion Square and others in Baggot Street. I walked from Dublin Castle the other day and passed a general practice. There is another general practice in Temple Bar. People will have to get the message that they should go to general practitioners when they are sick. They should only go to hospital if they have had an accident or some other emergency. We should try to get that message across to people and I hope the new boards will do it. I hope the college of general practitioners becomes involved in that too. Senator Feeney will be well aware of the problem about advertising but perhaps we should do more advertising. People should be able to get lists of general practitioners not just in local health centres but in shops and so on. It is easy to understand the reason people end up in casualty when they become ill.

Terrible problems are caused in accident and emergency departments as a result of over-consumption of alcohol. This is one area where reports have been ignored. All we do is wring our hands about it. A report was published in 1996, another in 2001, one last year and another this year, yet nothing has happened. Specific recommendations were made about identifying the mainly young people in accident and emergency departments and getting them involved in some sort of programme. Specialist nurses in particular were mentioned in the report.

I read a report to the effect that the Minister, Deputy Harney, is considering setting up special treatment units for minor injuries run by nurses. I would be more inclined to advise people to see their general practitioner in that case and get the nurses, if they can be found, involved in the programmes suggested by the four reports on alcohol, the last of which was sent to the joint committee on which many Members of the House sit. We must take notice of what is contained in those reports in terms of what we can do to improve the service.

We have a notion that once we produce a report we have done something but we have done nothing. We have just produced a report, although I suppose it is nice to have a sack of reports. I threw out a lot of them the other day because their recommendations will not be implemented in my time. We should have no more reports. We should implement the recommendations in some of the good reports already available.

I frequently raise the problem about the enormous amount of money spent on the health service for which there appears to be very little accountability. I welcome the fact that this board will try to deal with that problem. I realise a great deal of that money goes on wages but large amounts go on areas where I am sure more savings could be achieved.

The time spent on waiting lists is a major factor in the minds of the public but they are not the only important figures we need to consider. The United Kingdom recently reduced its waiting lists but the waiting time for diagnostic procedures has increased greatly and the waiting time to get on to a waiting list has gone up in some areas. We should not get too tied down with waiting time figures. It is important to remember that while the hospital treatment purchase fund is getting people off waiting lists, it is not doing anything for our health service.

I applaud the initiative which suggests that hospitals not offering accident and emergency services on a 24-hour basis should start doing elective work. I worked in the Adelaide Hospital when that hospital and the Meath Hospital had anentente cordiale and agreed to work together. We closed the accident and emergency department in the Adelaide Hospital — one had to travel only a short distance up the road to the Meath Hospital — and everyone in the Adelaide Hospital did elective work. The dreadful disappointment of operations and procedures being postponed is caused by major car accidents where six or eight people have to be admitted. That takes up the resources in the intensive care unit and other acute beds and the result is that other people’s procedures have to be cancelled. In our case we were doing the elective work for both hospitals which meant that operations and procedures were not cancelled. That gave great satisfaction not just to patients but to staff as well because when everyone is geared up for a day’s work and then the procedure is cancelled because of a serious incident, it is very disappointing.

Having read in the newspaper this morning that there would be a longer lead-in time to the Bill I had hoped we could put off taking Committee Stage next week and not rush it through the House. I have not had an opportunity to read everything that went through the House last night. I read the Bill as initiated and as amended in select committee but I have not had a chance to read it all as yet. I am sure that is the case with other Members. I had hoped we could put off Committee Stage to allow us do that. The Minister, Deputy Harney, provided a good deal of time for Committee Stage of the Environmental Protection Agency Bill and I had hoped this Health Bill would get just as much consideration by this House. Perhaps the Minister might think again about that.

I welcome the Minister of State, Deputy Power, to the House. It is an honour to speak in his presence. I am delighted to have an opportunity to speak on this important Bill.

The two key requirements of the health service are investment and reform. On the investment front, over the coming year the Government will invest €11 billion in the health service. That is by any standard a huge amount of money. It is an increase of €1 billion on the amount spent in 2004 and accounts for 25% of all expenditure on public services, yet we still have people waiting on trolleys and overcrowding in accident and emergency departments. That is the reason the reform programme is as important as the amount of money spent.

The current health system has been in existence for over 30 years and is creaking under the strain. Its inability to cope is best demonstrated by the absence of an improvement in service or output, despite the significant increases in investment the service has received. Reform brings many challenges, and the Minister, Deputy Harney, is rising to them. Ten weeks after taking office she has introduced a Bill which will radically overhaul the way our health system is managed and is determined it be passed by both Houses of the Oireachtas before Christmas. I and my party colleagues will do everything to support her endeavours. The Opposition claims this Bill is being rushed through too quickly. Ironically, the same Opposition has been demanding reform and action for the past 12 months. Confronted with ambitious and significant legislation, it now balks at the opportunity.

I congratulate the Minister and her Ministers of State on grasping the nettle of reform and embarking on this programme with courage, commitment and conviction. The Minister has a track record of confronting and succeeding in challenges, such as smoky coal in Dublin, ending the nightmare of emigration and dole queues and the insurance industry. She will also succeed in this challenge.

When the Estimates were announced on November 18, the Minister made it clear her tenure at the Department of Health and Children would not be more of the same. With regard to the issue of medical cards, she was faced with a stark choice to either simply extend the number of traditional medical cards by 45,000 or choose a more innovative approach. She chose the latter. The new GP cards will enable an additional 200,000 people to visit their GP free of charge. This will relieve pressure on accident and emergency units as many people go directly to A&E because of the cost associated with visiting GPs. These new GP cards will allow thousands of families visit their doctor and receive assurance at no cost. The 30,000 additional medical cards and 200,000 new GP cards constitute a great initiative and the Minister deserves congratulations.

This legislation will have a very significant effect on our health service and consolidate its fragmented structures. We are all too aware of the failings of the current system. It is a towering bureaucracy which successive Ministers of Health have tried in vain to contain. To an extent, the Bill represents the enactment of copious reports recently commissioned by the Department of Health and Children. It is time that such reports, commissioned at substantial cost, are implemented and this is what the Bill seeks to achieve.

The Health Service Executive will reform and restructure the way in which health services are delivered. In its role as a separate entity it will be able to call on the expertise of various people needed to achieve success. It can interact with the Department in a unitary way and demand the Department sets clearly identifiable goals and policies. There will no representation in the north west and or south east. It is time we got away from that so that we know what we are doing.

The case for reform of the health service is compelling. We need a service that is responsive and appropriate to the needs of the 21st century, that puts the patient first and is accessible to all. If the structures and functions of the current system are not organised or capable of delivering the ambitions of the health strategy, now is the time for change.

I welcome the Minister of State to the House. It is important to have such a debate, although I am disappointed, not in the time allocated for Second Stage, but that we are up against the Christmas deadline in terms of passing this legislation. It is probably not the Minister of State's fault. The Bill also came late to the Dáil. This legislation has been talked about for approximately 18 months, since the interim Health Service Executive was established. We now have a massive piece of legislation and not all amendments were debated in the Dáil. Many of them are significant and important. We are implementing a major administrative change in probably the most important area for which the Government has responsibility. We are doing so against a backdrop of a deadline. Regrettably we do not have enough time to fully debate the issue.

I have perused the recent Dáil and Committee Stage debates. The more one reads the legislation, the more concerned one becomes. Much is not included and much is not clear. If the Government is not clear about the issues, one wonders if we are going headlong into a major mistake. The legislation seems driven by an ideological imperative regarding centralisation. It seems the health boards must be abolished because they were somehow doing a disastrous job and costing a pile of money, that politicians should never have had a role in their function and that we would never have a modern health service while the structure existed. Opinion on the structure of the health boards was that it was unmanageable, unwieldy and at fault for the health service which exists. That is not true.

From the Prospectus and Brennan reports we know reforms are needed. Nobody in either House could dispute this fact. One must update a structure as important as the health service to ensure it delivers. It clearly has not been delivering. One only needs visit an accident and emergency department in any of the major Dublin hospitals, in particular the Mater, to realise something is seriously amiss. One only needs to look at waiting lists and listen to the complaints of communities across the country about the use of hospitals and the health service to know something is extremely wrong.

In spite of more and more money being poured into the health service in the past number of years by the former Minister, Deputy Martin, it is still not meeting the mark. This legislation is about administrative reform, as if that alone is the solution. If only it was. Let us assume it is the solution and that if the health service was better managed it would work more efficiently for everybody. What would be the best administrative structure? The Government has devised the most centralised and removed structure. There will be a board, but we do not know who will be on it or what their interests might be. A powerful chief executive officer will head the board, but he or she has yet to be appointed. The board will report to an Oireachtas committee under-resourced to do the job. Consultative forums will have no teeth. The workforce are, at this stage, unclear on certain issues and concerned about the future. Many communities around the country are also concerned.

In terms of administrative reform of the health board around the country, I noted on the map that north County Tipperary is now included in an area that stretches from north Tipperary to the top of County Donegal. Its central administrative function, or regional office, will be in Galway. The same outline is used by BreastCheck for administrative purposes. Its reason for using such a structure is that it needs a critical mass of population in order to operate correctly. I was astonished to see the same administrative boundaries applied to the health boards. The area is huge. North Tipperary, which is currently grouped with counties Limerick and Clare is disconnected from Limerick and creates a different dynamic for the staff in the north Tipperary area. Nobody has been able to tell me clearly what the future looks like. Here we are on 10 December being told that establishment day is 1 January. I note a report inThe Irish Times today, which suggests that while establishment day is 1 January 2005, many of the old structures will remain in place for the moment. Perhaps the Minister of State will clarify that point. The Tánaiste made no reference to that issue in her speech earlier. We are looking at a centralised administration, a board whose complexion is unknown, a CEO whose name is not known and a future we cannot predict. That is an unsatisfactory situation. Despite the fact that it is very long, the legislation does not spell out how the health service will work in practice. There are a number of issues I want to raise.

The Minister says, quite rightly, that the main ethos of the new administrative structure is the care and welfare of the patient. It is interesting, given the Bill is so substantial, that the patient is mentioned only once. This is an administrative structure, but it seems that while administration and accountability for public money are obviously important, this does not appear to be a structure designed to serve the patient. It looks like a structure designed to serve itself and the Minister. I note in particular the relationship between the board and the Minister and I begin to wonder if we are getting to the heart of the question as to why Professor Halligan did not take up the job. The Minister retains a large amount of power.

A budget is being given to the board with which to produce a world-class health service for the patient, allegedly. However, the Minister will issue directions to the board, which can be fired if it does not follow them. Therefore, the board is not independent and the power of the Minister is substantial. To a certain degree, that is probably necessary because the money is coming from the taxpayer and under our democratic system the Minister has accountability in that regard. By the same token the Minister is giving enormous power to the board, so there appears to be a recipe in place for serious conflict in the future between it and the Minister. I wonder how this can work out in practice.

In terms of the board itself I am concerned over its membership. There are currently very powerful players within the health service who have ways of making their voices heard. One thinks, for example, of the consultants and the royal colleges in particular. The power of the royal colleges to grant or withdraw their approval is critical as regards how a teaching hospital, for example, might or might not be run. Will the royal colleges be represented on the new board? Will pharmacists, nurses or workers be represented on the board? We do not know.

I am also concerned about the role of the voluntary and community sector. One of the major features of this legislation, apart from the removal of elected representatives, is the absence of the voluntary and community sector from the health board structure. I hope the Minister of State appreciates by now that there is major concern in this sector over its representatives being excluded from the superstructure being passed in this legislation. I know the Tánaiste referred to the voluntary and community sector in her speech. Aspiration is one thing, but reality is different.

I am sure Members of the House will have received, as I have, representations or an analysis from the disability federation arising out of what has not happened with this legislation in the Dáil and what remains to be done. I will be tabling amendments next week, for which I hope enough time will be given, to reinstate the voice of the voluntary and community sector within this framework. It is completely excluded and there is much concern, particularly among groups such as the Disability Federation of Ireland, which is so dependent as a representative group on its good relations with health boards. However, now it does not know with whom it has a relationship and nobody is able to tell it because the situation is so unclear. That is not satisfactory.

The Minister paid lip-service in her speech to the role of the community and voluntary sector. However, it is notable that the community and voluntary sector is a pillar of the National Economic and Social Forum as well as being an important partner in all of the national agreements that have underpinned the success of the economy. On the one hand the Government recognises the important role played by the community and voluntary sector, while on the other, it has excluded it from this vitally important legislation. There are so many groups who have had long relationships with health boards as service providers, lobbyists or representative groups who do not know what the future has in store for them. This has to be clearly spelled out. It is important in this respect that the role of the voluntary and community sector be formally recognised within the body of the legislation. I will be tabling amendments as regards this next week and I hope the Minister will look favourably on them. I do not understand how a Government which has given the voluntary and community sector a seat at a vitally important table, can exclude it from this legislation. That, at least, is my information which is set out clearly in documentation that I imagine the Minister of State will have received in the past day or two.

The regional health forums, in Part 8 of the Bill, for instance, only refer at present to members of local authorities. The proposed forums are no more than talking shops anyway and are a sop to members of local authorities who no longer have a role, given the abolition of health boards. This provision is designed to create an impression of a role. I am sure they will meet with great pomp and will be fully reported in the media, but at the end of the day they will have no comeback or input into the administrative structures being set up under the legislation. Those of us who have been around long enough recognise, on reading legislation, how it needs to look and what it needs to reflect in order to give bodies a statutory role and a seat at the table. The Minister of State is shaking his head at my assertion that the voluntary and community sector has no role. If he could show me that it has a satisfactory role, I would be obliged because I have not seen this so far. That certainly is not the information given to me by the groups themselves who obviously have major concerns in this regard.

I would also like to comment on the admission early in the Minister's speech that the health information and quality authority is not now being provided for in the legislation but is being brought forward early in 2005. This would appear to be going forward in the manner of a cart without the horse. The process of having quality information has been a cornerstone, as identified by the reports referred to by the Minister. The fact is we do not have the information we need. We do not have the databases we need for a CEO or board to make the decisions expected from them by this legislation. An administrative structure is being set up, the Minister will appoint a board and eventually, we hope, a CEO, give them money and instruct them to provide a world class health service, but without the information they need. It is a sign of the chaos which is indicative not alone of the way the health service is being managed, but also its reform. This legislation is a mistake and has not been fully worked out. The fact the board will not have the information it needs to get started is something of a joke. It leaves us with a structure devoid of democracy, with limited accountability and if it goes wrong the chances of turning back the clock are minimal.

I welcome the Minister of State, Deputy Seán Power, and wish the new Department team well with the important task ahead. Listening to the previous speaker one would wonder whether the Labour Party is the panacea for reform. She seems to have concluded that the Labour Party is exclusively right and that everything it suggests should be done and that our thinking processes do not function in the manner in which we go about business. I could hardly believe she had such a list of negative comments. However, I will try to turn matters around and put something positive into this debate, rather than have the one way traffic I have listened to over the past five or ten minutes.

This legislation is overdue as the set up of the health boards has been talked about since I was a member of a local authority. In those days medical committees were part of the local authority and worked well. However, they were dismantled. Local democracy worked in that area and I would like to see us get back to that situation. I have always believed that if we start locally and work matters out on a local basis we will get things right.

This Bill is about setting up a new executive which will disband the health boards which are fragmented. The mind boggles at the number of people who work in the health boards. It boggles as to who to call when one has to make a phone call to get information. The health boards have sub-committees and sub sub-committees and nobody knows who is accountable in the process of how to solve a problem. It has been difficult to wait to get this sorted.

Nobody is saying that we will have all the answers overnight. However, we must start with a structure, which this new executive gives us. Let it be hierarchical rather than the fragmentation we have had over the past decade where nobody could say who was accountable for what; the fragmentation and duplication of roles meant colossal bureaucracy.

The reason we must have this overdue legislation is to achieve the aim of putting the patient first. Every family in the country would have that priority and would want to ensure that every patient gets immediate treatment ——

Exactly, so why rush the Bill and not debate it properly?

I was not here to interrupt the Senator. I hope he allows me the courtesy of having my say.

Senator Ormonde, without interruption.

It is all about the patient.

I do not think so.

I come from a medical background and can tell the Senator that. I started there and will finish there.

On the issue of value for money, we all agree significant funding has been put into the health service, but we did not get great value for it. We do not know where the money went. It seems to have gone towards administrative costs and got lost in administration. It is important that the patient and value for money are the focus of our thinking. The patient must come first and we must ensure we have a system that gives a good return for taxpayers' money.

Let us start there. Nobody will say that we will have reform overnight, but the Minister, with her team, will do everything in her power to ensure reform. The Minister is bright, as bright as any Member of this House or the other and I challenge anyone to deny that. The Minister will take on all objectors because she understands and has a good grasp of the issues.

I welcome Part 8 and the proposal to set up fora, but I am not sure how this will work. How many fora will there be in each local authority area and what people will be on them? When will they be up and running? When will the regulations be introduced? It is important they begin immediately. I am unsure about what the advisory panels will do. We are setting up a hierarchy with the health executive under which we will have the regional fora which will work with local representation. However, I worry that if we set about diluting or splintering the hierarchical structure we are setting up, we will return to more of the same. We need to keep the hierarchical structure tight rather than introduce the lateral approach we had in the previous system which did not work. I am anxious that the Minister bear this in mind.

Another issue is the consultants who must be brought on board. Some 90% of them are ready to come on board to discuss how best we can improve the service, bring health professionals and administrative staff on board and get them working together. The system will not work unless it is integrated, co-operative and co-ordinated to maximise returns and ensure the patient comes first.

Many speakers have mentioned the number of reports we have had on health reform. We had to start somewhere. I came here from the education system where there were reports up to my eyes over the years. However, at some stage the reports worked and some parts worked very well. Under what was covered in the Hanly report Nenagh hospital is getting a huge extension which will increase accident and emergency services. The same is true for Ennis hospital.

What is the status of the Hanly report?

A start has been made. All will not be right overnight.

What is the status of the Hanly report?

The Senator is permanently interrupting. He should know better.

Senator Ormonde has the floor. Senator Browne should allow her to speak without interruption.

I am confused. The public wants to know. Nobody knows the status of the Hanly report.

The Senator is in bad taste. All I am saying is that we should start on a positive note. This is a new reform and much work remains to be done. We call on all the professionals, consultants, health professionals and staff to make the system better. We want priority given to patients so there will be no delays in accident and emergency units and beds will be available for the elderly and the ill whenever required. This is all people want.

We must consider how to structure accident and emergency admissions. Some people spoke about St. James's Hospital which I had reason to visit last year. I was astonished by how its accident and emergency system worked and the different divisions therein. Perhaps it could be used as a model all over the country for how to deal with those who drop in at 3 a.m. as against people with serious illness. We can only make such changes by sitting around a table and implementing a system we know will work.

This is a comprehensive Bill. It will work if all interested groups work together on reform. I wish the Minister, Deputy Harney, and her team well. I hope we will all support the Bill. The only way to go is forward. We have learned from the failure of the past and the failure of successive Governments. Let us be positive. The patient and value for the taxpayer must come first in the health service to ensure a quality of life for everybody who must attend hospital.

Cuirim fáilte roimh an Aire Stáit. There is no tougher or more important challenge facing society than the reform of the health system. We want to transform it through investment and reform and to deliver lasting progress.

Improvement of the health service is a priority of this Government and over recent years funding has been increased significantly. The increased spending from €3 billion in 1997 to in excess of €10 billion in 2004 is a clear indication of the Government's investment in the health service. One thing that has been demonstrated quite clearly by the investment of more than €7 billion in the health service is that money itself is not the answer. Attempts to reform the service commenced under Deputy Cowen when he was Minister for Health and Children and continued under Deputy Martin. The Tánaiste and her team of the Minister, Ministers of State — Deputy Seán Power, Deputy Brian Lenihan and Deputy Tim O'Malley — are endeavouring to complete the task.

When we look back at what happened in 1970, what is being said today is no different from what the Opposition said at that time. Nothing has changed but the date. There was a hue and cry when the health committees of county councils were disbanded. I worked in the health service for many years. Counties Longford and Westmeath were administered by one county manager, including the health service in those counties. When the health boards were established in the Health Act 1970 by the late former Tánaiste and Minister for Health, Erskine Childers, people said they would not work. The same people are saying the same thing some years later.

Let us dwell for a moment on what the health boards have achieved. Anybody who knows anything at all about the health service will know that it was not possible for it to remain as it was pre-1970. There is no question that the health boards have their faults, but they have brought regional services to many parts of the country that otherwise would never have them. There is no doubt in my mind about that and we must be fair.

In recent years the investment in the health service has achieved significant results including record levels of activity in the acute hospital system. A range of additional services has also been provided across all care programmes. For the first time ever in 2003, over 1 million discharges and day cases were treated in our hospitals. This represents an increase of 46,000 discharges, almost a 5% increase, on 2002.

I come from rural Ireland and remember a time when there was weeping and gnashing of teeth if an ambulance arrived to bring somebody to hospital. It was considered a terrible event. Now people go to hospital for elective procedures. There has been a significant increase in day surgery, which in the main is governed by elective procedures, 190,000 cases or 76% since 1997, giving a total of 441,000 at the end of 2003. That speaks volumes.

Just as we are meeting the challenge of public health issues, we are also meeting the challenge of building a new health system. I would be the first to say that commissioning reports to gather dust on shelves is not the way to do business. However, the Government is taking on board the three reports that have been commissioned and is putting them into effect.

One of the many empty claims from people on the other side of the House is that nothing has changed, that things are as they were in 1997. Some people say we are not spending enough while others say we have spent too much and that the money has been spent with no return. One can legitimately ask where the money has gone. It is easy to find out. That is no big deal. It has gone into hiring 8,200 new nurses, 438 new consultants, 661 new occupational therapists, 456 extra physiotherapists and 200 extra speech and language therapists. I could go on.

Since the Government came to power, a college of nursing attached to the Athlone Institute of Technology has begun general nurse training in the region. Not alone that, but in recent years there has been the first intake of student psychiatric nurses in 21 years. It is also interesting to note that the points required by the CAO for psychiatric nursing are only 15 less than for general nursing. This is a turnaround from a situation in which psychiatric nurse training places were not being filled in many health boards. That is a huge step forward and is another success for the Government.

Senator O'Meara criticised the establishment of the Health Service Executive. It is not long since a Labour Party Minister, who totally turned his back on the association of health boards and would not acknowledge it or attend its conference, wanted to establish a bord sláinte and abolish all the health boards. That was Labour Party policy at that time. Some people suffer from a political malaise called convenient amnesia.

No more than members of Senator Glynn's party.

Something must be done about the problems in accident and emergency services. The Midland Health Board recruited three new consultants, one of whom is based in Mullingar. If people go to Mullingar, Carlow, Portlaoise or wherever, get boozed up to the gills, get involved in a rumpus and require accident and emergency services in Portlaoise, Tullamore, Mullingar or wherever, cause disruption and in some cases assault staff, not alone should they be physically hit but they should be hit where it hurts most of all, in the pocket.

Hear, hear.


Special provision should be made for this. We cannot have people disrupting accident and emergency departments. It is almost as bad in a different way in the psychiatric services. This is a crazy scene. We have the best trained people in Europe in all our hospitals, yet we have gougers, and I do not apologise for the term, going in who are boozed up to the gills and creating mayhem. This should not happen and should not be allowed to happen to sick people and those trying to care for them.

The money has been invested in improving cancer survival rates and exceeding ambitious targets three years ahead of schedule. It has also gone into specific improvements in every element of the health system. In 2003, almost 200 more cases were dealt with in our hospitals than were dealt with before we started our programme. That in itself speaks volumes.

In 2003, more than 1 million people were treated in our health system. These are real people receiving real treatment for serious conditions. The additional staff recruited in recent years have contributed to this treatment. It is an insult to those people to say there has been no improvement in service delivery. I question what planet the people saying this are on.

Funding for the largest hospital refurbishment programme in the State's history has been put in place. Additional services mean additional resources, which is why we have more than trebled funding for the health service. We are not talking about funding alone; we are talking about human resources. People need to be trained.

In the past we all heard about difficulties in the area of orthodontics. When I first began to hold political clinics over 20 years ago if anybody mentioned orthodontics I slunk down under the table because there was nothing I could do for them. It is a totally different ball game now; through the efforts of an excellent consultant orthodontist, Dr. David Hegarty, we have turned the corner. We have eliminated waiting lists altogether in a number of counties in the old Midland Health Board region.

I do not agree with what is proposed regarding the consultative forum. It is absolutely imperative that the role of representatives from county councils and borough councils remain. I was chairman of the health board at the time when we were first consulted and I said there had to be an input from local representatives. These consultative forums will have a bearing. They will be an important conduit to convey grievances from members of the public to where it counts, Government. At the end of the day, responsibility must rest with Government, which has been given a mandate by the public that it must discharge.

I welcome the opportunity afforded to the House to discuss the health service. The maxim, "if it's not broken, don't fix it", is often used in politics which unfortunately does not apply to the health services or their structuring down the years. I very much welcome the fact that we are moving away from the former structures because they did not provide the necessary quantity or quality of service to patients, which is what this debate should be about. It is a little like the Government in that respect. It is not a question of a bigger or smaller Government or health service; rather it is a question of whether it will be a better health service. It is on that question that we should judge this Bill.

In almost every debate held in the House in the past two years, no matter what policy area is being discussed, Government Members have used the phrase "since 1997" as if some great age of enlightenment started in that year. We hear that since 1997 a certain figure has increased by a certain percentage and so on. When we refer to the health services, we should not use the term "since 1997"; we should begin our remarks using the term "since 1987". Senator Leyden, who was very much a player in the field of politics in 1987, will recall the slogan which Fianna Fáil used in that year to gain power, namely, "health cuts hurt the old, the sick and the poor".

What about "a lot done, more to do"?

Former Taoiseach, Charles Haughey, used the phrase when he led Fianna Fáil to election success in 1987 but, within months, he embarked on the most extensive slashing of health expenditure, hospital beds and health services in the history of the State. It is fair to state that we have not yet recovered from the cuts made in 1987 and the amazing policy of removing hospital beds and increasing waiting lists. We must ask ourselves whether this Health Bill will, at least, return the services and beds which existed in 1987 or increase them beyond that level. I have doubts that it will do so.

I was happy when the Tánaiste was appointed as Minister for Health and Children because she genuinely views the job as a challenge and genuinely believes progress can be achieved. However, we must be careful about where the starting point is. We spend a great deal of money on health in Ireland but, by European standards, we are very much mid-division. We cannot claim to spend the highest proportionper capita on health services in Europe. However, we spend billions of euro on health and we must ask ourselves if we are obtaining value for money which, I suspect, we are not.

Senator Glynn referred to orthodontics and indicated that, in his region of the country, tremendous progress has been made, which I am glad to hear. However, I recall a number of discussions on the Joint Committee on Health and Children in which orthodontics was the subject of serious debate. It appears to me that orthodontic services throughout the country are in crisis, certainly in the Southern Health Board region. As the Minister of State will know from parliamentary questions, there is an almost endless waiting list. When the parent of a nine, ten or 11 year old child comes to a clinic to inform one that he or she must wait three, four or five years to have his or her child seen treated by an orthodontist, one must ask if that is the type of modern health service of which we proclaim to be so proud.

We are duty bound on this side of the House to recognise achievements where they are made and acknowledge their results. To that end, I acknowledge that the national treatment purchase fund has been very successful. In that context, will the Minister of State discuss with the Tánaiste the possibility of extending the treatment purchase fund to the orthodontic sector? It is not good enough to tell a young teenager that the importance of his or her need for orthodontic treatment is recognised but that it will not be undertaken for three or four years. The extension of the treatment purchase fund to clear the waiting list for orthodontic treatment would allow us to start anew and I ask the Minister of State to consider the suggestion.

This Bill is wide-ranging because it deals with the reform of the structures, with which I have no difficulty as I believe they need to be radically reformed. However, although the Bill has not been introduced without being well-flagged in advance, the almost mad rush to process the Bill in a short space of time might not be the wisest way to go about our business. The Bill contains significant changes in how we do our business on the health front. However, much more dialogue and debate is required.

As the Minister of State knows well, we do not need more reports. The previous Minister for Health and Children must have been the champion of reports because, for every problem in the health service, he commissioned a report and for every report which was published, there was another report on it. There was a great deal of talk, paper and consultation with consultants but we did not see results. I want to see results from this process. I want to see the Bill resulting in the citizens receiving the quality and quantity of health care they deserve. That this Bill is our starting point demonstrates how badly we have managed the health service. It should be possible for the money we spend to give people a quality health service. I advocate an increase in the expenditure but we should not have waiting lists of many years for elective and other surgery given the billion of euro we spend each year. This issue must form the starting point for the debate as far as patients are concerned.

From the point of view of the patients and consumers for whom this Bill is intended, it is not a question of ideology or philosophy. The outgoing Chinese premier made the point that it did not matter if a cat was black or white as long as it caught the mouse. Irish patients are not worried about the philosophy or ideology of the health care service or whether the provider is public or private or a combination of both; they want a service delivered. That is the debate we need to have but I wonder if we are considering it. The Minister referred to structural reform in her speech but the Bill appears cumbersome and I wonder how quickly it can be implemented and how truly radical it will be.

A member of the Progressive Democrats once referred to a need to be "radical or redundant". In that context, we need to be radical about the health service. We need to work more closely with the people working in the service and not rush the Bill as much. In her speech, the Minister outlined the details of the national health consultative forum, the regional health forums, the advisory panels and the statutory complaints framework, all of which are valid. However, what we have not heard from the Minister with great certainty or definition is that, when enacted, this legislation will mean a better, more accessible service for the patient. We all face that challenge when debating health legislation in this House and that is what we want to see emerge. I am disappointed that we are rushing this legislation through on a Friday evening as if the world will change on 1 January 2005. I do not think it will but I wish the Minister well in her endeavours. If she takes on board what the Opposition is saying, we could all work together to improve the service. Patients want action rather than words.

I welcome the Minister of State, Deputy Seán Power, to the House and wish him well in his first and well-deserved Ministry. I had the pleasure of serving in Government with his father Paddy Power, who was a tremendous Minister for Defence and an excellent constituency worker. It is great to see the continuity and I wish the Minister of State every success in the Department of Health and Children.

The Minister outlined in detail the Health Bill 2004, a very complex and detailed Bill which will take some time to get through before the recess. The Minister clearly stated that the Bill is based on the recommendations of two reports, the Commission on Financial Management and Control Systems in the Health Service, known as the Brennan report, and the Audit of Structures and Functions in the Health System, known as the Prospectus report. Both reports were commissioned by the Department of Health and Children and published in June 2003.

It is important to put the origins of the Bill in context. The Bill proposes the most radical and dramatic changes from 1 January 2005. In the programme for Government published by the Progressive Democrats and Fianna Fáil, there is a very detailed assessment of the proposals which we outlined. They are based on the national health strategy in which many of us were involved. As a former chairman of the Western Health Board, I and others were involved in those discussions. It is important to put in context from where the Minister is coming.

It is the first time, possibly since the days of the former Deputy Brendan Corish, that the Tánaiste is also the Minister for Health and Children. The Minister, Deputy Harney brings to her portfolio a tremendous strength as leader of the only other party in Government with Fianna Fáil. She has great experience and was an effective Minister in the Department of Enterprise, Trade and Employment. I know from the present discussions that she has already succeeded in obtaining major additional funding from the Department of Finance and she will ensure that the health strategy works. I wish her well. The Ministers, Deputies Martin and Cowen were also very effective in both those Departments.

We should take a very positive approach to the health area. It is undermining to see inThe Roscommon Champion this week the same sort of propaganda being issued by Fine Gael as was issued during the local elections on 19 June 2004 in the Roscommon area and on 11 June in the rest of Ireland. The article is headed, “Naughten in new warning over Roscommon A & E", and it states:

The Health Bill which is going through the Dáil this week will lead to downgrading of Roscommon Hospital, according to Deputy Denis Naughten. He toldThe Roscommon Champion that the hospital may lose its accident and emergency unit as a result, in a statement dealing with the Health Bill which is going through the Report and Final Stages in Dáil Éireann and now being passed by Dáil Éireann.

This is the type of propaganda which was spread throughout the local elections of 2004 by leaflets which asked people to "save our local hospital services" by signing a petition. I remind Deputy Naughten, the Fine Gael Party and its spokesman for health in this House that we can look at the overall position regarding the reform of the health services and also look at the localscene. The latter reflects what is happening nationally.

On 15 May 2002, as chairman of the Western Health Board, I signed a contract for a new accident and emergency department at Roscommon County Hospital. That unit has now been provided with additional funding of €2.5 million for the appointment of more staff to be recruited early in 2005. That is a clear indication of the commitment of this Government to the development of the accident and emergency unit at the hospital. The Minister, Deputy Harney, has stated clearly that she will develop services at local level and ensure that they are maintained. I believe she will do so.

What about the Hanly report?

It is evident from the €2.5 million allocation made by the former Minister for Health and Children, Deputy Martin, that we will have 40 extra jobs in the Roscommon hospital accident and emergency unit. The nine observation beds in that unit will open and St. Colman's ward is currently being refurbished. That is a clear commitment to the retention and development of the accident and emergency unit at that hospital and that also applies to many other hospitals.

I invite the Minister to visit Roscommon early in 2005 to officially declare open the new accident and emergency unit of the hospital and view the excellent facilities. We have four consultant sessions weekly in the accident and emergency unit and are seeking a second consultant for four further sessions. That proposal has been forwarded to Comhairle na nOspidéal. I ask the Minister of State and his officials to take note of the application and to approve it as quickly as possible. Roscommon County Hospital has on call radiologists approved by the Department. It deals with 13,000 accident and emergency visits annually in a very busy unit. It has two excellent physicians.

We are debating the Health Bill rather than the health services.

I will put this in the context of the Bill. This Bill supports the development of local hospitals. I am pointing out what has happened in our local hospitals to date.

Where is the Hanly report?

The hospital has two surgeons, new theatres and new screening rooms.

It is called an "arts centre" on the Roscommon Road.

There was a group from Portiuncula Hospital in Ballinasloe outside Leinster House on Wednesday. On behalf of the Western Health Board and the Department of Health and Children I had the pleasure of signing the contract for the purchase of the hospital there.

They got rid of it.

We bought it to ensure that the maternity services there were maintained and developed. I will go into no further detail on Roscommon hospital but I am trying to highlight the scaremongering tactics of the Opposition parties, which are of no help.

Has the Senator got a firm commitment that the hospital will not be downgraded?

The Opposition parties are undermining the future development of Roscommon County Hospital instead of campaigning as I am for an additional physician, anaesthetist and support staff. That is what we will get early next year.

I will consider the Bill and its details but it is important to get that off my chest because I find it disturbing to read the propaganda in this regard.

It is his own party rather than the Opposition that the Senator needs to worry about.

As far as the regional health forums are concerned, I suggest to the Minister and his officials——

The Senator must finish.

I am sorry I have not got more time.

The Senator would have had more time if he had not strayed from the subject. He could also have found another way of raising the matter.

Perhaps I might have an opportunity on the Adjournment. The Cathaoirleach might encourage me to put down a notice on the Adjournment for further elaboration on the health developments and services.

It is very important that public representatives from each county and region have an opportunity to serve on the regional health forums and bring the views of the people to the new executive. I support that and I thank the Minister for putting it in the Bill, along with the reference to advisory panels. Last night RTE broadcast a very good "Prime Time" programme about the MRSA super bug. The situation is very serious and I ask the Department to carry out a detailed assessment of this dangerous bug. The danger of visiting hospitals and spreading and catching infection must be emphasised. I hope to have the opportunity of discussing Roscommon County Hospital in more detail perhaps as a matter on the Adjournment.

I welcome the Minister of State to the House. This is the first occasion I have had the opportunity of addressing him and I wish him well in his Department.

In my opinion this Bill will cause the break-up of the health boards. They have been the backbone of the health service which has not always been the best service but there should be political representation on health boards and the proposed political representation may not be sufficient. As chairperson of the Western Health Board, Senator Leyden fought extremely hard for the survival of Roscommon hospital. All politics is local and he ensured that the new accident and emergency department would be built and funded. I thank Senator Leyden for those gestures.

Hear, hear.

I worry about the manner in which this Government treats people who stand up to challenges.


Allow the Senator without interruption.

The Minister repaid Senator Leyden who was then a councillor and chairperson of the health board by not reappointing him. This is not the way that any Government should behave.

I have come to a better place.

It certainly helped the Senator to be elected to this House.

The reappointment of Senator Leyden is not relevant to the Health Bill.

It is very relevant to me.

I think he was very aggrieved as would I be if I were in his position. He worked very hard as chairperson of the health board, fought for the right cause and yet was dropped. It worries me that the local knowledge of politicians will not be as influential as it was in the past. Politicians are often accused of not making decisions for the common good, but on most occasions they make the right decision.

The health service is certainly in need of reform but I do not believe this is the right reform. I am quite upset when people accuse the Opposition of megaphone politics and of carrying out campaigns of misinformation. Every day I have people coming in to my office who have been on trolleys and people wondering what is wrong with the health service. They want real change just as I want real change. Unfortunately the health service is in a shambles. I do not think enough is being done and I think this Government is making the wrong decisions. It is up to me as a Senator and as an Opposition politician to highlight the deficiencies of this Health Bill. I will not accept anybody shouting across the Chamber at me or anybody else, saying that I am shouting for the sake of shouting. There are problems within the health boards and it is my right to raise these issues. One need only travel around the country to meet the kind of people who are on the radio talk shows and listen to those coming into constituency offices. This Bill gives too much power to the current Minister and we saw what the previous Minister did with his power. I wish the Minister of State well in his new appointment.

I compliment Senator Feighan on being so fair in his deliberations.

Senator Feighan has concluded. The Minister of State to reply, please.

I thank the Senators for their contributions on this important piece of legislation and for their good wishes. As the Tánaiste said in her contribution, this legislation provides for the complete reform of the organisation and management structures of the health services, the first in over 30 years. The Health Act 1970 provided for the introduction of the regional health board system. Prior to the establishment of the boards, the health services in Ireland were administered by the local county councils except in Dublin, Cork, Limerick and Waterford, where the service was managed by the joint health authorities.

The health strategy contained a commitment that an audit of functions and structures in the health system would be undertaken which would help clarify roles and co-ordinate the work of different organisations in the system. The aim of the Government's reform programme, based on the findings of the Brennan and Prospectus reports, is to provide a co-ordinated and integrated health service with a consistent, national approach to the delivery of health services, based on clear and agreed national objectives, within a strong accountability framework. It provides for organisational and structural reform based on the principle of placing the patient at the centre of the health service.

The reform programme was announced by the Government 18 months ago and the need for this legislation has been well signalled in the intervening period. This Bill is the second of two pieces of legislation to be brought before the Oireachtas in the current year in respect of the Government's health reform plans. The first legislation was the Health (Amendment) Act 2004. This Bill will replace that Act, the part of the Health Act 1970 establishing the health boards, most of the Health (Amendment) (No. 3) Act 1996 and the Health (Eastern Regional Health Authority) Act 1999.

It is recognised that the implementation of this reform programme is a major challenge. The Bill will mean the establishment of a unified management structure for the health services. Much work has already been carried out to establish and ensure a smooth transition to the new system on establishment day which will be 1 January 2005. However I reiterate that the transition is being undertaken on a phased basis. The provisions of this Bill are also designed to assist in the transition to these new structures.

As well as providing for the establishment of the Health Service Executive and the abolition of the health boards and the ERHA, the legislation makes provision for improved governance and greater accountability in the health system as well as planning, monitoring and evaluation.

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. The result will be greater clarity, transparency and accountability about lines of responsibility in the health system and this Bill clarifies the lines of responsibility and accountability. The legislation sets up the health service executive which will have responsibility for the delivery of health and personal social services. The statutory functions and responsibilities being taken on by the executive are set out in section 7 and Schedule 3 of the Bill. A review of this Schedule will give Senators an idea of the breadth of the functions currently being carried on by the health boards and other agencies being dissolved by this legislation.

The establishment of the Health Service Executive as a single entity with statutory responsibility for the management and delivery of health and personal social services, represents the central plank in reforming what are, as the Tánaiste described in her speech, the patchwork of amendments made to health legislation over the years which has led to the growth of 58 separate health agencies.

In carrying out its objectives and functions the executive is obliged to ensure that the services are delivered in an integrated and co-ordinated manner to ensure a proper continuum of care from hospital services through to primary and community care services. In delivering or arranging for the delivery of health and personal social services, the executive is required to have regard to the services being provided by voluntary and other bodies and the need for co-operation with other public authorities as necessary where their functions have an impact on the health or welfare of the public. Examples of this include co-operation with the Food Safety Authority of Ireland on food safety matters, the Department of Education and Science in providing services for children with disabilities or local authorities on public health matters. The executive is also being required to have regard to the need to co-operate and co-ordinate its activities with those of other public authorities if the performance of their functions could affect the health of the public. This is important for the executive in its role of protecting and promoting the health of the public.

I will now address some of the points made by Senators during the debate. I do not accept the argument that the legislation is being rushed through the Houses without consultation. The reform programme was announced by the Government 18 months ago and the need for the legislation has been well signalled in the intervening period. Communication and consultation have been at the core of the health reform process dating back to the national health strategy, Quality and Fairness, in November 2001. Immediately after the Government decision on health service reform in June 2003, the Secretary General of the Department briefed political parties on the proposals.

From the beginning, the process has involved an open discussion. The Prospectus and Brennan reports were published in June 2003 and laid before the Houses. At the time, 100,000 copies of an explanatory booklet outlining the reforms, The Health Service Reform Programme, were issued, particularly to those working in the health system. The previous Minister for Health and Children, Deputy Martin, and the Secretary General of the Department visited each health board area to meet and discuss the reforms with staff. Simultaneously, an extensive consultation and communication process was under way.

Following this initial process, the Department commissioned the Office for Health Management to conduct and information and consultation exercise reaching as many people and agencies in the system as possible. More than 20,000 staff were directly engaged over the summer months and into September 2003. They included staff and representatives of the Eastern Regional Health Authority, the health boards, the voluntary, hospital and disability sectors, the community and voluntary pillar, the trade unions and the Department of Health and Children. The Office for Health Management produced a detailed report of this process, which was published earlier this year.

This legislation is the second of two Bills brought before the House this year on the Government's plans for structural and organisational reform of the public health services. As I stated, these plans were widely notified and relayed on a fully inclusive basis. As recently as April and May last, the House discussed the Health (Amendment) Bill 2004, as part of the legislative arrangements necessary to underpin the reforms. In that context, my colleague, the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, discussed in detail the reform process and the arrangements to be put in place to implement it. He specifically informed the House of plans for further legislation, such as that before us today, which would establish the Health Service Executive, make provision for improved governance, accountability, planning, monitoring and evaluation, introduce a statutory framework for the handling of complaints and provide for democratic input at regional and local levels under the new structures. No surprises are being sprung on the House under the Health Bill 2004, as the changes involved have been well explained and communicated publicly and specifically previewed in the House.

The Government is strongly of the view that the executive should be as widely and directly accountable as possible for its decisions, plans and actions related to the discharge of its statutory functions. Such an approach is central to ensuring that the highest standards of service are achieved and maintained. It is, therefore, the Government's intention that this should be reflected in the quality of service the executive 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 interim Health Service Executive is aware of and making plans for the proper and effective discharge of its serious responsibilities in this area. Earlier this month, it announced that the overall structure of the executive would include an office of the chief executive officer and a corporate affairs directorate. In addition, responsibility for the important function of managing parliamentary affairs would be assigned by the chief executive officer to one of the central governance areas. As we move forward, the operation of any new arrangements will be monitored closely and reviewed as necessary.

The provisions of section 10, which provides that the Minister may give directions to the executive and that the executive shall provide any information and statistics required by the Minister, and the provisions relating to the production of service plans by the executive are strong accountability provisions. The Minister is politically responsible for the health service to the Oireachtas. In line with the recommendations of the Brennan and Prospectus reports, the executive will be responsible to the Minister for the management and operation of the health service. The Department will be responsible for supporting the Minister and the Government in all policy matters. The lines of accountability are clear and transparent and do not leave room for non-accountability at any level.

I thank Senators for their contributions. The Bill represents the first major reform of the delivery of the health service in 30 years. It is historic legislation which will lead to a more efficient, effective and patient centred service. I commend it to the House.

Question put.
The Seanad divided: Tá, 25; Níl, 9.

  • Brady, Cyprian.
  • Brennan, Michael.
  • Daly, Brendan.
  • Dardis, John.
  • Dooley, Timmy.
  • Feeney, Geraldine.
  • Fitzgerald, Liam.
  • Glynn, Camillus.
  • Hanafin, John.
  • Henry, Mary.
  • Leyden, Terry.
  • Lydon, Donal J.
  • MacSharry, Marc.
  • Mansergh, Martin.
  • Minihan, John.
  • Morrissey, Tom.
  • Moylan, Pat.
  • O’Brien, Francis.
  • O’Rourke, Mary.
  • Ormonde, Ann.
  • Phelan, Kieran.
  • Scanlon, Eamon.
  • Walsh, Kate.
  • White, Mary M.
  • Wilson, Diarmuid.


  • Bradford, Paul.
  • Browne, Fergal.
  • Burke, Ulick.
  • Cummins, Maurice.
  • Feighan, Frank.
  • Finucane, Michael.
  • Hayes, Brian.
  • Phelan, John.
  • Terry, Sheila.
Tellers: Tá, Senators Minihan and Moylan; Níl, Senators Browne and Cummins.
Question declared carried.
Committee Stage ordered for Tuesday, 14 December 2004.

When is it proposed to sit again?

Next Tuesday at 11.30 a.m.