Children's Health Bill 2018: Committee and Remaining Stages

Section 1 agreed to.
SECTION 2

Amendments Nos. 1 to 3, inclusive, are related and may be discussed together. However, there is no one present to move these amendments.

Amendment No. 1 not moved.
Section 2 agreed to.
Sections 3 to 5, inclusive, agreed to.
Amendments Nos. 2 and 3 not moved.
Section 6 agreed to.
SECTION 7

Amendment No. 4 is in the names of Senators Devine, Ó Donnghaile, Conway-Walsh, Warfield, Mac Lochlainn and Gavan, but there is nobody here to move it.

Senator Devine is now present. Unfortunately I cannot allow the Senator to go back and speak on the amendments to the other sections. Did the Senator not realise the time?

The storm delayed me.

I was caught here in the Chair. We are now on section 7, amendment No. 4.

I move amendment No. 4:

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

“(2) Children’s Health Ireland shall guarantee that there shall be no non-medical influence in the clinical operations of the hospital within the laws of the State.”.

Gabh mo leithscéal, Storm Ali has delayed me.

I have tabled this amendment in order to hear what the Government has to state about non-medical influence in the clinical operations of the hospital within the laws of the State.

The situation in the national children's hospital is different from that of the National Maternity Hospital and the issues of ethos and interference. Will the Minister assure us that there will be no such situation at the national children's hospital?

We have seen evidence recently in the Scally report of the paternalistic attitude to women in the State and the influence that outside agencies, namely, the church, have had on the treatment of women, in particular. This is a children's hospital and we cannot have what I term malign influences operating in it.

Should the Minister reassure us that no such situation will or can arise, I will be happy to withdraw this amendment.

I propose to speak once on the Sinn Féin amendments rather than address them individually. Is that in order?

We can deal with the amendment on section 7. The Senator will be able to speak as we proceed. The Senator cannot deal with all the amendments now. The Senator can speak on amendment No. 4.

May I speak generally on this amendment?

This Bill is long overdue. Obviously we have concerns about impartiality but what is being proposed is necessary and is modern. There is no sign that there has been any influence from outside bodies or specific religions.

We fully support the Bill. It is disappointing that the hospital is not yet built and that it will not be operational until 2022. I am surprised that Sinn Féin has tabled amendments because I am aware that its local councillors support the building of the hospital and want to ensure there is no delay.

I am disappointed that Sinn Féin has not come to support the Bill fully and that it is trying to change it at this stage, whereby it would then have to return to the Dáil.

I believe section 6 has been agreed to. Forgive me for being late. The storm is causing havoc. I wonder whether we could go back and discuss section 6?

I am not allowed, unfortunately.

It is really important.

The Chair is prevented from doing so. I am sorry about that. The Senator will have to speak on some other amendment. I am caught by the rules of the House. The Senator can speak at another time.

I want to respond to my colleague, Senator Ardagh. She knows that my heart and soul, and those of my party, are in providing a children's hospital. It is probably disingenuous of her to say that we are seeking to delay the Bill. It is not about delaying the Bill - it is about making it a better Bill. That is what we are here to do and it involves proposing amendments. I note that the Senator's party has tabled no amendments whatsoever. We have worked really hard on this Bill. I attended three weeks of oral hearings on this matter over the Christmas 2015 period. I am very disappointed that the Senator is being so disingenuous.

The Bill has been carefully drafted to ensure section 7 relates to the need for the new body to abide by Government policy, insofar as it relates to ministerial directives and guidelines. This important standard provision is essential in this case because we have to ensure the national specialised paediatric hospital, which will receive significant public funds, will deliver a safe service of a high quality. Section 6 relates to the objects and functions of the new body. Among its functions will be to "provide for patient safety and quality of patient care", to "promote excellence in the practice and provision of paediatric services" and to "advocate on behalf of children and young people about healthcare issues". It is clear that the focus of the new body will be on the care of patients. It will ensure the clinical operation of the hospital will be driven by the objectives of improving, motivating and protecting the well-being of children. Accordingly, I do not intend to accept amendment No. 4.

I am happy to withdraw the amendment. My rephrasing or interpretation of what the Minister of State has said is that there will be no non-medical influences in the running of the national children's hospital.

That is agreed to. I will withdraw the amendment on that basis.

Amendment, by leave, withdrawn.
Section 7 agreed to.
SECTION 8

As amendments Nos. 5 and 6 are related, they may be discussed together.

I move amendment No. 5:

In page 8, to delete lines 24 to 26.

I understand the need to provide for the hospital to be able to borrow for capital purposes against its income and assets. Such a provision is used by many universities and other institutions across the State. However, I do not see why the hospital would need to borrow for current purposes, given that the State should be funding it to deliver in line with demand. Hospitals run by the State should be funded for the provision of current services from the State from the Exchequer. If section 8(3) is left in the Bill, the current Government and future Governments will be allowed to underfund hospitals and instruct them to borrow money to provide paediatric healthcare services. Its inclusion will allow for exploitation, which is something we should be wary of because we have experienced enough of it.

I have proposed amendment No. 6 because I believe section 8(3) as a whole is questionable. Section 8(3) of the Bill exemplifies the concept of mission creep, which describes how objectives can shift gradually in a way that often results in unplanned longer term changes. I do not see why children's health Ireland will need to "acquire, hold and dispose of shares or other interests in a company, or become a member of a company". The mission of the hospital and its board is to provide paediatric healthcare for children across the State. I do not see why the board of the children's hospital will need to become a member of a company. Other subsections within section 8 give the board the scope to establish subsidiaries and so forth.

Its members are willing to take part in the formation of a company. It is a bit curious that children's health Ireland will need the ability to become a member of a company itself. I do not feel it is appropriate and I feel there is much more to this than meets the eye. Unless the Minister can give me a satisfactory answer, I will push the amendment to a vote.

Freedom must be given to a board. There may be circumstances where a development is required and it is essential that it is separated out from the hospital unit. It must be remembered that it cannot be done without the Minister's consent. It is not an unusual situation in the case of a large organisation providing a service such as this as there sometimes needs to be a separation of functions. I do not believe there is a need for this amendment to be pushed because the section clearly sets out the need for it to be done with the prior consent of the Department and the Minister. This has been drafted to give room for developments that are required in the course of the provision of services.

The new body will have to have an arrangement with multiple universities, academic institutions and research entities due to its national remit in the education of healthcare professionals in paediatrics and engagement in paediatric research. The formal arrangements between the universities and the new body will require some corporate identity to be decided. While this is not yet clear, it was considered prudent to allow the new body to become a member of a company, subject to the consent of the Minister. The provision also keeps options open for the type of structure that may be required for a body to carry out philanthropy for children’s health Ireland.

The provision allowing the new body to borrow for current as well as capital purposes is considered useful but is strictly controlled. The ability of service providers to respond to strategic investment opportunities in the public interest, within legal control limits, must be seen to be a progressive step in managing hospital facilities into the future.

The primary driver for a service provider to borrow is to drive better value in services provided to patients in a cost-effective and timely manner. Borrowing for current purposes could be considered in scenarios where the hospital cannot generate sufficient internal funding resources in the short term to develop a service but is able to demonstrate longer-term viability and an ability to repay. The ability to borrow within controls creates this opportunity.

Circumstances in which the new children’s hospital would make a case to borrow money or engage in activities that have an element of borrowing may arise in regard to leasing or licensing of commercial areas, or leasing of equipment. This could also encompass pump-priming investment in a strategic service initiative or expanding capacity that has potential to generate income for a hospital, such as attracting international patients to avail of cutting-edge, high-technology services or the specialist paediatric expertise and experience that will be available in the new hospital.

There is also the need to consider possible scenarios whereby the new body could require the potential to borrow to invest in extending existing services to generate hospital income by providing cross-jurisdictional services, for example, for Northern Ireland. As part of an accountability framework, such scenarios would be subject to approval of a business case demonstrating a return on investment with the potential to repay borrowings and generate hospital income.

The Bill allows for proper and fully accountable governance and management within the framework of national policy. It is acknowledged that, since the new body will be largely funded by the State, its borrowings will form part of the overall public debt of the State, as assessed by the EU and other bodies, and the State must exercise control before such liabilities are undertaken. The Bill, therefore, includes a provision for borrowing, subject to the approval of the HSE, the Minister, the Minister for Public Expenditure and Reform and the Minister for Finance. It is, therefore, considered appropriate to provide for the potential to borrow in the Bill. Accordingly, I do not intend to accept amendments Nos. 5 and 6.

I wonder what Sláintecare will think of this philanthropy and the dependence on corporate private funding for children's health. This is ideologically driven. The health of our nation, in particular that of children who will be in the wonderful flagship building which is going up in my neighbourhood, should not be dependent on scrambling for the scraps offered by philanthropy or private funding, as other hospitals are to their detriment. They are told that funding depends on how they treat their patients and how many they treat. It is unsustainable and I thought we had moved into a new era of health provision for the public, with an idea that was not ideologically driven and where we did not have to fight for funding with other hospitals and other services.

This is a new start. We know how rotten and unequal the health service has become but this will progress that situation even further. Funding for the entirety of the new children's hospital must be a priority. We must be proud to stand over what is a public service funded by taxpayers' money. I do not believe one taxpayer would want to deny the new hospital its opportunity to be funded from taxpayers' resources.

I am a bit surprised at the suggestion that we should not want a philanthropist to come along with an offer to provide funding. Universities are dependent on philanthropy and there have been many good developments in universities as a result of philanthropy. This is about paediatric care, and research and development. In medicine there are always situations where the State is not in a position to provide funding and research and development have depended a lot on philanthropy.

On the question of being able to borrow, as a budget is made up as early as June in the previous year, a hospital can be half way through a year when it requires action to be taken. It cannot get funding from the Department because the latter does not have it, because of the strict controls that are in place. Is the Senator saying we should not be able to borrow money to get something done which is crucially important for providing services for the people who need them? There has to be a bit of latitude and without giving a board the power to borrow one might as well not have a board. We will then be totally dependent on the Department to make a decision. There needs to be a bit of flexibility in order that the board can respond to needs as they arise, rather than have to wait for the next budget for money.

Amendment put and declared lost.
Section 8 agreed to.
SECTION 9

I move amendment No. 6:

In page 9, line 4, to delete "or current".

Amendment put and declared lost.
Section 9 agreed to.
Sections 10 and 11 agreed to.
SECTION 12

Amendment No. 7 is out of order, on the basis that it involves a potential charge on the Exchequer.

Can I discuss it?

Amendment No. 7 not moved.

Amendments Nos. 8 to 10, inclusive, 12, 17 to 19, inclusive, and 25 to 28, inclusive, are related and may be discussed together, by agreement. Is that agreed? Agreed.

I move amendment No. 8:

In page 10, lines 29 and 30, to delete "the Minister." and substitute the following:

"the Oireachtas, following a public interview process of candidates conducted by the Oireachtas Select Committee on Health.".

I will take all the amendments together. To ensure candidates are satisfactory, I am proposing that all board members are approved by the Oireachtas and that a public interview process be conducted by the Oireachtas Select Committee on Health. I do not believe it is appropriate for the Minister for Health to be allowed to appoint members to the board. These appointments should be transparent. Members of the board of the national children's hospital need to be appointed in a transparent manner and questioned on behalf of the public by the Oireachtas.

It should not be forgotten that in the not too distant past, Ministers have appointed to boards people who were unsuitable to be members of those boards. Amending the Bill in this manner would protect against the role of the Minister being used in a way in which it should not be used. Recently, a former Deputy and Minister of State was appointed to the board of Horse Sport Ireland by the Minister for Agriculture, Food and the Marine. It was stated that this person has a lifelong interest in horses, which is fair enough, but despite my research I could not find any practical or professional experience that the person had in this area. I have been a lifelong supporter of the Dublin senior football team but that does not mean I qualify for selection to play for the team. To be eligible for appointment to a particular board, people should have practical and professional experience in the area, which is what these amendments seek to achieve. If people have a problem with that, I assume they have a problem with transparency and accountability.

Amendment No. 13 deals with patient advocacy, but I understand it has been disallowed.

Exactly. Similarly, amendment No. 11 has been ruled out of order.

It is a bit of a shame.

I will speak to the amendment regarding appointments to the board. I agree with Senator Devine that this board is so important there needs to be transparency. We need to ensure we get the right candidates for the job. I hope the board of this hospital does not end up like the board of the HSE or other agencies, in that the Minister will act expediently and appoint a board on enactment of this Bill and thus we can get on with the job of building the hospital. It is hoped that the Public Appointments Service portal will be properly and efficiently utilised to this end.

I support Senator Devine's point that this board must be comprised of experts with lifelong experience in this area. The appointment of people just for their name or for the sake of it would be unwelcome. I also support Senator Devine's proposal in amendment No. 2 regarding the addition of the words "mental health". This amendment is important because it highlights the importance of mental healthcare and it shows that children's mental health must be looked after in conjunction with their physical health. It is necessary to spell out a commitment to mental health in this way because far too often, mental health has not been a priority and children today are suffering as a result. In that regard, one needs only to look to the shocking situations in Wexford and Cork.

I welcome the establishment of children's health Ireland and I am hopeful for the positive changes that it will bring.

A decision has been already made on amendment No. 2. I have given the Senator some latitude, but we are on amendment No. 8.

I know, but I just wanted to make that point.

In fairness, transparency is already provided for in the Bill because the Minister is accountable to the Houses. There is also full transparency in regard to appointments to all boards. On the issue of a person being required to have expertise in a particular area, I served on a State board for ten years. I was appointed to that board by Cork City Council on the basis of my legal expertise. It is helpful for a board to have members who have legal expertise in dealing with issues such that membership of this board is not all about medical expertise. A Minister would be silly to appoint people who do not have expertise in a particular area. The national children's hospital board will require a particular blend of people because this is going to be a major facility comprising medical consultants, nurses, catering staff, care assistants and many others who provide services for the hospital. It will also be tasked with ensuring that adequate information is getting out to the people on the front line, such as general practitioners. The board will also need people with management or legal experience to ensure it can take decisions which are in the best interests of the efficient running of the hospital for the benefit of the children who require it and their parents.

All of the above amendments relate to the appointment process of board members. The Bill provides that all members are appointed by the Minister for Health and, in the interests of securing the necessary skills and experience on the board, board members will be appointed on the basis of competencies, experience or expertise deemed relevant to the body's functions.

The integration of the three children’s hospitals into one new entity is a major change programme, with significant cultural and operational factors. The three children’s hospitals coming together have been at the forefront of paediatric healthcare. Each has demonstrated enormous commitment to, and has established a strong track record and a proud tradition in, the provision of healthcare services for children and young people in Ireland. As such, the three hospitals are key stakeholders in this project and their agreement and support are fundamental to a successful transition.

In drafting this legislation, we have been conscious of the need to achieve the integration of the three hospitals in a way which respects the values and cultures of each. One such example is the appointment of board members. Accordingly, the Bill provides that there is a role for the board in the appointment of board members, as is currently the case in the children’s hospitals. Accordingly, while all are to be appointed by the Minister, the board of the new entity will nominate eight of the 12 board members and the election by the board of the chairman of the board.

This is a public body created by statute and it is usual that State board appointments would be overseen by the relevant Minister, as is provided for here. The appointment by the Minister is normal practice and I do not see any reason to deviate from this. To require the board to be appointed by the Oireachtas would be unwieldy, requiring approval of both Houses and the President.

There is no precedent for how this would work.

The board provided for in the Bill will become the first board of the new hospital as soon as the legislation is commenced. Senators know that the three boards are to be combined and there is to be continuity on the three hospitals coming together.

I thank the Minister of State for her response. Sinn Féin and the signatories to these amendments in no way want to stall the progress of the building of the national children's hospital. I assure everybody that the hospital is being built. Every day I leave my home, often after sleepless nights, I see the work at the end of my street. My house is full of muck and dust. I want the hospital built. I have given a personal reason for wanting it built but we need it built for the children of this country. It is going up speedily. This Bill needs improvement and that is what amendments are for. Amending is what legislators do. We scrutinise Bills and try to improve them, rather than delay.

The Minister of State has said what is occurring with the boards and appointments is normal practice. We need to reflect on where normal practice has got us. It has us bogged down with scandals, corruption and delays in provision, affecting people at every level of service delivery in the country.

Senator Colm Burke is missing the point. He is fuzzying the intention of these amendments. I did not specifically say it was a matter of medical practitioners and medical professionals being on this board. I agree with the Senator that a mixture of skills is needed. I am not just protecting the medical profession. I would like the Senator not to fuzzy up the intention of this amendment and to understand it a little better.

I am not fuzzying up anything.

Public confidence in the health service is what we most need. We need to ensure these amendments are accepted. Those who oppose them are deciding they do not want that to happen. Transparency and becoming independent from what we had in the past are vital to building public confidence in the battered and uncertain health service that we now deliver.

Senator Devine, like me, lives close to the hospital. I do not doubt at all the sincerity of her intervention on the Bill. I acknowledge the difficulties that have arisen in the building of the hospital. I acknowledge there is a committee in place for the neighbours and local councillors. They seem to be doing well in working with the board and the hospital. The Senator does not want to delay the process; none of us does. We want to get this done as quickly as we can.

Amendment put and declared lost.

I move amendment No. 9:

In page 10, lines 31 and 32, to delete "the Minister" and substitute "the Oireachtas".

Amendment put and declared lost.
Section 12 agreed to.
SECTION 13

I move amendment No. 10:

In page 11, line 19, to delete "the Minister" and substitute the following:

"the Oireachtas, following a public interview process of candidates conducted by the Oireachtas Select Committee on Health,".

Amendment put and declared lost.
Amendment No. 11 not moved.

I move amendment No. 12:

In page 11, line 22, to delete "the Minister" and substitute the following:

"the Oireachtas, following a public interview process of candidates conducted by the Oireachtas Select Committee on Health,".

Amendment put and declared lost.
Amendment No. 13 not moved.

Amendments Nos. 14 to 16, inclusive, are related and will be discussed together.

I move amendment No. 14:

In page 11, line 28, to delete "5 ordinary members" and substitute "all ordinary members".

These are technical in nature and consequential to the amendments on the board of children's health Ireland that were ruled out of order. While the amendments were ruled out, the reason for their submission still needs to be discussed. The group of amendments relates to the board of Children's Health Ireland.

Sinn Féin believes there are problems with the size and nature of the board. The size is too small so we propose to increase the number to 18. We also feel the additional six positions should cover representatives of ICTU, patient advocates and two members of Dublin City Council, DCC. Representatives of ICTU would be important in relaying concerns of staff across the hospital and would guarantee a healthy working link between the board and staff in the hospital.

In the week that Dr. Scally highlighted the need for more patient advocates within the health service, the inclusion of two patient advocates on the board would strengthen the relationship between it and the parents and their children in the hospital.

A few months ago, before the recess, Seanad Éireann passed a motion unanimously to include parents' voices. In that case, it was related to the national steering group for policy-making for children with complex medical needs. Unfortunately, the HSE, in its wisdom, has ignored this and has thwarted the wishes and motion of Seanad Éireann.

There is a representative of DCC on the current board of Crumlin children's hospital. This practice should be continued since the size of the hospital is increasing. There should be two DCC representatives. To ensure candidates are satisfactory, I have proposed that all board members be approved by the Oireachtas and that a public interview process be conducted by the Oireachtas Select Committee on Health. That also goes for the other 12 members.

It is not appropriate for the Minister for Health to be allowed to appoint members to the board. The Minister of State spoke about the residents' action groups in the area. I refer to the area within a 1 km radius of the children's hospital at the St. James's Hospital campus. The local councillors are doing sterling work. Such people on the ground know what is going on and they know how to fix things. They know how to talk to residents and serve as the conduit between the board and BAM Ireland, which is the construction company, and the hospital when it is in service.

As it stands, there is a councillor on the board of the children's hospital in Crumlin. Such appointments should be transparent and members of the board need to be appointed transparently in order that they can be questioned on behalf of the public by the Oireachtas.

Unfortunately, I will withdraw the amendment. I will resubmit the amendments ruled out of order, stipulating that we need additional members. We seek to add non-remunerated members with observer status so there will be no cost to the Exchequer.

Is the Senator talking about amendments Nos. 14 to 16, inclusive?

Amendment, by leave, withdrawn.
Amendments Nos. 15 and 16 not moved.
Section 13 agreed to.
SECTION 14

I move amendment No. 17:

In page 12, lines 3 and 4, to delete "the Minister" and substitute the following:

"the Oireachtas, following a public interview process of candidates conducted by the Oireachtas Select Committee on Health,".

Amendment put and declared lost.

I move amendment No. 18:

In page 12, line 7, to delete “Minister” and substitute the following:

“Oireachtas, following a public interview process of candidates conducted by the Oireachtas Select Committee on Health,”.

Amendment put and declared lost.

I move amendment No. 19:

In page 12, lines 8 and 9, to delete “Board, 4 of whom shall be appointed on the nomination of the Board and 2 of whom shall be chosen by the Minister.” and substitute “Board.”.

Amendment put and declared lost.

Amendments Nos. 20 to 24, inclusive, are related and may be discussed together by agreement. Is that agreed? Agreed.

I move amendment No. 20:

In page 12, to delete lines 10 and 11.

These amendments are technical and consequential on the amendments on the board of children's health Ireland and have been ruled out of order. Therefore, I withdraw these-----

These amendments have not be ruled out of order.

I will withdraw amendments Nos. 20 to 24, inclusive.

Amendment, by leave, withdrawn.
Amendments Nos. 21 to 24, inclusive, not moved.

I move amendment No. 25:

In page 12, line 28, after “Board” to insert the following:

“if approved by the Oireachtas following a public hearing of the Oireachtas Select Committee on Health”.

Amendment put and declared lost.

I move amendment No. 26:

In page 12, line 30, after “reappointment” to insert the following:

“if approved by the Oireachtas following a public hearing of the Oireachtas Select Committee on Health”.

Amendment put and declared lost.
Section 14 agreed to.
SECTION 15

I move amendment No. 27:

In page 12, lines 35 to 37, to delete all words from and including “the Minister” in line 35 down to and including in line 37 and substitute the following:

“the Oireachtas shall appoint a person to fill the resulting vacancy following a public interview process of candidates conducted by the Oireachtas Select Committee on Health.”.

Amendment put and declared lost.

I move amendment No. 28:

In page 13, lines 2 to 4, to delete all words from and including “be filled on” in line 2 down to and including line 4 and substitute the following:

“be filled on the nomination of the Oireachtas following a public interview process of candidates conducted by the Oireachtas Select Committee on Health.”.

Amendment put and declared lost.
Section 15 agreed to.
SECTION 16

Amendments Nos. 29 to 31, inclusive, have been ruled out of order as they impose a potential charge on the Revenue.

Amendments Nos. 29 to 31, inclusive, not moved.
Section 16 agreed to.
SECTION 17

I move amendment No. 32:

In page 14, to delete line 7 and substitute the following: “profession,

(g) is found to have a conflict of interest, including any prospect of financial gain from the functions of the services provided by Children’s Health Ireland and its subsidiaries.”.

I seek to add a new subsection to section 17 disqualifying someone from holding officer or from being a member of the board if he or she is found to have a conflict of interest, including any prospect of financial gain from the functions of the services provided by children's health Ireland and its subsidiaries. This is eminently sensible as a situation cannot be accepted where someone is supposed to be making decisions from which he or she could benefit financially. It would be prudent and proper to accept this amendment. There is this situation in numerous agencies and organisations. Somebody with a conflict of interest should not sit on the board or hold office.

The Bill creates a new entity which, as a State body, will be subject to the highest standard of corporate governance and accountability required of State bodies, including compliance with the code of practice for the governance of State bodies. All board members must comply with the relevant provisions of the Ethics in Public Office Act 1995 and the 2001 legislation. Compliance with the Ethics in Public Office Act is considered for appointment. The Ethics in Public Office Act 1995 provides for the registration of interests of board members. In addition to the requirement under the Ethics in Public Office Act 1995 and the Standards in Public Office Act 2001, the new body will be required to prepare a code of ethics and conduct for board members, including requiring the disclosure of board members' interests, and procedures for dealing with conflict of interest of situations. Board members are obligated to conform to procedures laid down in relation to conflict of interest situations, including acceptance of positions following employment or engagement by a State body that may give rise to potential for conflict of interest and confidentiality concerns. As this matter is already provided for in the establishment of this body, I do not intend to accept the amendment.

Amendment put and declared lost.

Amendments Nos. 33 to 41, inclusive, are related. Amendment No. 41 is a physical alternative to amendment No. 40. Amendments Nos. 33 to 41, inclusive, may be discussed together by agreement. Is that agreed? Agreed.

I move amendment No. 33:

In page 14, line 18, to delete “The Minister” and substitute “The Oireachtas”.

As I stated in regard to other amendments, these amendments transfer responsibility from the Minister to the Oireachtas to ensure candidates and board members are satisfactory and have been properly vetted by the Oireachtas. I do not believe it is appropriate for the Minister for Health only to be allowed to appoint members to the board. Such appointments should be transparent. Members of the board of the National Children's Hospital need to be appointed in a transparent manner in order that they can questioned on behalf of the public by the Oireachtas. We have a history of Ministers appointing unsuitable members to boards.

Amendment No. 32 sought to add a new subsection disqualifying someone from holding office or from being a member of the board if found to have a conflict of interest, including any prospect of financial gain. This is eminently sensible as a situation cannot be accepted where somebody is making decisions from which he or she can benefit financially. However, in order to digest what the Minister of State said, I will withdraw this amendment and speak to my colleagues about resubmission in the Dáil.

Amendment, by leave, withdrawn.
Section 17 agreed to.
SECTION 18
Senator Máire Devine: I move amendment No. 34:
In page 14, line 26, to delete “The Minister” and substitute “The Oireachtas”.
Amendment, by leave, withdrawn.

I move amendment No. 35:

In page 14, line 31, to delete “The Minister” and substitute “The Oireachtas”.

Amendment, by leave, withdrawn.

I move amendment No. 36:

In page 14, line 33, to delete “the Minister” and substitute “the Oireachtas”.

Amendment, by leave, withdrawn.

I move amendment No. 37:

In page 14, line 39, to delete “the Minister’s receipt of the report.” and substitute “the receipt of the report by the Oireachtas.”.

Amendment, by leave, withdrawn.

I move amendment No. 38:

In page 15, line 1, to delete “the Minister” where it firstly occurs and substitute “the Oireachtas”.

Amendment, by leave, withdrawn.

I move amendment No. 39:

In page 15, lines 2 and 3, to delete “the Minister’s opinion” and substitute “the opinion of the Oireachtas”.

Amendment, by leave, withdrawn.

I move amendment No. 40:

In page 15, lines 5 to 11, to delete all words from and including “appointment—” in line 5 down to and including line 11 and substitute the following:

“appointment elect a member to be nominated to the Oireachtas for appointment as chairperson of the Board, and where the Oireachtas approves of the nomination, the member shall be appointed as chairperson for a term of 5 years.”.

Amendment, by leave, withdrawn.

I move amendment No. 41:

In page 15, lines 5 to 11, to delete all words from and including “appointment—” in line 5 down to and including line 11 and substitute the following:

“appointment elect a member to be nominated to the Minister for appointment as chairperson of the Board, and where the Minister approves of the nomination, the member shall be appointed as chairperson for a term of 5 years.”.

Amendment, by leave, withdrawn.
Section 18 agreed to.
Section 19 agreed to.
SECTION 20

Amendments Nos. 42 to 44, inclusive, are related and may be discussed together by agreement. Is that agreed? Agreed.

I move amendment No. 42:

In page 15, line 31, to delete “or a local authority”.

I do not see why a member of a local authority would be barred from membership of the board, nor do I believe any Member of this House would want that. However, I can understand why there is an exclusion of Members of the Oireachtas and MEPs. As I said, there is a Dublin City Council representative on the current board of the children's hospital in Crumlin and this good practice should be continued. Since the size of the hospital will increase, it makes sense that there should be two Dublin City Council representatives on the board. Over many years, we have seen the benefit of members of local authorities being on the boards of hospitals and on other boards. During the problems which arose over the National Maternity Hospital having a member of Dublin City Council on the board was absolutely invaluable in the direction that the hospital took and we need to learn from it. However, as this amendment is consequential on those which have been ruled out of order, I will withdraw it.

While my colleague has withdrawn the amendment, I do agree with her that members of councils have qualifications. I served on Cork City Council and the board of the Port of Cork, having been appointed by the council. Rules have come in in recent years that now bar a councillor from sitting on any State board. I am not clear that is correct because in fairness to councillors they have not got onto councils easily. They have skills outside of the medical area, for example. I do not believe someone should be automatically barred. For argument's sake, a person sitting on the board who was not a councillor could not run for local office if he or she wanted to retain his or her seat on the board. I wonder whether that is a good idea. It is something that we need to review not only in respect of this board but for all boards. I do not disagree with my colleague on this isue. It is something at which we need to look in the long term.

Amendment, by leave, withdrawn.

I move amendment No. 43:

In page 16, line 2, to delete "or a local authority".

Amendment, by leave, withdrawn.

I move amendment No. 44:

In line 16, lines 7 and 8, to delete "or a local authority".

Amendment, by leave, withdrawn.
Section 20 agreed to.
SECTION 21

Amendments Nos. 45 and 48 are related and may be discussed together, by agreement. Is that agreed? Agreed.

I move amendment No. 45:

In page 16, line 16, after “allow” to insert the following:

“, with details of the expenses paid out to each Board member to be publicly published after each year”.

This again is about "transparency", the word and truth to which we should aspire for this term of the Oireachtas. We have been shocked many times in recent history to hear that board members or chief executive officers, CEOs, of State and semi-State companies have been claiming ridiculous expenses and abusing their position in other ways. It is an embarrassment. If we are serious about transparency we must ensure there are provisions to scrutinise the expenses been paid out of the public purse or from funds from hospitals. Public confidence in what services are provided and how governance is carried out requires transparency and openness on expenses and make these amendments important.

I do not intend to accept amendments Nos. 45 and 48 as the provisions are not required to be specific. Under the Bill, the remuneration of CEOs and allowances for the CEO and board members must ultimately be approved by the Minister for Public Expenditure and Reform. Section 10 of the Bill requires the board to keep a proper record of accounts of all incomes and expenditures of the body and the subject matters of the expenditure. This will include as standard practice details of expenses paid to individual board members and the remuneration and allowance of the CEO. The Bill also provides that the annual financial statements will be presented in such a form that the Minister may, with the consideration of the Minister for Public Expenditure and Reform, specify that the body's financial statements will be audited by the Comptroller and Auditor General and copies will be laid before each of the Houses of the Oireachtas as section 10 accounts. The Minister will specify the annual report and financial statements publication will include information regarding individual board member's expenses and the salary and expenses of the CEO.

Is Senator Devine pressing amendment No. 45?

I am pressing the amendment. We cannot sit back on our laurels when we have had so much corruption in this country on different boards and involving different CEOs. Anything that will improve that and be seen to improve it is surely in the best interest. I will push the amendment to a vote.

There is full accountability. In fairness, any board has to assure all expenses are accounted for. As that includes remuneration to the CEO and board members, the system is already in place.

I will say to Senator Colm Burke that the system has failed at times.

I am not clear what board Senator Devine is referring to when she says the system has failed. That was where people were working in the particular organisations where it failed. It was not the board of directors where it failed.

Perhaps it was oversight then?

No, it was not oversight. The issue that Senator Devine is raising is about board directors. The lack of accountability she referred to was by those employed within the particular organisations as opposed to-----

Senator Devine is entitled to press the amendment if she so wishes.

I accept that but the Minister has given clarification on the matter and there is full accountability. The implication here is that there is not accountability, whereas the legislation is quite clear in saying that the Minister is putting in place legislation which means that the board is accountable for every expense incurred.

I accept what Senator Colm Burke is saying but Senator Devine is entitled to press for a vote. Is she pressing for a vote?

Does the Minister want to come back in?

I want to add a point before the vote is taken. Making this information public is good practice. The Minister will be keen to ensure it is in the interest of transparency and accountability. There is also no reason to not publish it as it would fall to be released under the freedom of information legislation if so required. It should also be noted that the Bill does not allow board members to receive fees. This is in keeping with the voluntary ethos of the three hospitals coming together. It is important to make that point.

Is Senator Devine still pressing the amendment?

I am pressing the amendment to a vote.

Amendment put and declared lost.
Section 21 agreed to.
Section 22 agreed to.
SECTION 23

Amendments Nos. 46, 47 and 49 to 51, inclusive, are related and may be discussed together, by agreement. Is that agreed? Agreed.

I move amendment No. 46:

In page 16, line 35, to delete “the Minister,” and substitute “the Oireachtas,”.

Perhaps we will get this amendment through. These amendments go into two distinct sets. The first incorporates amendments Nos. 46 and 47 and they are similar to those to which I have spoken previously in respect of replacing "the Minister" with the "Oireachtas". I will not repeat myself. The second set incorporates amendments Nos. 50 and 51 in which I have included subsidiaries of children's health Ireland. I have included the amendments to ensure that subsidiaries of children's health Ireland are also subject to oversight by the Dáil's Committee of Public Accounts and the Comptroller and Auditor General. We have the case too often where there is no public accountability by subsidiaries of State companies or State organisations. I am sure we have all seen situations involving the Committee of Public Accounts and the Comptroller and Auditor General where a CEO or other representatives state they cannot answer questions regarding a subsidiary as the Committee of Public Accounts and the Comptroller and Auditor General have no oversight or responsibility for that subsidiary. It feels sometimes like the proverbial two fingers are being given to the Oireachtas. We saw that most recently with Irish Water where the Comptroller and Auditor General is prohibited under legislation from auditing the accounts of Irish Water or its subsidiaries. The Committee of Public Accounts is similarly formally precluded under its terms of reference from examining issues in respect of those accounts.

These amendments are sensible and practical. They will ensure transparency when it comes to public moneys and they will guarantee public trust.

These amendments relate both to the appointment of a CEO and to whom that person would be accountable. They also relate to the appearance of that CEO before the Committee of Public Accounts.

I do not intend to accept the amendments. In line with the usual practice, the appointment of the CEO of a state body will be a matter for the Minister rather than the Oireachtas. With regard to the determination of pay and allowance, it is appropriate that the responsibility for this should lie with the Minister for Public Expenditure and Reform. This is standard practice in legislation and there is no valid reason to change this.

For reasons of accountability, it is, once again, standard practice for the CEO of a body to be accountable to the board of that body. It would be unprecedented and it would amount to poor governance to have a CEO directly accountable to two different groups of people.

The purpose for which the CEO would appear before the Committee of Public Accounts is that the committee would examine a report to the Dáil on the annual financial statement and report of the Comptroller and Auditor General with regard to children's health Ireland. Children's health Ireland will prepare financial statements for the following standard rule and will be audited by the Comptroller and Auditor General. Section 9 of the financial report standard 102 deals with the requirement to prepare and consult a financial statement under the section, and the new body will be required to present a financial statement both for itself and for any of its subsidiaries on a consolidation basis. This means that the CEO is required to give evidence on the economy and efficiency of the standard of the new body in the use of resources, systems, procedures and practices employed by subsidiaries of the new body for the purpose of evaluation and effectiveness of its operations. It would, therefore, be unnecessary and incorrect to reference this separately. Accordingly, I do not intend to accept the amendments.

Amendment put and declared lost.

I move amendment No. 47:

In page 17, lines 4 and 5, to delete “the Minister and the approval of the Minister for Public Expenditure and Reform.” and substitute “the Oireachtas.”

Amendment put and declared lost.

I move amendment No. 48:

In page 17, line 13, after “disposal” to insert “and shall be publicly published annually”.

Amendment put and declared lost.
Section 23 agreed to.
SECTION 24

I move amendment No. 49:

In page 17, line 32, after “Board” to insert “and the Oireachtas”.

Amendment put and declared lost.

I move amendment No. 50:

In page 18, line 9, after “Children's Health Ireland” to insert “and its subsidiaries”.

Amendment put and declared lost.

I move amendment No. 51:

In page 18, line 11, after “Children's Health Ireland” to insert “and its subsidiaries”.

Amendment put and declared lost
Section 24 agreed to.
Sections 25 to 67, inclusive, agreed to.
Title agreed to.
Bill reported without amendment and received for final consideration.
Question proposed: "That the Bill do now pass."

I welcome the passing of this Bill and the speed with which the National Children's Hospital is being delivered, given the difficulties in the area. I tabled 51 amendments because I have examined this Bill from head to toe and there are areas in it that needed tweaking and strengthening. I did this so as to improve the Bill, to try to explain it to people and to try to make it better.

There is understandable public cynicism about how we run the health service and we must make people understand that we are serious about change. I tabled 51 amendments but did not do so for the good of my health. I did it for the good of public health and I welcome this Bill.

I welcome the Bill, which is complex. It deals with the amalgamation of three organisations, which is always a complex process. I recall long ago when the maternity services in Cork amalgamated, which did not require the setting up of a board, the process was complex. It involved staff who had worked separately and independently in different organisations coming together. In this instance, there is an added problem in that it involves three separate organisations coming together. There is also an issue with regard to properties attached to the organisations coming under the control of the board, which I welcome.

This development is long overdue. It has been discussed for approximately 25 years. I am delighted with Senator Devine's comments regarding the progress of the project. It is important that it be built in a timely manner and delivered by the date set out. In the context of the health services overall, we must make sure that we learn from this and do not make the same mistakes. We must avoid delaying future projects in the way this project was delayed. It went through the planning process numerous times and now, at last, we are going to have an end product which will benefit the entire population, in that it will provide services for children and their parents. We must have a proper structure in place. The various stakeholders, including those in the three different organisations who are handing control over to a new body, have been co-operative. There has been a lot of give by people and we must appreciate the work they have done over the years in developing the services. All of that must be taken into account. I thank the Minister of State, the departmental officials and all of those affected, particularly the staff and management in the three organisations, for their work and commitment in delivering this project for the country.

I thank all Members for their co-operation. I particularly thank all of the departmental staff for the work they have put into this. It is a complex document but in a number of years from now, we will have a hospital of which we can all be proud and which will improve the quality of life for children from all parts of the country. That is something that we all want and I cannot see it being delayed any further. I welcome the passage of the Bill in this House and hope it continues on its journey in the coming week.

I congratulate the Minister of State.

Question put and agreed to.