Health Service Executive (Governance) Bill 2018: [Seanad Bill amended by the Dáil] Report and Final Stages

This is a Seanad Bill which has been amended by the Dáil. In accordance with Standing Order 148, it is deemed to have passed its First, Second and Third Stages in the Seanad and is placed on the Order Paper for Report Stage. On the question "That the Bill be received for final consideration", the Minister may explain the purpose of the amendments made by the Dáil. This is looked upon as the report of the Dáil amendments to the Seanad.

For Senators' convenience, I have arranged for the printing and circulation of the amendments. The Minister will deal separately with the subject matter of each related group of amendments. I have also circulated the proposed groupings to the House. A Senator may contribute once on each grouping.

The Minister has tabled several amendments that arise from the changes made to the Bill by the Dáil. In view of the number of amendments, and to avoid repetition of debate, I propose that amendments made by the Dáil and related amendments tabled by the Minister will be debated together in related groups. Decisions on the amendments tabled by the Minister will be taken when discussion on all groups of amendments has concluded. I remind Senators that only the subject matter of each grouping of amendments made by the Dáil and the amendments tabled that arise out of the amendments made by the Dáil are to be discussed.

Question proposed: "That the Bill be received for final consideration."

I invite the Minister to speak on the subject matter of the amendments in group 1.

Amendments Nos. 1, 3, 4 and 5 relate to health needs assessments and ministerial directions. A health needs assessment is a systematic method of identifying the unmet health and healthcare needs of a population and identifying the changes required to meet those unmet needs.

Amendment No. 1 amends the Long Title consequential to the inclusion of provisions on health needs assessments.

The purpose of Amendment No. 3 is to include provision for the issuing of ministerial directions for the conduct of health needs assessments within section 10 of the Health Act 2004, which covers ministerial directions more generally.

Amendment No. 4 clarifies section 10(6) of the Act. Section 10(6) requires the Minister for Health to lay copies of directions issued under section 10(1) before both Houses of the Oireachtas. The Minister may amend or revoke a direction issued under section 10. Amendment No. 4 amends section 10(6) to clarify that any revocations or amendment to a direction under section 10(1) should also be laid before the Houses.

Amendment No. 5 inserts a new section 10AA into the Health Act 2004. This section addresses the details of how the ministerial directions relating to health needs assessments will operate in practice, the implementation of such directions and related matters.

Does anyone else want to offer at this stage? As no one is offering, I call on the Minister to speak to group 2 now, please.

I will be speaking on Amendments Nos. 2, 11 to 18, inclusive, 21 to 23, inclusive, 26 to 28, inclusive, and 31 to 33, inclusive, from the Dáil. Most of these are consequential to amendments Nos. 11 and 21, which strengthen the roles and responsibilities of the Board and chief executive.

Amendment No. 21 requires the chief executive to ensure that appropriate systems, procedures and practices are in place for certain purposes. Amendment No. 11 requires the board to satisfy itself that these systems, procedures and practices are in place and appropriate. The board must be satisfied in regard to systems to achieve the HSE's object, which 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.

Amendment No. 21 sets out the role of the chief executive in respect of compliance with Government or ministerial policies, whether set out in codes, guidelines or other documents. The chief executive must ensure that the appropriate systems, procedures and practices are in place. As well as the provisions I have set out, Senators will note that amendment No. 11 also requires the board to establish and implement arrangements to manage the performance of the chief executive.

Amendments Nos. 12 to 18, inclusive, 26 to 28, inclusive, and 31 to 33, inclusive, are technical amendments to the Bill arising out of amendments proposed relating to the functions of the board. They amend section references.

Amendments Nos. 2 and 26 to 28, inclusive, are also consequential to amendments Nos. 11 and 21 and are intended to ensure consistency of language in the Health Act 2004 where reference is made to Government policies.

Seanad Report Stage amendment No. 6a is a new and related technical amendment. This is a purely technical amendment to change the name of section 16P from "Role of the Board" to "Functions of the Board" to better reflect the language in the Bill.

Group 3 relates to membership of the board, which is the subject matter of amendments Nos. 6 to 10, inclusive, 35 to 37, inclusive, and Seanad Report Stage amendments Nos. 1 to 6, inclusive, as well as Nos. 7 to 9, inclusive. I ask the Minister to speak on these, please.

HSE board membership was debated by the Select Committee on Health and amendments Nos. 6 to 10, inclusive, and 35 to 37, inclusive, were made on Report Stage in the Dáil following the Committee Stage debate. The Dáil amendments relate to the board and include health professional membership.

Amendment No. 8 from the Dáil provides that at least one of the persons appointed to the board must be a person who is practising, or has practised, as a member of a health profession, whether in this country or elsewhere. Under Amendment No. 10 from the Dáil, health professional is defined to mean doctors, nurses, midwives, dentists, pharmacists and the health and social care professions regulated under the Health and Social Care Professionals Act 2005. Board membership was increased by one. The other amendments on Report Stage in the Dáil in this grouping were consequential to this.

We have a further set of amendments today relating to board membership arising from the Dáil amendments. During Report Stage in the Dáil I was asked by nearly all sides of the Chamber, including the Sinn Féin Party and the Fianna Fáil Party, to look at further increasing the representation on the board to ensure there were two positions for health care professionals and to ensure there was a specifically dedicated seat for financial expertise. During Report Stage in the Dáil I committed to bringing in amendments to increase the number of health professionals on the board from one to two. This is reflected in a new Seanad amendment, amendment No. 3. I also committed to bringing an amendment to expressly provide for a person with financial expertise on the board. This is the new amendment No. 4.

Arising from these amendments, amendment No. 1 increases the number of ordinary members from nine people to ten people. Amendment No. 2 is a technical drafting amendment to take account of the inclusion of the new provision on financial expertise in amendment No. 5.

Amendments Nos. 5, 7, 8 and 9 are consequential to the increase in board membership and cover the quorum for the board and arrangements for calling board meetings.

Amendment No. 6 is a typographical change for consistency with other parts of the Bill.

As I have outlined, these new amendments arise from debate in the Dáil and reflect commitments that I gave there. Effectively, they ensure that two seats on the board are dedicated for health professionals and that there is express provision for a seat for a person with financial expertise on the board. I also wrote to the Chairman of the Oireachtas health committee informing him and the committee of my intention to make these changes in the Seanad to fulfil a commitment I gave across the political divide.

Group 4 covers the role of the board in determining the terms and conditions of the chief executive. This is the subject matter of amendment No. 19. I ask the Minister to speak on that.

Amendment No. 19 includes a role for the board in respect of the terms and conditions of the chief executive and brings the provision in line with many other Acts. Terms and conditions for the chief executive will be determined by the board, but, importantly, with the approval of the Minister for Health of the day and given with the consent of the Minister for Public Expenditure and Reform. This amendment is to ensure that the legislation is clear and in line with other Acts.

Does anyone wish to comment on that? You are all happy with it.

We will move on to amendment No. 20, which the Minister will address individually.

The Bill as published prohibited the CEO from holding any other office, employment or business unless the board approved it. Amendment No. 20 was made on Dáil Report Stage and prohibits the CEO from holding any other office under any circumstances. Senators will recall that this matter was raised during debate in this House last year, including by Senators Devine and Boyhan. I agreed to this change to the legislation in the Dáil by way of an amendment brought forward by Deputy Louise O'Reilly.

We covered amendments Nos. 21 to 23, inclusive, in group 2. I invite the Minister to address amendment No. 24.

Amendment No. 24 amends provisions relating to the CEO appearing before Oireachtas committees. The Bill had contained a standard provision, found in many Acts, that the CEO is not required to give an account before a committee of any matter relating to the general administration of the HSE that "has been, or may at any future time be," the subject of proceedings before a court or tribunal in the State. An amendment was made by the Dáil to remove these words.

Senators again raised this issue in the House, and I agreed in the Dáil to make the change. I was somewhat nervous of the potential consequences, but the Dáil was of the view that CEOs and committees would act responsibly in this regard.

Group 4 comprises amendments No. 25 and 34.

Amendment No. 25 is a technical correction to section 12 to replace the words "the person referred to" with the words "a person referred to in". Amendment No. 34 is a technical correction to Schedule 2 to the Health Act 2004 and provisions for authenticating the seal of the HSE. The reference to an employee of the board is corrected to refer to an employee of the HSE.

Amendments Nos. 26 to 28, inclusive, were discussed under group 2. Group 5 comprises amendment Nos. 29 and 30.

Amendment No. 29 amends provisions relating to the HSE's audit committee. The Bill as passed by this House provided that the audit committee membership is made up of one board member and not fewer than four external members. This was based on arrangements for the audit committee under the directorate governance model. However, in light of the new independent board governance model, membership of the audit committee was reviewed and provision was made for further board membership on the committee. Amendment No. 29 provides that not fewer than three members of the new HSE board will be on the audit committee. The latter will continue to have not fewer than four external members.

Amendment No. 30 is a technical drafting amendment to replace an indefinite article with a definite article.

Dáil amendments Nos. 31 to 37 were dealt with in our discussion of previous groups. We will now deal with the Seanad Report Stage amendments arising out of amendments made in the Dáil, which were discussed in the relevant groups of Dáil amendments.

Government amendment No. 1:
In page 9, to delete line 10 and substitute the following:
"(c) 10 ordinary members.".
Amendment agreed to.
Government amendment No. 2:
In page 9, line 11, to delete "Subject to paragraphs (b) and (c)" and substitute "Subject to paragraphs (b), (c) and (d)".
Amendment agreed to.
Government amendment No. 3:
In page 9, to delete lines 21 to 23 and substitute the following:
"(c) At least 2 of the persons appointed under paragraph (a) shall be persons who are practising, or have practised, as a member of a health profession, whether in or outside the State.".
Amendment agreed to.
Government amendment No. 4:
In page 9, between lines 23 and 24, to insert the following:
"(d) At least one of the persons appointed under paragraph (a) shall be a person who, in the opinion of the Minister, has experience of, or expertise in, financial matters.".
Amendment agreed to.
Government amendment No. 5:
In page 10, line 1, to delete "4 members" and substitute "5 members".
Amendment agreed to.
Government amendment No. 6:
In page 10, line 16, to delete "section, "health profession" means" and substitute "section, ‘health profession' means".
Amendment agreed to.
Government amendment No. 6a:
In page 11, to delete line 1 and substitute "Functions of Board".
Amendment agreed to.
Government amendment No. 7:
In page 31, line 26, to delete "Any 7" and substitute "Any 8".
Amendment agreed to.
Government amendment No. 8:
In page 31, line 29, to delete "7 members" and substitute "8 members".
Amendment agreed to.
Government amendment No. 9:
In page 31, line 35, to delete "6 ordinary" and substitute "7 ordinary".
Amendment agreed to.
Question, "That the Bill, as amended, be received for final consideration," put and agreed to.

When is it proposed to take Fifth Stage?

Question, "That the Bill do now pass," put and agreed to.

When is it proposed to sit again?

At 10.30 a.m. tomorrow.

The Seanad adjourned at 7.15 p.m. until 10.30 a.m. on Wednesday, 29 May 2019.