I welcome the Bill. Anybody who examines the composition of the Department of Health and Children and the health boards and at the way services have been delivered will see a lack of integration between the Department and the health boards which leaves much to be desired. Over the years, many of us have examined what was happening to the delivery of health care, but how many of us have wondered whether we were obtaining value for money in this respect? How many people are satisfied that adequate funding is going to the coalface where patient services are delivered? The Minister has access to all three reports, which indicate that change is needed since so much has moved on in terms of health care.
I recall that last year health board representatives appeared before the Committee of Public Accounts, of which I am a member. On one occasion, a health board representative predicted that in June the board would have a deficit of €13 million. In December, however, we discovered that the same health board had a surplus of €6 million. More recently, representatives of three health boards appeared before the Committee of Public Accounts. The Mid-Western Health Board and the Western Health Board each had a surplus of €15 million, while the South Eastern Health Board had a surplus of €6 million. If these boards were functioning well and were properly managed, why did they need to have such surpluses at the end of the year? Could some of that money have been used to deliver extra services in each of those three health board areas? The only conclusion one can come to is that the money should have been used to that end.
How many people were aghast to find not only that information technology systems were incompatible between the various health boards, but were also incompatible with the Department of Health and Children? There would be real difficulties in planning for the future if statistics were not up to date and there was no integrated IT system.
The Bill examines health board structures, in addition to going to the heart of the Department of Health and Children. A proper restructuring of that Department is both timely and necessary. I was a member of the Southern Health Board for several years and its chairman for two years. While it is easy to criticise, it should be emphasised that there are outstanding people working in the health services. Outstanding contributions have been made on health boards by members of the medical profession and political appointees, including local authority members.
The democratic deficit has been mentioned and that issue should be examined seriously. In the past, when there was a move to close certain railway lines, there was a similar move to close some hospitals. However, the fact that local representatives were sitting on health boards meant that many hospitals were kept open, and they are thriving to this day. I would not like to see the removal of elected politicians from health service management structures. I am glad the Minister for Health and Children has indicated that there will be a democratic input into the four regional boards he is to establish, including the involvement of local politicians. That is an important matter upon which the Minister should lay great emphasis when finally deciding what form those structures will take.
There has been a media frenzy over the question of removing politicians from health boards and their cost, which of course was minuscule. It is strange that there was no media frenzy about the role of medical personnel on health boards and how well they were able to look after the interests of their own people, sometimes to the detriment of delivering services. As regards new structures that are to be established, I would like to think that the medical profession will not be in as strong a position as before when they could influence — adversely, at times — decisions that should have been progressive and in the interest of patient care.
The Brennan report is an outstanding publication because it got to the facts and highlighted financial control inadequacies within the health boards. The report reflected badly on the control mechanisms that operated within health board structures. It showed that some health boards did not even know the number of people who were employed. It showed that during the Celtic tiger era, large numbers of people were taken on, many of them in central services, but was the same percentage of personnel taken on to deliver patient care?
The proposed new structures are well worth introducing. They should be given a new focus, direction and dedication towards delivering patient care. The opposition has talked about the dangers of centralisation but let us look at the facts. Under the old system, health boards had individual departments for payroll services, human resources and information technology. Such services were, thus, being unnecessarily duplicated across the country. The new centralised structures, including the hospital agency, community care and mental health services, will have a dedicated focus so that health services will be run far more efficiently. All the expertise required for one particular area of health care will be centralised. That is a good thing which everyone will welcome.
An integrated IT system is certainly to be welcomed. If the ESB can have a national payroll, why can the various health agencies not have one? Is there any reason we cannot have a central purchasing agency for the health service, including all our hospitals? Is there any reason why health boards and health agencies had to advertise separately rather than centrally? The centralisation of certain areas of the health service will bring about major improvements.
No doubt, however, there will be a big question over staffing. I estimate that approximately 5,000 people are involved in the centralised services. The Minister for Finance has indicated that there will not be redundancies, as such, within the system but that is a problem Mr. Kelly will have to face. There will be people who are surplus to requirements when the new management structure comes into place. He has adopted a sensible approach by embarking on a process of consultation with staff and unions. Many of these people can be retrained to operate at the coalface of health service delivery.
I also wish to deal with the issues of the hospital agency, community care and mental health services. We should welcome the placing of all acute hospitals and the delivery of acute services under one umbrella. The co-ordination and integration of those services and the re-direction of patients from Dublin to other centres of excellence is something we support and espouse.
Difficulties can arise, however, if proper integration is not maintained. If a consultant in an acute hospital indicates that a patient can move on to a step-down facility and separate agencies with separate funds are responsible for each facility, what guarantee is there that the patient will be transferred? We must achieve proper integration. Last year, 1,200 acute beds in University Hospital, Cork, were tied up by patients whose families refused to move them from those beds, resulting in 1,200 fewer operations for those on waiting lists. For the new structure to work, there must be integration to ensure ease of access to step-down facilities for patients who are fit to move from acute beds.
An issue raising its ugly head is the funding of mental health services. In the three reports that have been produced there was little emphasis of funding for this area. In some of the presentations we have received in the Oireachtas Committee on Health and Children, it was stressed that there must be a focus under the new arrangements for the funding of mental health services. We are all aware that hospitals gobble up funds. We told Mr. Kelly, therefore, that under the new funding arrangements in 2005 for the various agencies, money for mental health should be ring-fenced. That cannot be forgotten.
There will be problems establishing the new structures. Some health boards chief executive officers will not be appointed to the new regional boards and staff wonder how they will be assimilated into the new system. Mr. Kelly is a wily operator. He is embarking on a process of consultation with staff and has appointed 30 people to examine the options open to him. He is ensuring the path to change is made easier by consulting those affected.
In terms of location, the Minister of State should remind the Minister for Health and Children, a fellow Cork man, when he is planning the decentralisation of health services that there is a great town in Cork South-Central called Ballincollig.