Health Service Executive (Governance) Bill 2012: Report Stage (Resumed) and Final Stage

Debate resumed on amendment No. 2
In page 6, line 26, after "Act" to insert the following:
", one of whom shall be a Director of Mental Health".
-(Deputy Caoimhghín Ó Caoláin).

The focus of this amendment is the designation of the role of director of mental health. I know an appointment has taken place since the amendments were tabled and wish the appointee good luck in his new role. However, the core issue is one that I and others, particularly those concerned with mental health reform, share and wish the Minister to consider at this time.

There is a difference of opinion. The note the Minister of State read prior to the recess suggests my arguments do not stand up in respect of the requirement of the Bill that appointees to positions at directorate level be employees of the HSE at a specific or comparable grade within the HSE. The note states that to be eligible, one must be an HSE employee. At least we agree on that point. However, it goes on to state the competition to fill the new posts was open to HSE employees and other public service employees. It might have been, but the use of the word "was" is particularly relevant because we are now talking about a Bill that will apply to the situation that will obtain in the future. Presumably, it did not apply to the particular appointment or appointments made heretofore.

I have linked amendment No. 4 with amendment No. 2, even though, regrettably, they have not been grouped in the groupings presented. Under Part 3A, inserted by section 7, section 16A(3) states:

A person may not be appointed as an appointed director unless he or she is a person who is an employee of the Executive holding the grade of national director or other grade in the Executive which is not less senior than the grade of national director.

It is very clear from that language used that the intention of the Bill is that those who will be considered for such positions must be within the service of the HSE and holders of a post with a particular level of responsibility, that is, national director or other grade that is not less senior than the grade of national director. My argument has been that we should not reserve the opportunity, particularly in the case of the director of mental health, to such a restricted cohort. It is not to say the competency would not be found within their number, but we should leave it open to ensure the widest possible access and competition to ensure the very best person is considered for appointment to fill this post. I make no apology for making a particular case for the area of mental health. The Minister will know from his years here, including his time on these benches, that the mental health service has been the poor relation within the overall configuration of the health care sector. It is critically important that the individual who will take up the position not only has the competency but also a particular feel for the role and the importance of bringing mental health issues to centre stage in the consideration of all health care matters. This is no reflection on Mr. Mulvany who, no doubt, will demonstrate these skills.

I again appeal to the Minister to accept amendment No. 2 and await his response.

I support Deputy Caoimhghín Ó Caoláin's amendment. This issue was raised on a few occasions on Second and Committee Stages. I referred to it when representatives of the HSE recently appeared before the Oireachtas Joint Committee on Health and Children. I am not casting aspersions on those who have been appointed. We wish them well in the very onerous and challenging tasks that lie ahead of them.

However, this legislation will be very restrictive as to who can be appointed. The issue was raised by various advocacy groups who campaign for a better awareness of mental health issues and better mental health supports and services. The groups were concerned that the person best placed to be appointed is the person with the best experience and ability. This legislation confines the number of people who could be considered for this post or any of the other directorates. The specific area of mental health was raised with us by advocacy groups across the country. I do not understand why it is necessary to have a provision in legislation as to how appointments should be made. The Public Appointments Service is an appropriate body and there are other ways of interviewing and vetting candidates in order to choose the most suitable applicant. That process should be available to any person who wishes to put forward their credentials, undergo the scrutiny process and be appointed on merit as opposed to being appointed by virtue of the position he or she holds and that this is enshrined in legislation. I do not understand the logic of this being enshrined in legislation. Is it designed to enable the metamorphosis of the HSE into some other organisation by protecting those who have now been appointed? This is my concern. I am sure those individuals who have been appointed would not be afraid to go through an appointments system in which the applicant is assessed on his or her qualifications and experience and other criteria normally used in an interview process so that they could fill the posts when this legislation is passed. That is the issue that needs to be addressed.

On the issue of mental health, it should be stipulated in the Bill that there would be a director for mental health and that the selection process would be open to anyone. This is not to cast any doubt on the ability, or integrity or capability of those appointed under the current system. I do not agree with enshrining the process in legislation.

I thank the Deputies opposite for their contributions. On the amendment, when performing their functions as members of the directorate, appointed directors will be acting collectively as part of the governing body of the HSE. This is distinct from their individual responsibilities as senior employees in the grade of national director relating to a particular service area.

As indicated on Committee Stage it is not feasible for me to accept this amendment with the specificity it involves which means singling out one service area, however vital. I am very happy to place on the record of the House that it is my view and it has been my view for many years that mental health services have been the Cinderella of the health services. I have often remarked upon the fact that the institution known as St. Ita's was put at the end of a peninsula and the original design was for it to be put on Lambay Island but this proved too expensive. It was a case of out of sight, out of mind. All of our health policy is aimed at destigmatising the issues around mental health and ensuring that the treatments take place in the same locations as all other health care provision, in primary care centres and in hospitals. These large institutions from the Victorian era should be closed.

I am happy to state that my intention is to appoint a new national director of mental health as a member of the HSE directorate. As I said on Committee Stage, I fully understand the good intentions and the reasons for this amendment and I share the Deputy's view on the importance of mental health services. However, as I have explained, I will not be in a position to accept the amendment and I ask the Deputy to consider withdrawing it.

I ask if the Minister could clarify something that is not a small matter. I pointed out the difficulty at times in understanding - perhaps the use of language is part of the problem. In my view, language has to be clear and understandable so that we know exactly what we are dealing with because otherwise we are talking at cross purposes.

I made reference to page six of the Bill, subsection (3), lines 31 to 36, which are the subject of amendment No. 4 in which I seek their deletion. My understanding of this in the context of amendment No. 2 is that it absolutely restricts the appointments of directors to those who are employees of the executive holding the grade of national director or other grade within the executive of not less seniority than the grade of national director. Yet the Minister of State has responded already on this amendment stating that the filling of this post, or other posts perhaps, was open not only to HSE employees but also to other public service employees. Am I correct in saying that the prompt note which the Minister read into the record of the House earlier was particularly built around the fact that it is in the past tense - was open? Therefore, it is a distraction from the fact that we are dealing with legislation yet not enacted nor even passed as a Bill. It is important that we have absolute clarity and understand exactly what is being said and exchanged across this Chamber. I believe that what is in the Bill is much too restrictive. I seek an amendment No. 2, "In page 6, line 26, after "Act" to insert the following:", one of whom shall be a Director of Mental Health". This has been filled and has actually become a fact and this is welcome. I think it could be in the Bill which would give significant comfort to the many people who, like the Minister, have shown a concern for how mental health has been treated historically.

We will deal with amendment No. 4 presently. In subsection (3) on the same page there is a very defined limitation of access to compete for such appointments. I believe it should be open to the widest possible scope of expertise, both within the health service and externally. I do not think it is enough to say if they are successful and if they are appointed, then they will surely be part of it. That is not what this subsection requires; it requires that they are already in the service of the health service and that they already hold the position of a national director or a comparable grade. I think that is much too restrictive.

I would be disappointed that we are not able to make progress with some of these amendments for the very good reasons that we have argued. I think that the effort we have employed both on Committee Stage and now on Report Stage merits careful analysis and a weighing up of the arguments by the Minister. In this particular instance it would signal a mighty positive towards not only mental health reform but also the many other NGOs and those who are concerned about mental health services in our health service. These are concerns that have not been lessened over these two years of the Minister's stewardship. He should make no mistake about it that the €35 million just rings in our ears. We need a certainty for the future. There is a chance to do that in this legislation and I would hope that the Minister would reconsider and perhaps also explain what I see - if I am missing something, so be it and let me become aware of it - but from what I hear I believe there are conflicting messages with regard to what the Bill proposes and what the Minister of State has already responded regarding said appointments.

I am sorry the Deputy does not agree. We are in complete agreement on the need to send a strong message on mental health. This is the first time there will be a separate and distinct post of national director of mental health in the HSE. The person who has been appointed on a director-designate basis will be responsible to the director general for the budget and resources applied to mental health and for advancing the Government's stated policy of implementing A Vision for Change.

I remind Deputy Ó Caoláin that a key purpose of the Bill is to abolish the board structure and replace it with a directorate model. The directors are to be employees to ensure that their focus is on operational responsibility and accountability. Any new employment competition will be run in accordance with Public Appointments Service processes. The past tense to which the Deputy alludes is of no particular significance. I am not prepared to accept the amendment and, respectfully, I ask the Deputy to withdraw it.

I will not persist in addressing the matter. Certainly, I will have an opportunity to address some of the salient points in the next grouping, which includes amendments Nos. 3 and 4. I am not happy to withdraw the amendment, however. I welcome wholeheartedly and without hesitation that a director of mental health appointment has been confirmed, which is hugely important. The other steps, however, would have been hugely important and that importance is not lessened by the fact of the director of mental health appointment. The need is for certainty into the future, which is always important. As one never knows who might be in office at any point in the future, let us guarantee it now. It is a legacy the Minister could leave by taking on board amendment No. 2.

Amendment put and declared lost.

Amendments Nos. 3 and 4 are related and may be discussed together.

I move amendment No. 3:

In page 6, line 30, to delete "greater than 6" and substitute "greater than 8".

Currently, the Bill provides that the directorate, which will be the governing body for the HSE, will consist of the director general and not more than six other members, who are referred to in the Bill as "appointed directors". Only HSE employees at the grade of national director or no less senior grade will be eligible to be appointed as directors. The decision to include employees in no less senior grades was the result of a Committee Stage amendment I introduced. Amendment No. 3 will give practical effect to that provision by making provision in respect of the size of the directorate. The HSE has recently appointed people to head up key service areas, including a national director of mental health, a national director of hospitals, a national director of primary care, a national director of social care and a national director of health and well-being. I have always made it clear that my intention is that employees in charge of key service areas will be members of the directorate. It is also my intention that the person heading child and family services will be a member of the directorate pending the introduction of the new child and family support agency. As I stated on Committee Stage, however, the governing body of the HSE should have scope to encompass other very significant people in the HSE. I propose amendment No. 3, therefore, to increase the maximum number of appointed directors from six to eight. This will allow relevant service heads and a small number of other key senior employees such as the chief operations officer and the chief financial officer to form the governing body of the HSE. I assure Deputies that there will be no additional cost associated with the making of this amendment.

Having set out my reasons for increasing the maximum size of the directorate, I turn to amendment No. 4, proposed by Deputy Ó Caoláin, which is grouped with amendment No. 3. However, I do not want to second-guess what the Deputy may say. While amendment No. 4 relates to the composition of the directorate also, its effect would be to have no requirement that members of the directorate be drawn from among employees in senior management positions in the HSE and no requirement that the directorate need necessarily have any HSE employee on it. This would not fit with one of the central policy objectives underpinning the Bill, which is to abolish the board structure of the HSE, the members of which are traditionally drawn from outside persons, and replace it with a directorate the members of which come from senior management in the executive. The directorate structure reflects the need for greater operational management focus on the key delivery of services and greater transparency in the funding of service delivery and accountability. Deputy Ó Caoláin's amendment envisages outside persons being appointed to the directorate, which is consistent with a board structure rather than a directorate model. I hope the Deputy understands why I do not propose to accept the amendment.

However, I make clear that the intention is that appointed directors are drawn from HSE employees irrespective of when the person was appointed to his or her grade. Separate from the Bill, but as part of the overall policy underpinning it, new senior HSE posts were approved. A Public Appointments Service competition was held to fill the new posts. The director general designate of the HSE announced on 17 May 2013 that the Public Appointments Service had concluded a recruitment process on behalf of the HSE for five new national directors and a chief financial officer. It is my intention that people recruited under the competition will be appointed to the directorate.

I record my support for amendment No. 3.

I thank the Deputy.

We get off to a positive start on the grouping, at least. The words used in the amendment are "not greater than" which means the Minister is not locked into making eight appointments. He is not locked in to a maximum of six appointments either but has flexibility in other areas of importance which must be reflected in the make-up of the envisaged directorate. That is good to go and I will support it.

Amendment No. 4 is not about demanding that the membership of the directorate is made up of people outside the Health Service Executive. It is about having the option of appointing - I repeat - the best possible people to take on these roles of responsibility. I emphasise that these are responsible roles. Next to the Minister's own role, the members of the directorate will have the responsibility of oversight of the single largest swathe of public moneys expended annually. It is a phenomenal responsibility. While I have no issue at all if all appointments are made from within the service and expect that many if not all will be, I am concerned that the door is closed. It is strange because only in the last number of days, we have heard that serious consideration is being given to the idea of ministerial appointments from outside the elected make-up of the House. The issue has been reflected on over the course of the weekend gone by and in other fora. There is precedent for it. This is about circumstances in which someone presents who can bring an expertise to bear. Clearly, he or she is not going to come from a background which is not associated with or reflective of the roles and responsibilities with which he or she would be entrusted as a member of the directorate. He or she would come from a background in health. There are many precedents, including precedents in other Departments, where appointees have not come through the respective departmental strata but have been brought in from within the citizenry of the State and beyond. It is something we should always leave open to consideration, which is all the amendment seeks to do.

Removing the restrictive language of subsection 3 on page 6 allows flexibility. That is all it does. It does not lock in the Minister to anything. It is worthy of support for that reason. It is important to those who have given advocacy to this argument. I acknowledge the efforts of Mental Health Reform, which is the backdrop to the argument in this instance. However, amendment No. 4 is not confined to mental health considerations. It could apply to any of the directorate roles within the make-up of the new directorate.

I appeal to the Minister to reconsider his position on amendment No. 4. It is not at variance with the Minister's amendment, No. 3, and the two can work well in tandem. I am supporting No. 3 and the Minister is due to support No. 4.

We are dealing with this issue again. I have not heard a reason for the Minister's placing of such restriction on a panel of people who are to take on very important roles in the delivery of health care. It is narrowing it to a few people. In recent years, the Government and others have placed emphasis on looking beyond the Civil Service in the delivery of public services and seeking outside expertise and competence. This ties the hands of the Minister drastically in terms of an independent appointments system to assess the criteria of an individual's application so that he or she can be appointed on merit. It cannot be done if the legislation goes through as it is. The provision is in place for no other reason than to provide security and straightforward passage to those who will be appointed to the transformed HSE in a number of years' time. I cannot see the logic of enshrining this measure in legislation as it ties the hands of anyone making a determination on the most suitably qualified person to deliver the onerous task of health care.

From the point of view of the Minister and - I do not mean this in a dismissive manner - whoever is Minister in the years ahead, the purpose should be to appoint the best person on merit. The legislation will not allow that to be done, regardless of who is there at present. These are the only ones who will qualify, although they may be exceptionally bright and talented people. The provision ties the hands of the Minister for the next number of years in terms of appointments. I cannot understand why the Minister would do that.

I thank Deputy Ó Caoláin for supporting amendment No. 3. I cannot accept amendment No. 4 because that brings us back to something more akin to a board than to what is intended. The purpose of this legislation is to establish a directorate that is directly involved in, and focused on, service delivery.

I listened to what Deputy Billy Kelleher said and he is right that we are trying to bring in fresh blood across the system. It is important to remember that this is a temporary structure to get us to the health care commissioning agency, which will be advertised publicly. There is no question of smoothing the way for people to get into that organisation using this route. The Deputy is aware of my criticisms of the formation of the HSE and the amalgamation of 11 health boards, when everyone was promised they could not only keep their jobs but keep the same jobs. We got none of the savings or efficiencies that would normally be expected when amalgamating organisations. One expects greater efficiency through a reduction in staff numbers as there is duplication of function across 11 organisations. This is one of the reasons the hospital groups will be effective. They will do away with much of the fragmentation in the health service and duplication in management and administration, with human resources and management across 49 hospitals decreasing to a system that has management across six hospitals. In addition, there will be a new national paediatric hospital group. I hear what is being said but I regret I cannot accept amendment No. 4.

It looks as though we do not have a deal. There is no point in dragging this out unnecessarily. I have not heard an explanation of why the Minister of State, Deputy Kathleen Lynch, suggested earlier that the situation was other than what subsection 3 seeks to lock us into, namely, restriction to those in the service and those at particular grade levels. What she put on record in regard to other public service employees is in the past tense and will not be the case once the Bill is enacted. Her contribution was unhelpful and I am concerned at what it intended to do. Whether it was to confuse or to distract I do not know, but I am not happy with it.

Amendment No. 4 is very reasonable and does not take from the legislation. Many people have director roles in different aspects of our public service and the different agencies of government and they were appointed from outside the structures of the entity. There are examples aplenty I could cite that are not akin to boards, as the Minister suggests. The directorate the Minister seeks to put in place will not be weakened by opening it up to the best possible expertise and the greatest energy and enthusiasm, which is necessary. This is particularly true in driving forward reforms in the area of mental health and driving forward the implementation of A Vision for Change, which I acknowledge we are all committed to.

I have covered all the points and, as the Deputy pointed out, we covered this on Committee Stage. No more than the other Deputies, I do not wish to delay the passage of the Bill.

Amendment agreed to.

I move amendment No. 4:

In page 6, to delete lines 31 to 36.

Question, "That the words proposed to be deleted stand", put and declared carried.
Amendment declared lost.

Amendments Nos. 5 and 12 are related and may be discussed together.

I move amendment No. 5:

In page 6, line 41, after “determine” to insert the following:

“but the total annual remuneration for each director shall be no more than €100,000”.

I have consistently argued, as I do in amendments Nos. 5 and 12, for a cap to apply at the highest pay levels of the public service. That is hugely important in these economically straitened times. These amendments are consistent with my and my party's approach to this matter. Such a step together with the reductions in Deputies' and Senators' pay, which we have argued should continue, would save approximately €4.3 million per annum.

Rather than targeting pay at the lower end of the scale, which has been the case under this Government's austerity approach, the Minister's colleagues in Cabinet who are making these decisions should look at the top end and tax at a higher level those who are on the highest income streams, as well as taxing wealth. Sadly, the Government has chosen to punish average and lower paid public servants, with which I strongly disagree. Of course, the Government has also breached, as has the Minister in his Department, the guidelines regarding the pay of ministerial advisers. The guidelines appear to be an à la carte option in that Ministers can take them or leave them. Most of them have left them and allocated very generous pay terms to a number of ministerial advisers in their employ.

I do not expect the Minister to accept these amendments. I have argued for them, as have colleagues in my party as well as other Members in the House, across all the portfolios. It is critical that we revisit this matter time after time to make the point that the only way we can properly show leadership in these times is if those on the most generous pay terms are prepared to take the greatest pain, and not the reverse as is currently the case. That is not to suggest that we are hoping to penalise people or make life any more difficult for them than it is for anybody else: far from it. I tabled amendments Nos. 5 and 12 because I believe the capping of pay at €100,000 at the highest levels of the public service in the current economic circumstances is not unreasonable. It is fair and is a generous return for anybody's labours. I hope the Minister is prepared to give it serious thought and not ignominiously dismiss these propositions.

This amendment is worth discussing in broader terms in respect of the health service. Figures provided by the Health Service Executive to Deputy Finian McGrath in response to a parliamentary question show that two top earners shared a pay pot of €882,694 last year. The breakdown of the earnings of the two shows that they earned €358,566 in salaries and an additional €450,000 in various allowances. The two also received an additional allowance of €74,000. It is a short reply but it sums up the point Deputy Ó Caoláin is making.

The overall figures reveal a pay bonanza for thousands of HSE high earning staff, with the majority being consultant doctors. Last year, 2,571 consultant doctors received €476 million, an average of €185,000. The figures show that one employee was in the earning band of between €300,000 and €400,000. The information shows that a further 22 staff earned between €250,000 and €300,000, receiving a total of €5.79 million in pay. The figures show that 1,034 staff earned between €150,000 and €200,000 last year. A total of 32,616 staff, or 34% of the HSE workforce, received pay of less than €30,000, while 20,000 or 21% were in receipt of between €30,000 and €40,000 per annum.

There is a great disparity between the low pay scales and the very high pay scales. The consultants are often easy targets, and the Minister did not spare them when he sat on this side of the House, but we must see a readjustment. Governments will always claim they have a progressive tax system in place but the last two budgets have been regressive. That has been acknowledged independently. The higher earners have not contributed as much in terms of tax deductions across the workforce. We can argue over the figure of €100,000 and what the figure should be, but there is certainly a big disparity between the very high earners in the HSE and those who are contributing on the lower pay rates. It should be borne in mind that even the nurse graduate scheme that was proposed provided that qualified nurses would be recruited at a lower pay scale. That was proposed by the Minister previously, so I believe there is merit in the amendment.

This is a broad debate that must take place. If we want a fairer society, as was promised, the figures outlined to Deputy Finian McGrath show that we have a long way to go to make our society fairer and more equitable, where everybody carries a fair share of the burden. Those figures are very revealing. In the context of the amendment, they outline why people at the lower pay rates feel aggrieved. I realise it is a broader debate but this amendment highlights that there is a disparity between the vast majority of the workforce in the public sector and those in the high echelons of that sector. Politicians are often criticised, often quite correctly, but there has been a big reduction in the pay scales for politicians. The Taoiseach's salary has been reduced, as have the salaries of Ministers, Ministers of State, Deputies and Senators. That is fine and we accept that we must make our contribution too, but there still appears to be a cohort that seems to be almost exempt from doing its fair share. When one sees people in the HSE still earning more than €300,000, one must question why that is the case.

I could say a great deal in response to the last speaker. First, however, I know of no official in the HSE being paid at the level the Deputy mentioned. If he is alluding to academic appointments, that might be a separate matter. Certainly, no official is being paid at the level the Deputy mentioned.

The pay of the Taoiseach is €100,000 less than when the Deputy's party was in power. We have reduced the pay for new entrants to the consultant grade. I still consider the rates fair at €116,000 to €121,000 when the starting figure in the UK is £80,000, which is less than €100,000. There are new controls being introduced in the insurance area as well to ensure we have audit and particularly clinical audit and that there is a review of what we pay for the procedures being performed. Some of them that used to take two hours now only take 20 minutes.

The Deputy mentioned a fairer society and that is an aspiration of this Government. However, it takes time to undo the damage that was done by the previous Government over the long period of time it was in office. Of course, it was the Deputy's Government that introduced the new consultant contract, which I welcomed only on the basis that it took consultants off the pitch in terms of being blamed for all the problems of the health service and not that it was a good deal for the taxpayer.

In respect of the substantive issue here, it is useful and important to repeat the point I made on Committee Stage, that an appointed director will not receive any additional remuneration by virtue of his or her appointment to the directorate. An appointed director will be remunerated on the basis of his or her substantive post of national director or other senior grade.

These substantive posts are very senior positions within the organisation and the salary levels set reflect the responsibilities undertaken. In the case of the director general, we must remember the difficult and very significant responsibilities attached to the job. As well as chairing the directorate, the director general will be responsible for managing the HSE, ensuring that Government policies are met and delivering on reform. The remuneration being offered for these posts reflects the demands of the posts and is consistent with Government pay policy. I would further point out that the HSE has 100,000 employees and is responsible for delivering an extremely complex health care system across the entire lifespan of our people and across multiple settings, including care in the home, in the community, in hospitals and in long-term care institutions. The remuneration reflects the serious responsibilities placed on the individuals concerned. Furthermore, the director general's salary is over one third less than that of the previous incumbent, the CEO of the HSE. In fairness, the moneys that are on offer here are commensurate with the nature and responsibilities of the job. It is important to note that being appointed a director does not increase that pay.

The Minister used the phrase "commensurate with the responsibilities" of the job. As a Deputy, I know the extent of the reductions we have taken over recent years, in terms of both salary and expenses. I am still willing, even though I know it stretches me with a young family and college responsibilities, to give that leadership and to face further reductions. It is not about what we do here. I would say that the reality is, for the vast majority of Deputies and Senators, that were we in other walks of life, what we actually get paid would not at all be commensurate with the huge number of hours that we work on a daily basis. However, we have roles and responsibilities and we are here to fulfil them. Many people in the public service are very highly motivated, no less than those in elected public life. I believe that there is a further responsibility on their shoulders to give the very best leadership and that can be demonstrated best by a willingness to do, as the Minister would argue, more for less. That is a phrase the Minister uses vis-à-vis so many other aspects of what he hopes to achieve in his role as Minister for Health.

He regularly talks about getting more for less. That is something we can all practise. I am indicating a willingness to do that and I believe those at the highest echelons of the health services and the HSE should also show that example. The members of the directorate and the director general, who do indeed have significant roles and responsibilities, just as we all have in our roles here, can do their work for a much reduced level of remuneration than is currently being offered. I believe that is the example that must be given. Then we must look at all the other areas where the shoulders that can bear it best will start to seriously take the weight of the current challenge and not those at lower to middle income levels within the public service, who have been much too over-burdened.

I must point out again that earlier Deputy Ó Caoláin argued that we should open this up to wider public opportunity but the reality is that if I was to offer the remuneration to which the Deputy refers, there would be little or no interest. It is difficult enough as it is, with the Government cap, to attract the calibre of people that we need to bring into our services to deliver for our people. The current director general designate will be on a salary of €195,450 per annum, as director general. The previous incumbent was on €300,000 per annum, plus additional benefits. This is a substantial reduction. The posts of national director, level two, have been approved with a salary of €158,000. The chief financial officer and the chief operational officer will be at national director, level one, with salaries of €172,000. These are substantial salaries but these are jobs that have huge responsibility associated with them.

I have already made my point with regard to the generality to which the Deputy alludes. I do not believe it is reasonable to ask what the Deputy suggests in his amendments and I do not propose to accept them. However, I will confirm to the Deputy that I am certainly doing an awful lot more for an awful lot less remuneration and I know that most politicians are, but so be it. We put ourselves forward and asked the people to give us the honour and privilege of serving them and are delighted to do it. It would not be appropriate, however, to try to lay our own personal choices down as absolutely mandatory for all others who work in the public sector. I believe these salaries are set at a level that reflects the huge responsibility that the people who occupy these positions will have. If they deliver, as I expect they will, we will have a much improved health service.

We are in times of great economic strain and in those circumstances, an argument still stands for further reductions in pay at the highest levels, rather than continuing with the burdening of those who are very clearly already beyond affording the hits they are taking. I rest the case. I have made it and the Minister has responded as I expected. I am pressing the amendment.

Amendment put and declared lost.

I move amendment No. 5a:

In page 6, between lines 41 and 42 to insert the following:

“(5) For the purposes of subsection (3) and section 16B (4), a person shall be considered as holding the grade of national director or other grade in the Executive which is not less senior than the grade of national director, where that person stands appointed to a post at such grade on a temporary or acting basis for so long as that appointment subsists.".

The rationale for this is that the Bill provides that members of the HSE directorate are referred to as appointed directors and that only HSE employees in the grade of national director, or other not less-senior grade, are eligible to be appointed to be directors. We must, however, allow for all eventualities, including where an employee may be acting in the relevant grade on a temporary basis but his or her substantive grade is less senior. Amendment No. 5a addresses this, in line with legal advice. I hope the Deputies can accept this amendment, which is technical in nature.

I ask for a little elaboration on this. The amendment states that a person shall be considered as holding the grade of national director or other grade which is not less than that, where that person stands appointed to a post to such grade on a temporary or acting basis. Where is that appointee coming from? This is relevant in terms of some of the questions I posed earlier.

This amendment only appeared today, as far as I understand it. It is not on the original list of Report Stage amendments but is on an additional list. I also saw a1 as a sole amendment on an earlier substitute amendments list, in the name of Deputy Kelleher.

Would the Minister like to elaborate on that? I do not think it is as simple as he suggests. In the context of the questions I posed regarding the earlier exchange with the Minister of State, Deputy Lynch, on amendment No. 4, which was defeated, an elaboration is required.

I will happily do that for the benefit of the Deputy. This situation has already arisen in that the interim national director for child and family services in the HSE is in an acting position in the context of the transfer of child and family services to the new child and family support agency. I have previously signalled my intention that the national director for child and family services will be a member of the directorate, pending the establishment of the new agency. Amendment No. 5a will facilitate this. In order to act up one must be an employee of the HSE.

In my earlier comments I had the same gentleman in my mind, among others. I recognise that. The Minister will recall I talked about appointments from outside the jurisdiction in regard to other areas. Where does this fit in regard to subsection (3)? I sought its deletion. What is the net effect of the amendment? It is open to interpretation and I am asking for certainty. I understand somebody is being appointed to a post. Is this what the commentary from the Minister of State earlier referred to? Somebody can be appointed to a post even though he or she is not a national director or holding a grade of comparable seniority, and by appointment he or she is thereby viewed retrospectively to have had that qualification.

This issue is complex and its outworking is difficult to envisage. Things seem to be pulling in two different directions, one of which is locking us in. Deputy Kelleher and I have argued against that with reference to subsection (3). I may be missing the point, but this amendment suggests that some flexibility and imaginative application of the status of appointees may be considered. Maybe the Minister could help me with that.

I would be very pleased to help the Deputy with that. He might recall that during earlier Stages of the Bill I pointed out that it was possible to bring in new people from outside who can be promoted upwards. Equally, it is important to point out that the original recruitment in these areas would be through an open competition by the Public Appointments Service and it is an open and transparent process.

The fact that people have to act up on occasion, as is currently the case, speaks for itself. It is quite clear why we need this amendment, and we are introducing it on the legal advice of the Office of the Attorney General because we have a real-life situation to address. The issue is not purely theoretical. It does not pull in any opposite direction but does de facto allow for greater flexibility, which is something about which the Deputy and Deputy Kelleher are concerned.

I do not want to be so bold as to suggest that it almost confirms the points Deputy Kelleher and I argued heretofore. At this point in time we have had limited sight of the amendment. To my knowledge it was only published today and I have not had any opportunity to evaluate the language involved. That is becoming quite a task in itself in regard to legislation in these times.

In a spirit of flexibility, I am inclined to say "Okay." However, the Minister should appreciate that it is not appropriate that we have not had prior sight of the amendment nor an opportunity to evaluate it in the context of all we have discussed.

I appreciate flexibility and support, and given that the Deputy is inclined to support the amendment I am inclined to thank him.

Amendment agreed to.

Amendments Nos. 6 to 11, inclusive, and amendments Nos. 13 to 18, inclusive, are related and may be discussed together.

I move amendment No. 6:

In page 8, to delete lines 1 to 3.

Section 16(b) sets out in detail the term of office of an appointed director. The term of office of a member appointed to the directorate is three years and he or she may be reappointed by the Minister for a second or subsequent term.

In the select sub-committee Deputy Kelleher drew attention to the provisions of the Bill that disqualify a person from being an appointed director or director general where he or she has made a composition or arrangement with creditors. Deputy Kelleher queried what this meant and whether it was in keeping with the stated position of the Government in regard to how arrangements under the Personal Insolvency Act should not impinge unnecessarily on a person's life or activities. I undertook to revert to the select sub-committee on what a composition or arrangement with creditors meant before Report Stage and I have recently written to its Chairman. The legal advice is that a composition or arrangement with creditors, as used in the Bill, means something done under legislation. This has traditionally been the bankruptcy Acts and will now encompass the Personal Insolvency Act.

Having consulted with the Minister for Justice and Equality, who has responsibility for the legislation, and having considered the matter in the context of Government policy on personal insolvency and the Committee Stage debates, I am now moving the necessary Report Stage amendments to delete the references in the Bill to disqualification from being an appointed director in the HSE or being director general of the HSE where the person involved has been adjudicated bankrupt or has made a composition or arrangement with his or her creditors. These are amendments Nos. 6 to 11, inclusive, and 13 to 18, inclusive.

We had this debate on the pharmacy legislation. Pharmacists cannot practise once they are deemed to be bankrupt. A commitment was given that the issue would be examined in the context of legislation in that area. I welcome the amendments. We are living in a very different world from that of a number of years ago. As I said, we can have a debate, as we often do, on how we arrived at this point. It is important that we never include in legislation something that would inhibit an individual who, for whatever reason, has been declared bankrupt or has made a composition arrangement with creditors from participating in an activity. That would undermine the capacity of such people to earn a lawful salary. I welcome the clarity that has been brought to the matter and I hope the issue will be examined in any other legislation that is introduced. As a nation we are trying to move to a situation in which people who have been burdened with debt, for whatever reason, and have filed for bankruptcy or come to a composition under the Personal Insolvency Act are not thereby ineligible for particular posts. It shows we do not always waste our time on Committee Stage. I thank the Minister.

I join Deputy Kelleher in his comments. We addressed this issue in regard to pharmacists. There was acceptance across the board that in the circumstances it was an inappropriate penalty to apply to those practising as opposed to owning a business. I ask the Minister to give us a further indication of the intention of these amendments in regard to the holding of positions by those who are adjudicated bankrupt.

It is difficult to understand, if it was deemed appropriate at drafting stage to include these provisions, why they are now being deleted. The provision in paragraph (c) that a person who has been adjudicated bankrupt is disbarred from appointment as a director of the Health Service Executive seems absolutely sensible. There might be less to say for paragraph (d), which provides that a person who has made a composition or arrangement with his or her creditors is likewise disbarred, but the same concerns arise. These provisions were initially considered necessary to include in the Bill. In fact, I understand it is standard practice for such provisos to apply in respect of appointments to senior positions. I was not party to the discussions on this matter at Committee Stage, so I hope the Minister can offer a good explanation as to why it is now considered necessary to remove these safeguards.

The new personal insolvency legislation has broad-ranging implications for all such legislative provisions. Having consulted with the Minister for Justice and Equality, who has responsibility for that legislation, having considered the matter in the context of Government policy on personal insolvency, and having taken on board the points raised by Deputies Billy Kelleher and Caoimhghín Ó Caoláin on Committee Stage, I am now moving the necessary Report Stage amendments to delete the provisions disqualifying a person from being an appointed director in the HSE, or indeed director general of the HSE, where he or she has been adjudicated bankrupt or has made a composition or arrangement with his or her creditors. Such persons, in other words, are no longer automatically disqualified from membership of the directorate. The original provisions, which, as Deputy Róisín Shortall rightly observed, tend to be standard, now require amendment in the context of the insolvency legislation. I thank the Deputies opposite for their contributions on this point on Committee Stage.

The Minister did not explain why these provisions were considered necessary at one point but are now required to be deleted. Safeguards such as these are very important in respect of very senior public positions. It would be completely acceptable to impose some type of time limit, for example, in respect of persons who have been adjudicated bankrupt at some point in the past. My reading of the proposal, however, is that it could lead to a scenario in which a director of the HSE who was adjudicated to be bankrupt could continue in the job. That seems wholly unacceptable given the types of pressure to which a person in that situation would be subject. There is an undesirability in the prospect of such an individual being responsible for a very significant budget. The Minister has not referred to the potential dangers of such a scenario. I am concerned about the basis for his decision to delete this section, given that it was deemed necessary in the first instance.

I accept the Deputy's bona fides in articulating her concerns. The historical view would have been that a person who was bankrupt was not suitable to be in a senior position. As we all know, however, life in this country has changed inexorably in recent years, with large numbers of people now finding themselves in financial difficulty, in negative equity and so on. As a result, there is a new view abroad. I wrote to the Minister for Justice and Equality, Deputy Alan Shatter, seeking advice on this issue. He indicated that any restrictions on employment consequent on a bankruptcy adjudication or composition are contained in legislation and codes of practice for particular sectors. He referenced the Electoral Acts and the Pharmacy Act 2007 by way of example, to which Deputies opposite also alluded, and to codes of conduct for solicitors, gardaí and so on. In the Minister's view, it is a matter for the Minister responsible in each sector to examine the position and make any necessary changes, and he is already making arrangements to address such restrictions in the broad justice sector. The Minister further indicated that while policy in this regard will be a matter for each Minister, he is of the view that such restrictions should be abolished to the greatest extent possible.

In terms of the stresses to which a person who has been adjudicated as bankrupt would be subject, I cannot imagine how those stresses would be relieved or in any way reduced by the loss of his or her job.

Question, "That the words proposed to be deleted stand", put and declared lost.
Amendment declared carried.

I move amendment No. 7:

In page 8, line 4, to delete "(e) has been convicted" and substitute "(c) has been convicted".

Amendment agreed to.

I move amendment No. 8:

In page 8, line 6, to delete "(f) has been convicted" and substitute "(d) has been convicted".

Amendment agreed to.

I move amendment No. 9:

In page 8, to delete lines 20 to 22.

Question, "That the words proposed to be deleted stand", put and declared lost.
Amendment declared carried.

I move amendment No. 10:

In page 8, line 23, to delete "(g) is convicted on" and substitute "(e) is convicted on".

Amendment agreed to.

I move amendment No. 11:

In page 8, line 25, to delete "(h) is convicted of" and substitute "(f) is convicted of".

Amendment agreed to.

I move amendment No. 12:

In page 9, line 24, after "determine" to insert the following:

"but the total annual remuneration of the Director General shall be no more than €100,000".

Amendment put and declared lost.

I move amendment No. 13:

In page 9, to delete lines 37 to 39.

Question, "That the words proposed to be deleted stand", put and declared lost.
Amendment declared carried.

I move amendment No. 14:

In page 9, line 40, to delete "(f) has been convicted" and substitute "(d) has been convicted".

Amendment agreed to.

I move amendment No. 15:

In page 9, line 42, to delete "(g) has been convicted" and substitute "(e) has been convicted".

Amendment agreed to.

I move amendment No. 16:

In page 10, to delete lines 8 to 10.

Question, "That the words proposed to be deleted stand", put and declared lost.
Amendment declared carried.

I move amendment No. 17:

In page 10, line 11, to delete "(g) is convicted on" and substitute "(e) is convicted on".

Amendment agreed to.

I move amendment No. 18:

In page 10, line 13, to delete "(h) is convicted of" and substitute "(f) is convicted of".

Amendment agreed to.

Amendments Nos. 19 and 20 are related and may be discussed together. Members should note that the correct version of amendment No. 19 is on the additional list of amendments and is a substitute for the corresponding amendment on the principal list dated 22 May 2013.

I move amendment No. 19:

In page 11, to delete lines 22 to 40 and substitute the following:

"(4) Where the Director General is absent the functions of the Director General referred to in subsection (1) may be performed by such appointed director as may be designated by the Director General from time to time, with the consent of the Minister, and where no such designation has been made, and the Director General is unable by reason of his or her ill health to make such a designation, by the Minister.

(5) If the office of Director General is vacant, the functions of the Director General referred to in subsection (1) may be performed by such appointed director as may be designated by the Minister for the purposes of this subsection.

(6) For the purposes of subsections (4) and (5), where in this Act or in any other enactment functions are assigned to the Director General or provision is made in this Act or in such enactment as to the manner in which a function so assigned is to be performed by the Director General any such reference to the Director General shall be construed as including a reference to the appointed director designated by the Director General or the Minister under subsection (4) or, as the case may be, the Minister under subsection (5) for so long as that appointed director stands so designated and entitled to perform the functions of the Director General.

(7) Where the Director General resumes duty the person designated under subsection (4) shall cease to perform the functions of the Director General.".

As outlined on Committee Stage, the Bill currently provides that in the extended absence of the director general, or if the office of director general is vacant, the functions of that office may be performed for a period not exceeding six months by an appointed director - that is, a member of the directorate designated by the Minister. There is currently no provision in the Bill to deal with short absences of the director general. I introduced a Committee Stage amendment to deal with that. The other change I proposed in committee was to allow the director general rather than the Minister to designate the appointed director to cover absences. This seems to me the most efficient operational arrangement. The designation would, however, require the consent of the Minister. The situation is different if the office of director general is vacant. In those circumstances, the Minister can designate and appoint a director to fill the gap pending the recruitment of a new director general.

The amendment I introduced also removed the maximum period during which cover could be provided on a temporary basis during an extended absence or when the office was vacant. Deputy Caoimhghín Ó Caoláin voiced concerns that removing this time limit could lead to unsatisfactory circumstances in which an acting situation was allowed to continue indefinitely.

Moving this time limit could lead to unsatisfactory circumstances where an acting situation was allowed to continue indefinitely. I therefore withdrew the amendment and undertook to give it further consideration. Deputies will see that amendment No. 19 addresses absences of any duration and provides for the director general to designate and appoint a director to stand in for him or her during any absence. Some role is, however, retained for the Minister to take account of unforeseen circumstances where the director general is absent but had not made such a designation and is unable to do so due to ill-health as when taken suddenly ill or perhaps involved in an accident. With an organisation of national importance such as the HSE it is, I think we would all agree, essential that there is always someone with clear authority to perform the functions of the director general.

The reference to a maximum of a six month duration for cover is not included. I appreciate the point Deputy Ó Caoláin made on this matter on Committee Stage and have given it some thought. The difficulty is that we have to try to anticipate various scenarios. It is possible, for instance, that the officeholder could be seriously ill but expected to be fit enough to return to work after treatment and recuperation and indeed could be well on the way to recuperation and suddenly suffer a relapse. With a serious illness this could take longer than six months and to deal with such circumstances we should not specify a maximum period for which someone can stand in.

Turning to circumstances where a designation by a Minister is to fill the gap when the post is vacant I should clarify that this would always be a temporary arrangement. The Bill makes it clear that the Minister must take steps to fill the vacancy as soon as may be. This is covered in section 16L. I hope, therefore, that the Deputies accept the rationale behind amendment No. 19 and support it. The Bill currently provides in section 16K(5)(b), as a result of an amendment tabled at the Select Sub-Committee on Health and Children that the appointed director designated by the director general for the purposes of his or her absence or, in the case of a vacancy, the appointed director designated by the Minister if any has to be so designated, will, if present, chair meetings of the directorate.

Amendment No. 20 maintains the situation and is consequential on amendment No. 19. The Bill already provides that the appointed director designated to stand in for the director general should chair meetings of the directorate when the director general is absent or the office is vacant. Amendment No. 20 is a technical amendment to cover the situation in which the director general is absent, and he or she has made no standing in designation and is incapable of doing so by reason of illness.

I welcome the Minister's commentary following on from Committee Stage. I note that in the addendum amendments to amendment No. 19 he has twice changed the word "delegation" in sub-section (4) to "designation". I think those are the only changes in the subsequent amendment. The Minister has taken on board the arguments. What can and cannot be done will present in time and I accept that amendment No. 20 is technical as he describes it so I have nothing further to say on these amendments.

Amendment agreed to.

I move amendment No. 20:

In page 15, to delete lines 3 to 11 and substitute the following:

"(b) if and for so long as the Director General is not present, or if that office is vacant, the appointed director designated by the Director General or the Minister under section 16G(4) or, as the case may be, the appointed director designated by the Minister for the purposes of section 16G(5) shall, if present, chair the meeting, or".

Amendment agreed to.

I move amendment No. 21:

In page 19, line 45, after "Executive" to insert the following:

"and the Joint Oireachtas Committee on Health and Children".

Amendment put and declared lost.

I move amendment No. 22:

In page 26, to delete lines 10 to 26 and substitute the following:

"(2) In any legal proceedings, a certificate that—

(a) states that a specified function was on a specified day delegated or subdelegated to an employee of the Executive,

(b) states that the delegation or subdelegation of the function concerned remained in force on a specified day,

(c) specifies the limitations, if any, imposed on the delegation or subdelegation of the function concerned, and

(d) is signed by the Director General or an employee of the Executive who has subdelegated a specified function of the Executive delegated or subdelegated to him or her under section 16H,

shall, unless the contrary is proved, be evidence of the matters stated in the certificate.".

This amendment relates to section 20 of the Bill which itself amends section 77 of the Health Act 2004. This deals with certificate evidence regarding delegation and subdelegation of functions within the HSE in legal proceedings. The amendment is a drafting one to ensure that the subdelegation of functions is properly covered.

Amendment agreed to.
Bill, as amended, received for final consideration.
Question proposed: "That the Bill do now pass."

I call Deputy Ó Caoláin.

I have no problem with speaking first but Deputy Kelleher has precedence because of his party's numerical strength. It is only a temporary matter but we will let it be.

We are larger in numerical strength but equal in weight of argument.

To be consistent I have to oppose the passage of this Bill in view of the concerns that I have outlined previously. I believe it vests significant power in the office of the Minister and that is not a healthy situation. We can argue over the rights and wrongs of the establishment of the HSE, the amalgamation of the health boards and whether it was done in a way that brought about cost savings. It did not. Nobody was made redundant. I accept that it is the Minister's right and duty to set policy but my concern is that implementation of policy could be decided for political reasons. I know he argues that he wants to be accountable to the Dáil and he wants to make the health services accountable to the Dáil through the office of the Minister. That accountability could remain the case but I have concerns about decisions on the allocation of resources and the delivery of health care because it vests such huge power in him, in terms of his influence over the directorate, that it could politicise the health service. We have had this debate and I do not want to go back over it but we put down a motion of no confidence last year on that specific issue, with regard for example to primary care centres, Wexford Hospital and St. Luke's Hospital in Kilkenny and the prioritisation of funding to these hospitals.

The Minister can argue and can say, with justification, that it is his right to make representations to, or to receive representations from, other Ministers but when resources are scarce the fundamental principle of their being allocated based on need must surely apply and there is no check in this legislation that will guarantee that. That is my concern. I know that the Minister is talking about going through a transformative programme of taking the HSE and establishing hospital groups and moving to universal health insurance and all that flows from that. They are all policy decisions. It is the Minister's right and entitlement and duty to make policy decisions. I may oppose those policy decisions but he has an obligation to make them. At the same time I am very concerned that the delivery of and decisions as to where health care would be resourced and where funding would be allocated would be solely within the gift of the Minister of the day.

We have had difficulties in the past across all hues and colours of political parties in government where resources were concentrated and directed for political gain and advantage. I do not think that is acceptable. Yes, the Minister should be accountable in the Dáil in respect of policy and its delivery but surely there must be some separation so that key decisions with regard to provision of resources and the primary care centres are not made for political reasons. I hate bringing this up again and again but I feel very strongly about it. I did not lightly table a motion of no confidence in the Minister but it was based on the principle that we cannot have a situation in which resources are scarce and other areas may need them and their allocation is decided on for political reasons.

This is public funding and there should be some way of ensuring the policy decisions the Minister outlines are implemented at arm's length when it comes to resourcing, allocation and implementation. For that reason, I have to be consistent and oppose the passage of the Bill. I thank the Minister for listening to our suggestions on Committee Stage, but the principle of vesting overarching power in the hands of the Minister of the day is unacceptable. It will politicise the delivery of health care which will undermine the public’s confidence in believing scarce resources are allocated on need as opposed to political considerations. This is clearly unacceptable. We talk about the dawn of new politics, a democratic revolution and all that will flow from it. This legislation is the exact opposite as it concentrates power, decision-making and influence in the hands of the Minister of the day which will lead to difficulties. Previous Ministers were scourged in the Chamber, accused of passing responsibility for the allocation of health resources to the board of the Health Service Executive. However, during the unseemly time when the allocation of primary health care centres was an issue, we had the Minister with his logarithmic and logistical progressions and his theorems. I still have not received answers on that matter. Accordingly, I have concerns with the actual principle of the Bill which is handing the health service, policy and its implementation to the Minister for Health.

I would not expect many to lament the passing of the HSE board which is long overdue. I do not oppose this development, but section 12 gives the Minister of the day significant and increased powers to amend HSE service plans. In principle, that is not objectionable. However, I am deeply concerned that while the Bill makes the directorate of the HSE more accountable to the Minister, there is nothing, as I said earlier, in this legislation that makes the Minister more accountable to the House and, in turn through us, the people. That is a fundamental flaw.

All along the way with the Minister of State, Deputy Kathleen Lynch, earlier, and the Minister there has been solid opposition to engaging with Opposition Members on their carefully worded amendments which have tried to enhance and strengthen the democratic process and the consideration of legislation in these Houses and, particularly, at the Oireachtas health committee. However, it was all to no avail. The Minister did not even consult Opposition Members, but he will consult whomsoever he chooses outside the House. Members on this side have an equal mandate to the Minister’s and share a responsibility to help shape the most efficient and effective health service. However, Opposition Members are only consulted afterwards when all is decided. We are always told last what the Minister has agreed to do, which is wrong. That is not the way it should be. I believe strongly in consultation and that Members who have a long-track record of interest in health services issues have something more to give than just a reaction to what the Minister and his colleagues wish to drive forward. Consultation should be a very important part of a reformed Houses of the Oireachtas.

It causes me considerable disappointment that this has not been facilitated in the amendments we have brought forward, amendments which would not take from or emaciate the Bill. I am not happy that the Minister will have the powers provided by the Bill, but he remains aloof from all the voices the people have sent here. For that reason, I regret that I will not be supporting the passage of the Bill. We have brought forward amendments to improve the Bill’s outworking. We have argued for ministerial accountability to the Oireachtas and the people. We have outlined the need for fundamental reform in how health services are structured and funded. Savage cuts have been imposed by the Minister and his Government colleagues in the past two years. I accept that they inherited an already difficult economic situation, but this legislation makes a bad situation worse. I will be opposing the passage of the Bill.

I have serious concerns about the impact of this legislation. It has been presented to us under the guise of reform when, in fact, it is a fig leaf to deal with a corporate governance mess created by the Minister for Health. It shows scant regard for the elements required for corporate governance in the health service, the premier public body, with a staff of nearly 100,000 and a budget of €13 billion. It is incredible that the Minister is moving to remove checks and balances which have applied in the past in this organisation.

It is very easy to denigrate the HSE. Goodness knows, we are all too well aware of the flaws in its establishment. However, it is much more challenging to reform an organisation. It is easy to say we will abolish it, staking a claim to the swashbuckling approach to health reform never having thought about what will replace it. It may be slow going, dull and boring, but at this stage in the country’s development people have come to realise the importance of good standards in corporate governance, as well as the importance of having checks and balances to ensure transparency and accountability in public organisations. I am concerned that this message does not seem to have got through to the Administration.

The standard practice in a public body is that an independent board operates at arm's length, provides oversight and accountability for the spending of public money and is accountable to the taxpayer for the spending of that money. However, unfortunately, in 2011 one of the early steps the Minister took, to make some kind of name for himself, was to abolish the board of the HSE, a board which was made up of very well respected public people, in the guise of doing something about the problems in the health service. As a result of that, a legal difficulty was created and this "makey-up" board was put together to tide the Minister over as a vacuum was created in the governance of the health service. Rather than now admitting that was a mistake and putting in a proper independent board, a convoluted structure is being proposed under this legislation to create a directorate where there will be no division between senior management and what is supposed to be the oversight body, which is the directorate. In corporate governance terms, that must raise very serious questions and concerns. I am surprised this legislation has got to the point it is at given the lack of proper procedure and given the fact that a type of circular arrangement is proposed under the legislation where the director general outside of the boardroom will be in charge of the other directors but when they go into the boardroom that position will be reversed and the director general will be answerable to his senior management team because they are directors in effect.

This is an extraordinary model for corporate governance. It is hugely problematic and does not provide the independent oversight that is required. This kind of lazy and unacceptable approach runs through the Bill. It also comes to the fore with the appointment of the first director general where there is no requirement to have a public open competition. The Minister will decide who will get that job, just as he decided who was going to be brought into the Department of Health to head it up both in terms of the Secretary General and the new layer he created with the special delivery unit. People were again brought in without there being a public competition and under very unusual remuneration arrangements where two people were paid through a UK company. It is quite extraordinary and incredible that a Minister with little political experience can get away with this kind of thing. I believe that we will pay a price for that in the future.

It is also quite indicative of certain disregard for proper corporate governance that when I raised the issue of the possibility of a person who has been adjudicated to be bankrupt continuing as a director or director general of the HSE and said that it would be wrong for a person with those kinds of pressures to continue in that job, the Minister said that it would not help the pressure if they lost their job. That is not the point, rather the point is that a person in that situation is required to be accountable for the spending of large amounts of public money and there is a legal and moral responsibility on Ministers to protect the public purse and ensure proper procedures are in place.

I continue to have serious concerns about this measure and the fact that far too much power is vested in one person, namely, the Minister and that there are none of the normal checks and balances required under modern day corporate governance standards. It seems incredible that this convoluted structure is being put in place for a very short period, as it has been stated that the HSE will be abolished completely by 2014. I challenge anybody on the Government side of the House to tell us what will replace the HSE. Who will deliver the services? I repeat my concern that this is part of a plan to dismantle the public health service and that we will end up in a situation, as the Minister has stated in replies to parliamentary questions, where insurance companies will be the principal purchasers of health care in hospitals and in primary care. It is not in anybody's interest that we have a health service that is determined and effectively run by insurance companies that become the principal purchasers of care at primary and hospital care level. That is the reason I have serious concerns about where the Minister is headed in regard to our public health service, and this legislation adds to those concerns. I am completely opposed to it.

I regret that the Deputies opposite feel they cannot support the Bill. However, I will address some of the issues raised by them. Regarding the way the directorate will work, it will have collective responsibility as the governing authority for the HSE. In practice, the directorate model will involve a combination of a senior management team working together on major corporate issues but with the usual operational line of reporting to the director general for the specific service functions.

Regarding accountability, the HSE has responsibility for the organisation and delivery of health services and the directorate will be accountable to the Minister for the performance of the HSE functions. It will have to explain its decisions. As chairperson, the director general will account to the Minister on behalf of the directorate in regard to the way the HSE's functions are performed. He or she will do this through the Secretary General of the Department of Health.

The Bill builds on existing accountability provisions in the Health Act of 2004. It allows the Minister to issue directions to the HSE on the implementation of ministerial and Government policies and objectives relating to HSE functions where the Minister believes that the HSE is not having sufficient regard to such objectives or policies in performing its functions. The Minister will also be empowered to specify priorities for the HSE, to which the HSE must have regard in preparing its service plan. The Minister may establish performance targets for the HSE in regard to these priorities. Directions, priorities and targets will not be made in regard to individual patients or service users.

Comments were made about the Secretary General who was appointed in the normal way that all Secretaries General were appointed, namely, through the public appointments system and through competition and, ultimately, I, as Minister, am presented - as are all Ministers - with a choice of three different individuals to appoint.

Deputies spoke about protecting the public purse. Regarding the Department, we have seen our budget cut by €3 billion. We have reduced the number of staff by more than 10,000 in recent years, and there is still not just a safe service but an improved service. That is an improvement that is measurable and reproducible, as in the emergency department figures which show a 24% reduction in the number of people who have to endure long trolley waits at the end of last year-----

That has nothing to do with protecting the public purse.

-----and inpatient figures which show that we met our target of one year a year ago and our target of nine months last year, and we will meet our target of eight months this year.

That will be a first.

Deputy Dooley finds this highly amusing but he should be aware that we have measured for the first time the number of people waiting on an outpatient waiting list. That is something from which his Government ran away, would not acknowledge, examine or count and did not want anyone to know about.

The Minister changed the parameters to make it look good.

It is 386,000, which is an awesome number but when put in perspective is one with which we will deal-----

Just like he dealt with the accident and emergency departments.

-----because we see 200,000 patients in our outpatient clinics every months. We will deal with this in the way we have-----

The trolley count.

-----in regard to those who are urgent cases. Cancer cases are being dealt with first and other cases are being dealt with in chronological order. The real scandal is not the 386,000 people who are waiting but rather the 16,800 who wait longer than four years.

We have brought in hospital groups, which I believe will allow hospitals to make better use of their resources; reduce fragmentation and duplication; have greater autonomy locally; and give them greater control over budgets and recruitment and, to a large extent, procurement. In the area of community care, the integrated service areas are being reviewed with a view to bringing them into line with what is taking place in local government and the hospital groups.

It seems that, on the one hand, I am criticised for taking too long to make the changes and clear up the mess we were left with, but, on the other, I am accused of going too fast. On the issue of governance at the hospital in Tallaght, we were fortunate to have the services of Sir Keith Pearson who, arising from the HIQA report, has developed a new model of governance throughout our hospitals and hospital groups. While I regret that the Deputies believe they cannot support the Bill, I thank them nonetheless for their contributions.

I wish to address the comments of Deputy Caoimhghín Ó Caoláin. We have an Oireachtas committee dealing with health issues and there is consultation. However, the Government cannot be expected to accept all Opposition suggestions on policy when the people have voted for the Government's policy, not the Opposition's policy. In fairness, we have-----

They certainly did not vote for the policies the Minister is now pursuing.

I did not interrupt the Deputy and will not stop to listen to his interruption. I have accepted several amendments from the Deputy and Deputy Billy Kelleher and incorporated them into the Bill. The Health Service Executive (Governance) Bill flows from the programme for Government and is part of a series of legislative and other changes which are intended to bring about radical reform of the health service and which will see the introduction of universal health insurance. The programme also envisages that eventually the HSE will no longer exist as its functions are moved elsewhere under the health reform plan. While the Bill is a transitional measure and only one element of the wider legislative and administrative reform process aimed at achieving a better health service, our debates have shown that we all agree that it is nonetheless an important element.

It seems appropriate to end by emphasising that the reform programme is ultimately about doing the best for the patient. The Bill, with the new management arrangements, will help to place a greater focus on service delivery and ensure more accountability during the time the HSE continues in existence. It is about ensuring better outcomes for patients and if this remains our focus, we will not stray too far wrong. I will take the Bill back to the Seanad to report on the changes made in this House.

Question put: "That the Bill do now pass."
The Dáil divided: Tá, 88; Níl, 41.

  • Bannon, James.
  • Barry, Tom.
  • Breen, Pat.
  • Bruton, Richard.
  • Burton, Joan.
  • Butler, Ray.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Coffey, Paudie.
  • Collins, Áine.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Corcoran Kennedy, Marcella.
  • Creed, Michael.
  • Daly, Jim.
  • Deering, Pat.
  • Doherty, Regina.
  • Donnelly, Stephen S.
  • Dowds, Robert.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frank.
  • Ferris, Anne.
  • Fitzpatrick, Peter.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Griffin, Brendan.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Kehoe, Paul.
  • Kenny, Seán.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lowry, Michael.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • Lyons, John.
  • McCarthy, Michael.
  • McEntee, Helen.
  • McGinley, Dinny.
  • McGrath, Mattie.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • McNamara, Michael.
  • Maloney, Eamonn.
  • Mathews, Peter.
  • Mitchell, Olivia.
  • Mitchell O'Connor, Mary.
  • Mulherin, Michelle.
  • Murphy, Dara.
  • Nash, Gerald.
  • Naughten, Denis.
  • Neville, Dan.
  • Nolan, Derek.
  • Noonan, Michael.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Phelan, Ann.
  • Phelan, John Paul.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Shatter, Alan.
  • Spring, Arthur.
  • Stagg, Emmet.
  • Stanton, David.
  • Tuffy, Joanna.
  • Varadkar, Leo.
  • Walsh, Brian.


  • Boyd Barrett, Richard.
  • Broughan, Thomas P.
  • Calleary, Dara.
  • Collins, Joan.
  • Colreavy, Michael.
  • Cowen, Barry.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Flanagan, Luke 'Ming'.
  • Fleming, Tom.
  • Grealish, Noel.
  • Healy, Seamus.
  • Healy-Rae, Michael.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Mac Lochlainn, Pádraig.
  • McConalogue, Charlie.
  • McGrath, Finian.
  • McGrath, Michael.
  • McLellan, Sandra.
  • Moynihan, Michael.
  • Murphy, Catherine.
  • Nulty, Patrick.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Sullivan, Maureen.
  • Pringle, Thomas.
  • Ross, Shane.
  • Shortall, Róisín.
  • Smith, Brendan.
  • Stanley, Brian.
  • Tóibín, Peadar.
  • Troy, Robert.
  • Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.
Question declared carried.

The Bill, which is considered to be a Bill initiated in Dáil Éireann in accordance with Article 20.2.2° of the Constitution, will be sent to the Seanad.