Children's Health Bill 2018 [Seanad]: Second Stage

I move: "That the Bill be now read a Second Time."

I am delighted to be here today to introduce the Children's Health Bill to this House. Last week, the Bill completed its passage through the Seanad and I sincerely thank all the Senators who made valuable contributions to the debate on this Bill. I also thank the Oireachtas Joint Committee on Health for undertaking pre-legislative scrutiny on the general scheme of the Bill last October and for its general support of the overall aims of the Bill.

The background to this Bill is the well-accepted need and long-held ambition to significantly enhance paediatric services for all the children of Ireland. In 2006, the Health Service Executive, HSE, published Children's Health First, which outlined that there was compelling evidence for one national specialist paediatric hospital based in Dublin, which would also provide all the less complex hospital needs of children in the greater Dublin area. The report underlined the need for access to urgent care centres in Dublin in addition to the proposed hospital. The establishment of the new children's hospital provides a unique opportunity to introduce a new model of care for all paediatric services. This is really important and we are not just building a new hospital, as it must enable a new model of care allowing us to tackle current and future challenges in child health. A network of care will be established throughout the country, reaching every community in Ireland through regional centres in Cork, Limerick and Galway. Under this new model service providers will work together to ensure the standard of care will be the same whether it will be in the new children's hospital, a regional unit or in the two paediatric outpatient and urgent care centres in Connolly or Tallaght.

Paediatric services in Dublin are currently provided by three separate hospitals, namely, Our Lady's Children's Hospital in Crumlin, Temple Street Children's University Hospital and the paediatric service at Tallaght. All three hospitals have a proud tradition of caring for our children and families over many years, which I acknowledge with gratitude. Importantly, all three fully support the development of the new children's hospital as a world class national hospital playing a central role in serving an integrated clinical network for paediatrics in Ireland. Currently, the three children's hospitals are voluntary hospitals with their own boards and the integration and oversight of services of the three hospitals is managed by the children's hospital group board, an administrative board. However, providing services under the same roof in the new facilities but not under the same governance structure would clearly not be feasible. The staff and services of the existing hospitals need to come together under one single governance and management structure, hence this important legislation. Operational and cultural integration of three organisations is complex and challenging and needs to happen well in advance of the transition to new facilities. Creating this new entity with single governance and management as early as possible is essential to support this complex integration programme.

Under the Bill, the board of the children's hospital group, which includes representatives of the three hospitals' boards, will become the first board of the new entity, thereby providing continuity in overseeing the important integration work. Establishing the legal entity as soon as possible, creating a virtual single hospital across three sites, will support service reorganisation and reconfiguration generally across the three hospitals where that can improve access, quality and cost-effectiveness in advance of the move to the new facilities.

As my colleague, the Minister of State, Deputy Catherine Byrne, said on Second Stage in the Seanad, in drafting this legislation we need to achieve the integration of the three children's hospitals in Dublin in a way that respects the values and cultures of each while creating a new entity with the effective governance and accountability required to ensure that the State's capital and revenue investment in this project delivers the benefits required for children and young people. We are making a massive €1 billion investment in children's health, which is right and proper, but we must ensure we have those governance and accountability structures to oversee it. I commend the three children's hospital boards and the children's hospital group board for their tremendous work and dedication to the progress being made to this project.

The approach in drafting the Bill has been to establish a distinct body with appropriate governance to take over the services currently provided by the three hospitals and to have a leadership role nationally in the implementation of the national model of care for paediatrics and neonatology. Like the existing children's hospitals, it will operate as a provider of services under section 38 of the Health Act 2004. In other words, it will be funded by the Exchequer through the health Vote. The functions of this new entity, children's health Ireland, will include planning, delivering and developing acute paediatric services as part of an integrated clinical network of paediatric care. The new entity will run the new children's main hospital and centres at Connolly and Tallaght when they are built. Before that, it will run the services on the existing sites at Tallaght, Temple Street and Crumlin.

The new entity will need to work closely with paediatric service providers in other hospitals across the country, in the primary care system and in the community. Accordingly, it is given broadly worded functions that provide clarity, authority and certainty relating to its leadership role nationally in paediatric healthcare and the national model of care. It will deliver on its remit for education, research, philanthropy and advocacy on behalf of children's health care in this country.

The new entity will be led by a 12-member competency-based board appointed by the Minister for Health, the first of which, as I stated, will be the board of the children's hospital group.

The Bill gives the board sufficient autonomy to make and implement the decisions required in order to effectively carry out its remit as a State body, subject to the high standards of corporate governance and accountability required of all State bodies.

The three hospitals coming together under this Bill have different legal forms and the provisions in the Bill relating to their transfers are, accordingly, slightly different. Our Lady's Children's Hospital and the Children's University Hospital Temple Street are established under the Companies Act - Temple Street as a subsidiary of the Mater Misericordiae and Children's University Hospitals Limited. Tallaght Hospital is a body corporate under charter and ministerial order.

As they are funded as section 38 bodies, the hospitals' employees are classified as public servants, subject to standard salary scales for the health sector and with access, in the main, to a public service pension scheme. The Bill provides that employees will transfer on existing rights and entitlements. As stated above, the proposed new entity will also be a section 38 body.

The Bill recognises the historical voluntary ethos of the three hospitals. For example, in line with their current practice, board members of the new entity will not receive fees. The Bill provides that the board of the new entity will nominate eight out of the 12 board members and the chairman of the board will be elected by the board.

Members may recall that I announced earlier this year that the new entity would not be called "Phoenix Children's Health". The legal name "Children's Health Ireland" reflects the object and functions of the new entity. However, it is considered that it may be useful for it to also have an operational name or, if we call it that, a brand name. We are not making any decisions on that name in this Bill. The Department is engaging with the Children's Hospital Group on arrangements for a new process to agree an operational name which would then be endorsed by Government. While ensuring wider consultation, this new process will acknowledge some of the work undertaken, particularly the valuable input of staff, patients, services users and the Youth Advisory Council. Members may have particular views on the operational name and I can assure the House that there will be opportunities to contribute to the naming process. Indeed, I would welcome the Members' views.

A two-step commencement approach is planned. It is proposed to establish children's health Ireland and its board before the end of 2018, and on 1 January 2019 proceed to transfer the three hospitals to the new entity. The transfer is best made at beginning of the year for a variety of technical and financial reasons. However, the transfer will be subject to the completion of the necessary preparations and confirmation by the new board that it is satisfied it has the necessary structures and processes in place for a safe transfer day.

I will now summarise the main provisions of the Bill, which consists of 67 sections contained in 9 Parts. Part 1, the preliminary and general part, provides for the Short Title of the Bill, definitions and administration costs. Part 2, establishment and functions of children's health Ireland, provides for establishment day and sets out the object and functions of the new entity. These have been well described already by me. It will be able to form or acquire subsidiaries or other corporate vehicles for limited reasons and only with the approval of the Minister for Health and the consent of the Minister for Public Expenditure and Reform. It may acquire and dispose of lands, borrow, and accept gifts. Part 3, the board of children's health Ireland, relates to the composition, role and modus operandi of the board. It will be, as I have said, a competency-based board. It is essential that we have such a board with the range of experience and skills to oversee the delivery of these services.

Of particular, note is the method of appointing members of the board. The first board will be the board of the Children's Hospital Group. Half, in other words, six members, will serve for three years and six for five years thereby ensuring continuity on the board. When the term of office of the six members appointed for three years expires, they will be reappointed or replaced on the basis of two chosen by the Minister, and four nominated by the outgoing board, similarly with those appointed for five years, and so on every two years thereafter. While the Bill does not provide for nominations by professional bodies, this is not to say that members of those bodies may not be members of the board at any given time through the variety of processes available. However, employees of the new entity cannot be members of the board. Board and board committee members may be paid expenses, but not fees. This is in line with the voluntary ethos of the three children's hospitals.

Part 4, which relates to the chief executive officer and employees of children's health Ireland, provides that the CEO will be appointed by the board, with the consent of the Minister, and can be required to appear before the Committee of Public Accounts, which is an essential component of public accountability. The CEO of the Children's Hospital Group immediately before establishment day will be the first CEO of the new entity. The superannuation provisions provide continuity for staff of the three hospitals - employees eligible for the single public service pension scheme will be members of that scheme and all other employees will remain or become members of the voluntary hospital superannuation scheme.

Parts 5 to 8, inclusive, relating to transfers of the three hospitals and the HSE to the new entity are quite similar, and I will summarise them together while drawing attention to some particular issues. These Parts contain standard provisions for the transfer of employees, property, rights and liabilities, contracts, agreements and records of Crumlin and Temple Street, and such as may be agreed or designated for transfer from Tallaght Hospital and the HSE to Children's Health Ireland.

Of note is that land and buildings are transferring to the new body only from Crumlin Hospital. Temple Street University Hospital does not own the land and buildings it occupies in Temple Street. It is owned by a holding company - The Mater Misericordiae and the Children's University Hospitals Limited - and, of course, there is no land to transfer from Tallaght Hospital which will continue in existence as an adult hospital. No decision has been taken yet as to what will happen to the sites when the services move out in 2022.

After the transfer to the new entity, Crumlin and Temple Street companies will be wound up by their directors under the provisions of the Companies Act 2014. As directors will no longer have the indemnity they would have enjoyed had the companies remained in existence, the Bill empowers the Minister of the day to indemnify past directors of Crumlin and Temple Street hospitals post wind-up where a director has discharged in good faith his or her duties in pursuance of the functions of the company concerned.

In relation to Tallaght, I will in time bring a motion before the Houses to move an order to amend the Tallaght charter consequent on the transfer of Tallaght's paediatric services to the new entity.

Part 9, the National Paediatric Hospital Development Board, provides for a number of amendments to the order under which the National Paediatric Hospital Development Board was established, and for the dissolution of that board in due course.

The statutory instrument is updated consequent on the establishment of children's health Ireland. For example, it substitutes children's health Ireland for the three children's hospitals in articles providing for consultation on the development of the new facilities, and amends the appointment process to the board to better reflect its role of constructing, equipping and furnishing the new facilities. Section 67 provides that the members of the board in office immediately before the section is commenced shall cease to hold office, thereby allowing for the appointment of a board under the new process.

In addition, the Bill provides that the board may plan, equip and furnish the maternity hospital to be located on the St. James's Hospital's campus next to the new children's hospital. However, this function will only be commenced if a future decision is taken that the board is the appropriate body to do this. It makes sense, I suppose, to future-proof as we bring this legislation forward.

The new children's hospital will be a world-class facility to care for children and young people from all over this country who are in need of specialist and complex care. I am so excited about this project. So many people have been waiting so long for this. Developing a new national children's hospital has been debated in this country for an awful long time. There is an entire generation of children who could have benefitted from a new national children's hospital who have grown up during the time people were debating the site, the location, the name and many other matters. We now need to get on and build it. That work is under way.

There is a considerable body of work that has been undertaken over the past number of years by a dedicated team of officials in my Department, by the existing three children's hospitals, both staff and boards, by the children's hospital development board and by the Children's Hospital Group and I thank everybody for that work.

We will move from a situation where we have good care in our children's hospitals today - I do not take that away from those hospitals in any way, shape or form - in antiquated facilities, a situation where mums and dads, if they are lucky, sleep on the floor beside the bed of their sick child. We have hospitals where children spend very significant amounts of time when they have complex medical needs and it is important that we can provide them with world-class facilities. It is also important when we build a new hospital that we aspire for that hospital to be world class in terms of the recruitment and retention of some of the best healthcare professionals that we ever could wish to see working in our health service.

The development of this hospital is a massive development for healthcare but it is also a massive investment in children. It is right that we invest in children who make up a third of the population - I know we all agree on that, right across this House and this country.

I am confident that the new facilities, along with the two outpatient and urgent care centres at the Connolly and Tallaght hospital campuses, will radically improve the quality of service for patients for years to come. Not all roads lead to Dublin and it is important, in debating this Bill, that we also talk about the regional units and that there will be a new model of care to look after every child in this country in the best possible way in meeting his or her medical needs regardless of what part of the country we live in.

I am pleased to bring this Bill before the Dáil and look forward to hearing the contributions throughout Second Stage. I hope this Bill can see speedy passage through these Houses.

As the Members will be aware, the Order of Business is that at 2.30 p.m. we must interrupt this debate to deal with the motion regarding proposed approval by the Dáil of a proposal for a regulation of the European Parliament and of the Council establishing the internal security fund. I will call Deputy Rabbitte after that 45-minute debate.

Debate adjourned.