Health (Amendment) Bill 2004: Committee Stage.

Section 1 agreed to.
Amendment No. 1 not moved.
Section 2 agreed to.
Question proposed: "That section 3 stand part of the Bill."

Section 3 seeks to repeal existing legislation and to remove the structures and procedures under which health boards operated formerly. All Opposition parties opposed the provisions in the Dáil. We are in favour of maintaining the current health board structures. The Bill removes political participation and accountability from the system.

Contesting the section represents a degree of hypocrisy by the Fine Gael Party. Over the past number of years, no structure was disparaged by its members to a greater extent than the health board system. As a long-time member of a health board, I bemoan the fact that the previous structures are passing. The health boards did a fine job in one way and another. I am not particularly amenable to the removal from the system of locally elected interests and I understand that the Minister has proposals to make pertaining to the participation of local authority members in the new structures. Therefore, I do not support Senator Feighan's opposition to the section.

The Government takes accountability very seriously. The Minister for Health and Children, Deputy Martin, is aware of concerns expressed on public participation within the restructured system. The Minister has already indicated his intention to bring forward proposals to provide opportunities for democratic input in the context of the new structures. He has given much consideration to the appropriate mechanisms to support the development of appropriate interfaces at regional and local level between locally elected representatives and the health service executive. Provisions to implement these mechanisms will be included in the legislation which is currently being drafted.

Provisions are likely to include the establishment of a series of regional fora to facilitate local representatives who wish to raise with the executive issues of local concern about health services within their regions. Membership of the fora will be based on the participation of a number of nominees from each local authority. Putting such arrangements in place will ensure that the voices of local public representatives will continue to be heard in the development of health structures. The arrangements will be designed to complement and reinforce the role of the Joint Committee on Health and Children in expressing the views of public representatives in the ongoing oversight of the health system.

The health strategy identified the need for a more structured approach to community participation in decisions on the delivery of health services. To this end, the health service executive in association with the Department of Health and Children issued guidelines on community participation. These guidelines set out the principles and framework for structures for such participation. Most health boards have established consumer panels that deal with a wide range of issues such as the development and delivery of services. Two boards have also established regional advisory panels for older consumers and their carers. The Minister intends to establish these structures on a legislative basis in the next Bill. I reject the amendment.

Is the Minister referring to section 4? We are not discussing an amendment. We are discussing section 3.

This section is a technical provision which enables the Minister, on commencement, to repeal certain provisions of the Acts of 1947, 1970, 1996 and 1999. Subsection (2) is a saver for the provisions of the Health Board Regulations 1970, which established the health boards, apart from the ERHA and the area health boards, and defined their functional area. It is required to ensure the boards can continue to operate in their functional areas following the commencement of the section. If this section was deleted, the Bill would be inoperable. I therefore recommend that the section stand part of the Bill.

It is cheap and disingenuous for Senator Glynn to attack my party on the issue of the health boards. Members of my party are on the Western Health Board, as are members of the Government parties.

We will come to this in section 4.

I am still talking about section 3.

If the Senator was being honest and truthful with himself he would know that the removal of public representatives from the health boards is a backward step. I appreciate that he must articulate the views of the Government, but most of the councillors on the health boards, including the Government councillors, are disgusted and devastated at this retrograde move. We are letting down the councillors and other public representatives who gave their expertise and time to discuss some complicated issues to do with health boards.

The so-called committee is merely a talking shop. Politicians will have no real involvement in the health system. If elected members cannot have any involvement, why do people run for election at all? We are leaving things up to the bureaucrats and consultants and effectively telling the health boards to run their own business. Who will ask the hard questions? Who has always brought consultants and middle and upper management to heel? The answer is politicians. Once again, the Minister is appealing to public opinion. He knows that people think politicians should not be on these boards.

I was elected in 1999 and sat on the boards of the VEC. I am sure Senator Glynn will agree that whatever party they belonged to, politicians have been honest and impartial and have given great service to the VECs and health boards. This is a backward step. That is why I oppose the section.

I fought a hard battle with the Minister about whether there should be a democratic input, along with the Association of Health Boards in Ireland, which I commend on its hands-on approach to this matter. Regardless of whether people like it, when the announcement was made there was very little noise from the other side. I accept there is great concern among locally elected members about this issue. I share that concern. However, I must be balanced and honest and say that the issue of representation has been addressed. The merits of the method of addressing it will not be known for some time.

I was a member of a health board for almost 23 years and chairman for two years. I worked for a health board for many years. Nobody appreciates more than me the value of locally elected members. That is why, as the Minister for Health and Children would confirm if he were here, I made ongoing representations for having local democratic input included in the structures.

There was a certain amount of acceptance among the Opposition of the abolition of the health boards. There is no point in saying black and meaning white; that is the case. The reason I fought so hard with the Minister for the recognition of democratic input was that I would not give anybodycarte blanche when it comes to the delivery of a public service. The health service is extremely important and it is imperative that it is responsible and answers to the people. In that context there should be democratic input. The Minister has acceded to my ongoing representations and those of the Association of Health Boards in Ireland. I wish the new structures well.

We do not all get what we want in this life. I am a Government Senator and a spokesperson on health and children, so I have a responsibility to the Government. However, I want to be balanced in my comments in the House and I will be so without fear or favour. The provisions for public representation and involvement are not ideal but they are a major step forward from the original proposal.

It is important to remember that the reform programme has it origins in the national health strategy, Quality and Fairness: A Health System for You. This strategy sets out the vision and goals to guide planning and activity in the health system up to 2010. While the strategy acknowledges that the current structures have served us well for more than 30 years, it is recognised that they need to be reviewed to ensure they are appropriate and responsive to the needs and challenges of delivering health services in the changing environment of the 21st century. It also identified the need for a consistent national approach to the delivery of health services, based on clear and agreed national objectives. This is an interim measure. The Minister, Deputy Martin, has stated his intention to introduce new legislation later this year. The new system will need to be highly responsive, so it must take into account the views of public representatives.

I highlight to Senator Glynn that representatives of the health boards came to the Fine Gael Parliamentary Party meeting seeking support for their proposal that political representatives should be on the health boards. We gave unqualified support to these people. Perhaps the Senator might ask these questions of some members of his own party who were part of that group. We gave an unqualified commitment to oppose this measure. I appreciate that the Senator works hard as the chairperson of a health board and provides a good service. I know he will miss it when he is no longer a member. I still feel, however, that the new structures are fobbing people off. They have been put in place to avoid the meaningful inclusion of elected members.

People come into my office who have lost their medical cards or who need representations. Where are they to go now? They must go to the people who make decisions without the impartial influence of elected members. Doctors and consultants do not run for election. They are part of this €10 billion system which is wasting taxpayers' money — the money of the people who vote. Yet we are giving power to the vested interests. The only people who do not have a union are patients. Politicians stand up for the rights of patients. If we no longer have a say, it is a backward step. Members of the new structures may be appointed by the Minister and will probably receive a nice cheque for turning up at the meetings. However, they will have no input into this disastrous health system.

The Association of Health Boards, which met representatives of Fianna Fáil and other parties, received very strong support from within the Fianna Fáil Party. The Minister has rowed back somewhat from the original proposal, which I welcome. I made it clear to all concerned that locally elected members — I said this at a meeting of the Midland Health Board last June when I was interviewed by RTE — are a very important conduit through which complaints can be channelled and opinions made known to the relevant health boards. The Minister has recognised that locally elected members are extremely important and put in place structures to address the issue.

Question put and declared carried.
Amendments Nos. 2 and 3 not moved.
Section 4 agreed to.
Amendment No. 4 not moved.
Section 5 agreed to.
Sections 6 to 29, inclusive, agreed to.
Schedule agreed to.
Title agreed to.
Bill reported without amendment.

When it is proposed to take Report Stage?

It is proposed to take Report and Final Stages at 11 a.m. on Wednesday, 2 June 2004.

Report Stage ordered for Wednesday, 2 June 2004.
Sitting suspended at 2.25 p.m. and resumed at 3.15 p.m.