I am pleased to introduce the Bill to the House. I thank the Joint Oireachtas Committee on Health for undertaking pre-legislative scrutiny of the Bill last October and for their broad support of the new children’s hospital project. I hope that with the positive contribution and co-operation of Members of both Houses it will be possible to have it enacted without undue delay before the end of the year.
The background to this Bill, pure and simple, is the well accepted need and long held ambition to significantly enhance paediatric services for children in Ireland. In 2006, the HSE published "Children's health first", which outlined that there was compelling evidence for one national specialist paediatric hospital based in Dublin that would also provide all the less complex hospital needs of children in the greater Dublin area. The report underlines the need for access to urgent care centres in Dublin in addition to the proposed hospital. In 2012, the Government decided that the new children's hospital should be located on the campus at St James’s Hospital and last year gave the green light to construction. The new hospital will be completed by the end of 2022.
The outpatient and urgent care centres will open next year at Connolly Hospital Blanchardstown and in 2020 at Tallaght Hospital. The national paediatric hospital development board, which is charged with this capital project, should be commended for its work on this complex project. Building the new facilities is but one aspect of the new children’s hospital project. This project cannot succeed without providing the right structure for the staff who provide the care for our children. Paediatric services in Dublin are currently provided by three separate hospitals, namely: Our Lady’s Children’s Hospital Crumlin, Temple Street Children’s University Hospital and the National Children's Hospital at Tallaght. All three have a proud tradition of caring for our children and families over many years. All three recognise the increasing demands on paediatric services and fully support the development of a single hospital as a world class national hospital playing a central role in serving an integrated clinical network for paediatrics in Ireland.
However, providing services under the same roof but not under the same governance structure is clearly not feasibIe. Currently, the three children’s hospitals have 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. The staff and services of the existing hospitals need to come together under one single governance structure, hence this legislation. Under the Bill, the board of the children’s hospital group, will include representatives of the three hospitals’ boards and will become the first board of the new entity, thereby providing continuity in the important integration work. Establishing the legal entity as soon as possible will further assist the ongoing operational and cultural integration of these three hospitals in advance of the opening of the new hospital and centres. I commend the three hospitals' boards and the children’s hospital group board for their tremendous work and dedication to this project.
In drafting this legislation, we were conscious of the need to achieve the integration of the three hospitals in a way which respects the values and cultures of each, while creating an entity with the effective governance and accountability required to ensure that the State’s investment in this project delivers the benefits required for children and young people. The approach 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 neurology. Like the existing children’s hospitals it will operate as a provider of services under section 38 of the Health Act 2004, that is, it will be funded by the Exchequer through the health Vote.
The functions of children’s health Ireland will include planning, delivering and developing acute paediatric services as part of an integrated clinical network of paediatric care. The entity will run the new children’s main hospital and centres at Connolly and Tallaght hospitals 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 in respect of its leadership role nationally relating to paediatric healthcare and the national model of care for paediatrics, as well as to deliver on its remit for education research, philanthropy and advocacy on behalf of children’s healthcare 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 said before, will be the board of the children’s hospital group. The Bill gives the board sufficient autonomy to make and implement the decisions required to effectively carry out its remit as a State body, subject to the high standards of corporate governance and accountability required of 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, Crumlin 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 the Minister 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 brand name. The Department is engaging with the children’s hospital group on arrangements for a new process to agree an operational name, which would be endorsed by Government. While ensuring wider consultation, this new process will acknowledge the previous naming process and the valuable input of staff, patients, service users and the Youth Advisory Council. Members may have particular views on the operational name and I assure them there will be opportunities to contribute to the naming process.
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, to 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 nine Parts. Part 1, preliminary and general, provides for the Short Title of the Bill, definitions and administration costs. Part 2, on 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. 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 Public Expenditure and Reform, it may acquire and dispose of land, borrow and accept gifts.
Part 3, on the board of children’s health Ireland, relates to the composition, role and modus operandi of the board. It will be a competency-based board. 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 of the board, that is, six members, will serve for three years and half will serve 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. 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, on the chief executive officer, CEO, 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. The CEO of the Children’s hospital group immediately before establishment day will be the first CEO. 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, 6, 7 and 8, 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 Children's 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, the 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 company remained in existence, the Bill empowers the Minister to indemnify past directors of Crumlin and Temple Street hospitals post wind-up where a concerned director has discharged, in good faith, his or her duties in pursuance of the functions of the company. As for Tallaght Hospital, the Minister for Health will, in time, bring a motion before the House to approve an order to amend the Tallaght charter consequent on the transfer of Tallaght Hospital's paediatric services to the new entity.
Finally, Part 9, on 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 the board in due course. The statutory instrument will be 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 effect its role of 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 a 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 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 so.
In conclusion, as Senators can see, progressing this Bill is a vital step in the new children’s hospital project. I believe the provisions in the Bill will allow the robust governance structure necessary to oversee the transition to, and provision of, a single national specialist hospital for the children of Ireland.
I look forward to hearing the views of Members on the Bill