Tuesday, 27 January 2004

Ceisteanna (20, 21, 22)

Billy Timmins


142 Mr. Timmins asked the Minister for Health and Children when the legislation establishing the bodies responsible for implementing the health reform programme will be published. [1539/04]

Amharc ar fhreagra

John Gormley


164 Mr. Gormley asked the Minister for Health and Children the legislative programme required to implement his health reform and when we can expect to see this legislation; and if he will make a statement on the matter. [2024/04]

Amharc ar fhreagra

Michael D. Higgins


210 Mr. M. Higgins asked the Minister for Health and Children the legislation planned arising from the health reform programme and the status of the Bills listed in the legislative programme; and if he will make a statement on the matter. [1894/04]

Amharc ar fhreagra

Oral answers (43 contributions) (Ceist ar Minister for Health and Children)

I propose to take Questions Nos. 142, 164 and 210 together.

The health sector reform programme has implications for all organisations in the health sector in terms of structures, governance, accountability, planning, monitoring and evaluation. Fundamental reform of the existing statutory provisions on the roles, organisation structure and management of the health system will be required to give effect to the proposals contained in the reform programme.

The Government's legislation programme makes provision for the enactment of legislation to give statutory effect where required to implement the proposals in the reform programme. The first element of the programme is the preparation of an establishment order under the Health (Corporate Bodies) Act 1961, as amended, establishing the interim health services executive on a statutory basis. The order is being finalised at present and I expect to be in a position to sign it shortly. This will empower the interim executive to carry out the set up tasks and preparations necessary to enable an orderly transfer of functions to the health service executive when permanently established by new legislation in January 2005.

It will be necessary to introduce new legislation to provide the main legislative basis for the implementation of the health sector reform programme. It will establish the new health service executive to replace the Eastern Regional Health Authority and the health boards. It will also provide the legislative basis for other aspects of the reform programme such as improved governance and accountability, planning and monitoring and evaluation. The establishment of the health information and quality authority on a legislative basis will also be provided for. It is also my intention that the new legislation will include provision for a statutory framework for complaints procedures in the health services as proposed in the health strategy. My intention is to have this legislation introduced by December 2004 so as to have the health services executive in place in January 2005.

The Government has also indicated its intention in the legislative programme for the spring session to introduce a Health (Amendment) Bill to cope with the situation which will arise following the local elections in June 2004. Given the impending establishment of and formal transfer of functions to the health service executive, the Government has considered whether it would be appropriate to proceed in the normal way with the appointment of local representatives to the health boards after the local elections. I intend discussing the matter further with the Association of Health Boards at a meeting to be arranged in the near future. Following that meeting, I will make a public announcement on the Government's intentions in this regard.

Can I ask about the Health (Amendment) Act which will do away with councillors and professionals from health boards? It causes me a great deal of concern that we are doing away with accountability in the service and not replacing it with any other form of accountability. The Minister said he would set up user groups and so on under the new legislation. That is a long way off. I do not think user groups will provide accountability. Who will run the health service between the time the professionals and councillors are taken away from the health boards and the health executive will be set up in 2005? Who will be accountable and who will ask the difficult questions?

The Bill will be an enabling measure to be given effect by the Minister in terms of dates and so on. There is a real issue around the immediate aftermath of the local elections where one is looking at a six month window between this and the establishment of the HSE. It is a time when members are appointed to a whole range of different bodies.

I have been on councils and there was a genuine issue to be met. When we met the Association of Health Boards in Ireland before Christmas, we said we would revert back to it in terms of alternative proposals to facilitate the articulation by public representatives in a given region of their views on the health service. I intend to meet the Association of Health Boards in Ireland shortly to discuss this issue further.

Given that the Minister is embarking on a major health programme such as the one under discussion, does he not accept that his failure to sort out his own smoking ban does not really inspire confidence? Furthermore, does he not accept that confidence is further eroded by the fact that he is abolishing a very important democratic input by local councillors into the health service and its management without having the faintest idea how he will ensure there is some democratic input in the future? Will he not acknowledge that user groups, regardless of their benefits, have no mandate or authority to speak on behalf of others and that the only people on health boards who have such a mandate are those who are democratically elected?

Will the Minister publish the terms of reference for the interim Health Services Executive? How will he ensure that the democratic deficit he is now introducing at local level will not be introduced at national level in terms of accountability to this House?

First, there is an Oireachtas Committee on Health and Children, which is a very significant facility at national level in terms of accountability to the Legislature——

What about the Minister answering questions regarding the HSE?

Yes. As we said, the CEO and board of the HSE will be accountable to the Minister for Health and Children, who will be accountable to Dáil Éireann in respect of its duties.

We do not have that information.

I said this already——

I know, but in terms of the operation——

Time is running out and a number of Deputies are offering.

Likewise, the HSE will also be brought before the Oireachtas Committee on Health and Children to account for itself and its stewardship. I envisage an enhanced role for this committee regarding accountability in terms of the new health structures.

Although many Members of this House urged for a long time that these reforms be made, I always predicted that, once they were announced, there would be 180° turns on the part of some, who would say, "Do not do this and do not do it now."

The Minister should not be silly.

I am not. The bottom line is——

The Minister is being silly.

I thought Deputy McManus was being relatively silly in advance by asking what hope the health reform programme has——

Let us have a decent debate.

Suffice it to say that this is the most substantive health reform programme in over 30 years. Many others have talked the talk but it seems, increasingly, that as the local elections approach the only agenda in town concerns how we can create political advantage by raising certain issues regarding the health reform programme.


For the past 50 years——

The Minister appointed a consultant in Mallow——

I want the Minister to be quite specific. If we come into this House and question him on the formation of the Health Services Executive, is there not a possibility that he or the Ceann Comhairle will say it is not a matter for the Minister but for the Health Services Executive?

That happens now.

Regarding services——

Will we have less accountability?

The organisational structure we now have for the delivery——

A Deputy

Like the National Roads Authority.

That is right.

——of services comprises the health board structure and a range of other——

There is local accountability.

——statutory bodies. When parliamentary questions are tabled — I read them — they imply that we have written to the CEO of the relevant health board and that the CEO has been asked to revert to the Deputy directly.

That was never the way to answer questions.

With respect to Deputy Durkan, he did it often enough himself——

I call on Deputy Crawford to put his question.

Let the Minister answer.

Could I make my point?

The Deputy has raised a legitimate issue in terms of the dividing line. In the context of the new health Act, a decision should be made in terms of the areas in which the Health Services Executive would be competent to reply and the areas in which the Minister would be competent to reply. Ideally, the Minister should be concerned with policy and strategic issues. The delivery of services is a matter for the executive body. I have had many parliamentary questions and I know why people tabled them — it is a democracy — but many of them concern individual ailments, etc. Nearly all of them are referred to the CEO of the health board.

We will not get replies.

Maybe there is a need for the executives and those in the health boards to address how they liaise with public representatives to avoid unnecessary duplication in the House. The new legislation——

That concludes questions for today——

The Minister will be answering fewer questions.

I doubt it.

Written Answers follow Adjournment Debate.