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Health Service Reform.

Dáil Éireann Debate, Wednesday - 3 March 2004

Wednesday, 3 March 2004

Ceisteanna (20, 21, 22, 23)

Denis Naughten

Ceist:

97 Mr. Naughten asked the Minister for Health and Children the structures and roles of the main groups involved in the implementation of health reform; and if he will make a statement on the matter. [6893/04]

Amharc ar fhreagra

Paul Kehoe

Ceist:

107 Mr. Kehoe asked the Minister for Health and Children if he will clarify the next step in moving to the new health structures; and the measures that are being taken to ensure that there is no diminution of services during the transition for either organisation or financial reasons. [6927/04]

Amharc ar fhreagra

Liz McManus

Ceist:

140 Ms McManus asked the Minister for Health and Children if his attention has been drawn to the potential conflict of interest arising from the appointment of the managing director of a major pharmaceutical company; the steps he intends to take to deal with this situation and ensure that the public interest is protected; and if he will make a statement on the matter. [7005/04]

Amharc ar fhreagra

Paul Nicholas Gogarty

Ceist:

170 Mr. Gogarty asked the Minister for Health and Children if those appointed to the interim health executive will have no conflicts of interest; the steps he will take to ensure there are no such conflicts of interest; and if he will make a statement on the matter. [7086/04]

Amharc ar fhreagra

Freagraí ó Béal (30 píosaí cainte)

I propose to take Questions Nos. 97, 107, 140 and 170 together.

The implementation of the Government's health service reform programme centres around a number of bodies including the programme's national steering committee, the Interim Health Service Executive, the Department of Health and Children and the existing health boards/ERHA.

I announced the establishment of the board of the Interim Health Service Executive last November and it held its first meeting in January. The members of the board were selected on the basis of their respective competencies and experience in areas which are directly relevant to the governance role to be exercised by the board. I am satisfied that all board members share a strong commitment to the successful establishment and functioning of the Health Service Executive and that they act with total integrity, motivated solely by the public interest. The membership of the board of the Interim Health Service Executive is set out later in this reply.

The interim HSE has been assigned responsibility for ensuring that all necessary measures are in place to ensure an orderly transfer from existing statutory agencies of authority, responsibility and accountability for the management and delivery of publicly-funded health services. In particular, the board of the interim HSE will have responsibility for: recommending the senior management structure for the new executive; recommending regional boundaries and location of regional headquarters for primary, community and continuing care services and appropriate management structures for consideration by the Government; and within approved parameters, selection and appointment of a chief executive officer to the HSE and subsequent appointments at senior management level.

The work to be undertaken by the interim HSE is one of four distinct but interrelated strands of activity taking place under the reform programme during 2004. The other three strands are: the legislative, mainstreaming, human resource and industrial relations aspects of the reform programme for which the Department of Health and Children will continue to have lead responsibility; the work of the Acute Hospitals Review Group chaired by Mr. David Hanly; and the ongoing management of the health system and internal preparations for the new organisation and governance arrangements being led by the chief executive officers of health boards/ERHA and the Health Boards Executive.

The Government has also appointed a national steering committee to oversee the implementation reform programme and to provide a co-ordinating forum and ensure overall consistency with the Government's decision. It will report on a regular basis to the Cabinet committee on the health strategy, ensuring that the Government is kept fully informed on all important issues. It will liaise with the health reform project office in the Department of Health and Children and the Interim Health Service Executive in the implementation process.

The membership of the national steering committee is also set out later in this reply. I am satisfied that the members of the committee reflect the appropriate mix of competencies and experience to support their role in the implementation of the health reform programme. The committee is made up of the executive chair of the interim HSE, chairman; heads of the Departments involved; the chair of the Acute Hospitals Review Group; the director of the Health Boards Executive and chief executive officer of a health board; and two external members with personal experience of large-scale change management in a private sector context.

I am satisfied that all members of the group share a strong commitment to the successful implementation of the health reform programme and act with total integrity motivated by the public interest. In particular, I am satisfied that, given the specific role of the national steering committee, no conflict of interest arises for any member of the group.

Both bodies are subject to the usual norms in regard to all public bodies, including the adoption of formal procedures to address any particular instance where a conflict of interest might arise for a particular member or members.

I would like to take this opportunity to express the Government's appreciation to the members of both bodies for their agreement to take on the demanding roles assigned to them and I look forward to working closely with both over the months and years ahead.

In regard to continuity of services in 2004, each of the health boards and the ERHA have submitted service plans to me setting out the quantum of service to be provided during 2004 for the funding received. All of the services plans were adopted by their boards/ERHA and I am assured that services will be provided in accordance with the service plans. My Department will continue to monitor performance in regard to service plans during 2004 in the usual manner.

The changes on which we are embarking put emphasis on the improvement and enhancement of patient/client experience as well as improving the experience of staff working in the health system and overall value for money. Various measures are being put in place during 2004 to ensure an orderly transition to the new structures and this will be the subject of ongoing discussions with the health boards/ERHA during 2004.

Additional information not given on the floor of the House

Board members of the Interim Health Services Executive:

1. Mr Kevin Kelly (chair)

2. Professor Niamh Brennan

3. Professor John A. Murray

4. Dr Donal de Buitleir

5. Professor Michael Murphy

6. Mr Liam Downey

7. Professor Anne Scott

8. Mr P.J. Fitzpatrick

9. Mr Michael McLoone

10. Mr Eugene McCague

11. Dr Maureen Gaffney

National Steering Committee Health Service Reform Programme Members:

Mr Kevin Kelly —Chair (Mr Kelly has also been appointed as Executive Chair of the Board of the Interim Health Service Executive)

Mr David Hanly —(Mr Hanly chairs the Acute Hospitals Review Group)

Mr Michael Kelly —Secretary General, Department of Health and Children

Mr Dermot McCarthy —Secretary General, Department of the Taoiseach

Mr David Doyle —Second Secretary General, Public Expenditure, Department of Finance

Mr Denis Doherty —Chairman, Health Boards Executive

Mr Seán Hurley —Chief Executive Officer, Southern Health Board

Mr Michael Dempsey —Managing Director, Bristol-Myers Squibb

Ms Maura McGrath —McGrath Associates, Management Consultant.

I thank the Minister for his comprehensive reply. I want to focus on one element of the Minister's response, namely, the Acute Hospitals Review Group. Does he not regard it as unusual that there is a lack of representation from small hospitals on the group, with only one representative out of the 21 members? Will the Minister not agree that the sole objective of the review group is to close the smaller accident and emergency units throughout the country such as the one in Portiuncula Hospital in Ballinasloe and the county hospital in Roscommon? In a few years from now will the pupils who are in the Gallery from Boyle, County Roscommon——

It is not in order to refer to people in the Public Gallery.

——have no service in County Roscommon or adjoining counties?

I have great respect for Deputy Naughten but he has some nerve to attack me about Roscommon because I am the one who provided the additional millions of euro to provide a decent——

The Minister might provide the staff and then we will be very happy.

——accident and emergency department in Roscommon. Let us be fair about this and stop the scaremongering. Let us forget about the doomsday scenarios. Last year we invested significantly in an accident and emergency department in Roscommon. It will not close.

It will not have staff.

We will not downgrade services and we will continue to enhance and add services to the regions. That is the bottom line. The Acute Hospitals Review Group is made up of people from a wide range of backgrounds, particularly from rural Ireland, to give a specific remit for demographic issues and rural peripherality in the consideration of the remainder of the country.

One member.

I do not know the Deputy's definition of "major hospitals" but I respectfully suggest there is a significant representation from the west in particular and the north-west because of its particular geographic topography——

Galway city is not rural Ireland.

——and a person with a remit in terms of national spatial planning. We have given clear terms of reference. For example, we have asked the group to make sure there will be continuing medical cover in acute hospitals going forward.

What does "medical cover" mean in Hanly speak?

It does not mean nurses.

The Minister should be honest. What does "medical cover" mean in Hanly speak?

What does the Deputy think it means?

It means everything except a doctor.

The Deputy is wrong. That is not what it means. We are talking about doctors.

It could include a doctor but it does not guarantee a doctor, and the Minister knows that.

That is what we have asked. We have asked them to give consideration to that because——

I call Deputy McManus.

First, does the Minister not accept that in setting up these new bodies we now have a situation which is characterised by confusion as to who is responsible, for example, for dealing with the issue of public private mix and equality in the health service? Second, on costs that are already building up we now know that it is likely that two jobs alone in these new structures —the CEO for the Health Service Executive and the chairman —will come to a total of approximately €500,000. Third, there is a conflict of interest which is inherent in the structures the Minister has created. In the national steering committee alone, apart from the chairman the only other people on the committee are civil servants. Interestingly, for the first time the Department of Finance has now got a powerful role in running the health service, but that is by the by. The only other person is the managing director of a major pharmaceutical company. How can the Minister stand over that? He has opened up a direct conflict of interest in regard to the most powerful body that will steer health reform in this country, and no explanation or justification has been given. No matter how often one protests, the reality is that in regard to a person now at the centre of the health reform programme, and I cast no aspersions on the individual involved——

That is what the Deputy is doing.

——his background, role and current job as managing director of a major pharmaceutical company, raise the issue of a conflict of interest that the Minister has not addressed.

With respect, it does not. That is a wrong assertion to make. It is ridiculous to assert that someone who happens to have significant experience in the area of change management in a particular industry is thereby debarred from any role in terms of structural reform, overseeing the Government decision and changing structures, represents a conflict of interest. The individual concerned made a significant contribution on the health strategy, for example, from a management perspective and so on.

The Minister is making people more anxious.

We should not try to create a cloud over people. That is wrong.

Written Answers follow Adjournment Debate.

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