Health Service Reform.

Dáil Éireann Debate, Wednesday - 7 April 2004

Wednesday, 7 April 2004

Ceisteanna (67, 68, 69)

Jan O'Sullivan

Ceist:

59 Ms O’Sullivan asked the Minister for Health and Children the progress made to date with regard to implementation of the Prospectus report on health structures; when he expects to introduce legislation to provide for the establishment of the four new regional health authorities; the provision there will be for democratic accountability in regard to these new authorities; when he expects that the new authorities will be operational; the plans he has for appointments to health boards in the period between the local elections in June 2004 and the establishment of the new authorities; and if he will make a statement on the matter. [10786/04]

Brian O'Shea

Ceist:

76 Mr. O’Shea asked the Minister for Health and Children the progress made to date with regard to the implementation of the recommendations of the Brennan report; and if he will make a statement on the matter. [10784/04]

Freagraí scríofa

Minister for Health and Children (Mr. Martin)

I propose to take Questions Nos. 59 and 76 together.

The implementation of the health reform programme, which includes both the Prospectus and Brennan reports, is currently under way. The current phase of implementation consists of four distinct but inter-related strands of activity which will take place during 2004. These strands are: the work of the interim health service executive, HSE, leading to the establishment and the orderly transfer of functions to the HSE; aspects of the reform programme for which the Department of Health and Children has lead responsibility, including legislation, the establishment of HIQA, governance, streamlining of agencies, HR/IR, financial management/service planning, etc.; 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 and the health boards executive.

A number of key bodies central to the reform programme are now in place. The national steering committee, NSC, charged with overseeing the implementation of the work programme of the four strands has been established. It provides a co-ordinating forum for actions being led in the respective strands and will ensure overall consistency with the Government's decision. It is to 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. The first meeting of the NSC took place on 16 February.

I announced the establishment of the board of the interim HSE last November and the board has met on a number of occasions. The interim HSE is now established as a statutory body on foot of S.I. 90/04. Under the establishment order, the interim HSE has been given the task of drawing up a plan for the Minister's approval for: the establishment of a unified management structure for the proposed new health service executive; the integration of the existing health board structures into the new health service executive; the streamlining of other statutory bodies, identified in the Prospectus report, to be incorporated in the new structure; the establishment of regional boundaries for the delivery of primary, community and continuing care services; the establishment of procedures to develop a national service plan for the delivery of health services; the establishment of appropriate structures and procedures to ensure the proper governance and accountability arrangements for the proposed health service executive; and the appointment of a chief executive officer.

The interim executive has also been given the task of making the necessary preparations to implement this plan, subject to ministerial approval, so as to ensure as smooth a transition as possible from the existing health board structure to the new health service executive structure.

The Deputy should note that there will not in fact be four regional health boards. Instead, there will be a single unitary structure, the HSE, which will be supported by three pillars, one of which will manage the delivery of primary, community and continuing care services. This pillar will be organised through four regions for administrative purposes. I have already clarified this in the House. Regional health authorities, as referred to in the question, will not be part of the new structure.

There is a need to strengthen existing arrangements in relation to consumer panels and regional co-ordinating/advisory committees in representing the voice of service users. These structures incorporate patients, clients and other users, or their advocates. They will work to provide a bottom-up approach to understanding the needs of service users at a regional planning level. These existing models are at different stages of development and will continue to be enhanced. These mechanisms will serve to bring the patients/clients' views and inputs to bear in the decision making process.

I am conscious of the concerns to ensure that there is adequate governance of the new structures in a radically restructured health system. I have agreed to bring more detailed proposals to Government on the representation arrangements shortly. I am satisfied that the new arrangements, combined with the introduction of system-wide best practice governance and accountability systems, will ensure a stronger more effective health system and an improved health service for patients and clients.

Last week, I referred to the Health (Amendment) Bill 2004 in the House which I expect to be in a position to publish shortly. I also referred to my plans for legislation to establish the HSE to replace the Eastern Regional Health Authority and the health boards and it is my intention is to have this legislation introduced by December 2004 so as to have the HSE in place in January 2005.

Pat Rabbitte

Ceist:

60 Mr. Rabbitte asked the Minister for Health and Children the progress made to date with regard to implementation of the recommendations of the Hanly report; and if he will make a statement on the matter. [10785/04]

Minister for Health and Children (Mr. Martin)

The key elements of current implementation of the report of the national task force on medical staffing — the Hanly report — are as follows: negotiations with the Irish Medical Organisation in relation to the reduction of NCHD hours are continuing in the Labour Relations Commission. A number of further meetings have been scheduled over the coming weeks and every effort will be made to complete these negotiations at the earliest possible date.

In recent weeks, a national co-ordinator and support team have been seconded to oversee the implementation process in the health agencies. Medical manpower managers are also playing a central role. A working group in each hospital is needed to implement these measures and to monitor progress in relation to the reduction in NCHD hours. The urgent need to establish these groups at both national and local level has been discussed with the Irish Medical Organisation. To date, the IMO has not agreed to the establishment or operation of these groups.

In relation to the consultant contract, a number of meetings have taken place between officials from my department, health service employers and representatives of the Irish Hospital Consultants Association and the Irish Medical Organisation. I anticipate that talks will resume when the Irish Hospital Consultants Association suspends phase 1 of its program of industrial action.

I announced the establishment of implementation groups for the Hanly report in both the east coast and mid-western regions on 27 February 2004. The groups will carry out the detailed work on identifying what services should be provided in each hospital, in line with the Hanly recommendations. I announced the composition of a group to prepare a national plan for acute hospital services on 27 January 2004. The group contains a wide range of expertise from the areas of medicine, nursing, health and social care professions and management. It also includes an expert in spatial planning and representation of the public interest.

The group has been asked to prepare a plan for the interim health services executive for the reorganisation of acute hospital services, taking account of the recommendations of the national task force on medical staffing including spatial, demographic and geographic factors. Neither the local implementation groups nor the acute hospitals review group has met as a result of the consultants' continuing industrial action. I ask that all parties return to the table to progress the work of these groups.

As regards medical education and training, the sub-group of the task force which dealt with these issues has remained in place. The group has been asked to examine and report to me on the measures required to accommodate NCHD training in all postgraduate training programmes within a 48-hour working week and safeguard both training and service delivery during the transition to a 48-hour working week. The group is also working with my Department to assist it in accommodating the integrated education and training functions proposed by the task force within the structures announced by the Government in June 2003 following publication of the Brennan and Prospectus reports. It is anticipated that the group will report before the end of the year.

Regarding accident and emergency services, there are a number of initiatives under way at present. These include prioritised planning for the discharge of patients by acute hospitals and increased liaison with between hospital and community services; additional funds — €21.4 million — to facilitate the discharge of patients from the acute system to a more appropriate setting; and additional emergency medicine consultant appointments, from 21 posts in 2000 to 51 posts approved by 1 January 2004.

Subject to resolution of outstanding legal issues associated with the required regulatory changes, I recently announced my intention to provide, at the earliest appropriate date, the necessary additional revenue funding to the pre-hospital emergency care council, PHECC, for the rollout of the training element of the emergency medical technician — advanced, EMT-A, programme.

In the mid-west, the health board has recently advertised for a number of emergency care physicians, fully registered doctors, to complement service delivery in emergency departments. I have also recently approved the appointment of the design team to prepare an outline development control plan for Ennis General Hospital. The plan will be prepared having regard to the development brief prepared by the project team which sets out the broad scope of the proposed future development at Ennis General Hospital and identified the priority areas for development.