Billy Kelleher
Ceist:2. Deputy Billy Kelleher asked the Minister for Health his plans to review the ownership and governance of hospitals; and if he will make a statement on the matter. [21080/17]
Amharc ar fhreagraWednesday, 3 May 2017
Ceisteanna (2)
Freagraí ó Béal (8 píosaí cainte)
I ask the Minister for Health if he has any plans to review the ownership and governance of hospitals and whether he will make a statement on the matter. Since I tabled the question, he said we should embark on a national conversation about ownership and divestment of health facilities to the State. Will he elaborate on where he sees that conversation going?
I thank Deputy Kelleher for the question. As the Deputy is aware and will appreciate, voluntary and non-statutory providers, including religious bodies, have historically played an important role in the provision of health and social services in Ireland. It is fair to say the current arrangements have grown out of a complicated past. Policy must reflect current realities as well as available options over the medium term. The recent debate surrounding the location of the National Maternity Hospital has generated increased discussion of issues of ownership and governance in our health services, and in particular our hospitals.
I am anxious not to delay the long overdue National Maternity Hospital project while this wider conversation is taking place, and that is why I have set out a process I would like to follow that is separate and distinct for the National Maternity Hospital in order to tease out the important issues that the public has expressed concern about in recent days and weeks. It is important to note that over the years not only has the role of religious personnel in the day-to-day operation of hospitals reduced but in some cases there has been a transfer of ownership to the State. Examples include the transfer Our Lady of Lourdes Hospital, Drogheda, to the then North Eastern Health Board. Other voluntary or charitable hospitals have closed, such as Hume Street Hospital, or have been subject to mergers into newly created public bodies, such as Jervis Street and the Richmond into Beaumont Hospital. Therefore, evolution is not new and change has also taken place across the wider health service in areas such as nursing homes and disability centres.
A number of our largest and most developed acute hospitals are voluntary hospitals. In contrast with health board or Health Service Executive, HSE, hospitals they have evolved governance structures with significant non-executive involvement. It is important in looking to the future that such strengths are recognised. It is also the case that in recent years, the nature of the relationship between voluntary organisations and the State has been clarified in a number of ways. The HSE operates a governance framework that governs grant funding provided to all non-statutory service providers and provides for detailed service level agreements. In the voluntary sector, it is required practice for public capital investment to be accompanied by a lien that protects the State's interest. All public hospitals are regulated by HIQA and are subject to national clinical standards and guidelines. Moreover, as part of the establishment of hospital groups, voluntary hospitals have been required to plan and deliver services in a manner that integrates service provision with HSE-owned hospitals in the region.
It is long overdue for us to try to structure this conversation about the direction people would like to take. We have seen similar conversations taking place with education. I am interested in the Deputy's view and I suggest to the House that we could benefit from such a conversation.
I thank the Minister. There is a Private Members' motion to be discussed tonight in that context and we can elaborate on it then. Much focus over the past fortnight has been on the ownership of St. Vincent's University Hospital but we are ignoring the fact that the National Maternity Hospital is a voluntary hospital in itself. The Coombe, which is intending to transfer to St. James's Hospital, is also a voluntary hospital, as is the Rotunda, which is going to Connolly Hospital. The three maternity hospitals in Dublin are voluntary hospitals as well. This leads to the greater question in the context of the establishment of hospital groups and the statutory provision of underpinning them with boards. Where will the voluntary governance structure fit into the new hospital groupings if we are to continue with the proposals that the Government has announced on having a hospital group with a governing board overseeing it? Reference has been made to the National Maternity Hospital and the controversy that has flowed from that. It concentrates the mind to a certain extent that we can no longer ignore the fact that voluntary hospitals in the main are largely funded by the State and contracted to provide services to the State. The issue of divesting and ownership are key matters that can no longer be delayed or obfuscated for much longer.
I largely agree with the Deputy. In the coming weeks I intend to go to Cabinet with proposals to put in place a process and structure to have this conversation. I am open to ideas from Opposition parties but I suggest that the forum on pluralism and patronage undertaken by the Department of Education and Skills in 2012 is a model that can work quite well. There would be a degree of public consultation and the input of clinicians. The Deputy's point is important as many of our hospitals are voluntary and many clinicians highlight the benefits of the voluntary system, preferring that system to working in a hospital that is fully owned and funded by the HSE.
It is important to say that of the 49 hospitals we have in this country, 15 are voluntary, with two having joint boards and 32 being statutory. We speak of voluntary hospitals and joint boards in a big discussion but they include Beaumont, the Rotunda, the Coombe, St. James's, Tallaght, Cappagh, Holles Street, the Mater, the Royal Victoria Eye and Ear Hospital, St. Vincent's University Hospital, St. Michael's Hospital, the Mercy University Hospital in the Deputy's county, South Infirmary-Victoria University Hospital, Our Lady's Children's Hospital, Temple Street and the National Children's Hospital at Tallaght. The Deputy is not trying to reduce the conversation to a simple matter but anybody doing so is missing the point that we have a rich tapestry in terms of how our health service is run and governed. It is high time we had a debate on whether there are better ways to do this and what direction people want to take. We should not ignore that all the hospitals I mentioned are either voluntary or have a joint board. They provide very important services.
The conversation has started and minds have certainly been concentrated in the past number of weeks. The Minister indicated that many of the hospitals are voluntary or have other forms of governance. In the conversation that must take place about divestment or ceding of ownership, we should be conscious of the fact that we cannot pass Bills of attainder and seize hospitals. We must do what is available to us in law and right for the health services. It should be done in broad discussions with the voluntary boards to see how the State can best involve itself in the context of capital investments put into these hospitals, as well as the day-to-day management and oversight of those hospitals.
That must be reflected, in view of the fact we will end up with hospital groups with a board, and there must be streamlined accountability and governance structures in place. Having a great deal of voluntary input could create difficulties, so we must have that discussion to ensure there is seamless governance of the hospital groups with all hospitals involved.
That is right. We will also have to be very much aware of the financial implications of this.
That should be an important part of the discussion. If it is the will of the people in this country that we should embark on divestment and purchasing sites and hospitals, it means we are suggesting that we use part of the finite health budget to buy hospital facilities that are currently available to us and providing a service. Perhaps that is the direction we need to take, but we must have that conversation. The Deputy is entirely correct that it must be in discussion with the voluntary hospitals. Some political parties in the House have suggested that I should, as it were, sneak in and seize hospitals from voluntary groups in the middle of the night. There are laws and a Constitution in this country so we must have a conversation, just as we have done in education. If we have that conversation I believe the health service can benefit and we can ensure that we keep the best parts of the tapestry. Some of the hospitals I have listed on the record of the House have very fine traditions of providing an excellent health service to the people of this country. However, as we move forward and invest in and build new hospitals, the point I have heard clearly from the Irish people is that they have strong views on the type of governance structure we should have in place in those new hospitals.