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Health Service Executive (Governance) Bill 2012 [Seanad]: Report Stage (Continued)

Wednesday, 12 June 2013

Dáil Éireann Debate
Vol. 806 No. 2

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  1 o’clock

(Speaker Continuing)

[Deputy Kathleen Lynch: Information on Kathleen Lynch Zoom on Kathleen Lynch]  Amendment No. 1 seeks to amend section 10A of the Health Act 2004 to give a role to the Joint Committee on Health and Children where the Minister is determining priorities and setting performance targets for the HSE. However, as the Minister stated on Committee Stage, priorities and target-setting for the HSE are issues for the Minister in line with Government policy, not matters for the joint committee, the role of which, in the Minister's view, is to monitor how Government policies affect people using the health service and bring concerns to the attention of the Minister. Accordingly, therefore, the Minister does not propose to accept the amendment.

I have seen it now from both sides of the fence. It is not as if the quarterly review or scrutiny that takes place with the joint committee does not have an impact on policy; clearly, it does. Deputy Caoimhghín Ó Caoláin's contribution on the cochlear implants issue is recent proof of this. That will be taken into account and impact on what we intend to do on that issue. I would not dismiss those engagements in any way. However, we could not possibly have a committee of the Oireachtas setting the priorities of all new Governments. It may change as time passes, but all new Governments come with a clearly stated policy on health issues.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher I support the amendment. The difficulty we have is that we adjudicate retrospectively. Let us consider the service plan. It is published and often consultation takes place after the event. Although we have quarterly meetings with the Minister, the HSE and the Minister of State, they are often on the basis of reaction. The purpose of the amendment is clear. It would not force the Minister to comply with what the Joint Committee on Health and Children suggested, but it represents a consultation process. We often refer to the need for transparency and accountability and involving as many people and stakeholders as possible in the decision-making process. This would be an ideal platform, whereby the priorities the Joint Committee on Health and Children believes should be included in the service plan could be presented in advance of its completion. That is really what it is about.

I accept that the Government has the right to set policy and that the Minister has the right to pursue and implement that policy. However, giving the Oireachtas committee an opportunity to have an input into the process prior to decisions on the service plan being cast in stone which we subsequently scrutinise is something worth considering. Let us broaden the debate to include Dáil reform and the discussion on committees being involved in the detailed scrutiny of legislation prior to publishing the heads of a Bill. This amendment would represent another positive step to ensure Oireachtas committees would play a meaningful role in advance of decisions being taken, as opposed to reacting to decisions already made. It is a worthy amendment from that point of view.

I have no wish to labour the point, but we oppose the Bill because of our concerns about it vesting vast powers in the Minister directly. The Minister will argue that this provides for greater democratic accountability. I have no wish to personalise the issue, but affording any Minister such authority is not good. Health issues should be de-politicised. We saw what happened in the case of primary care centres and, let us be clear, they were political decisions. The decisions on the funding of accident and emergency services in various places were also political. That is the right and entitlement of the Minister, but I do not believe health issues should be politicised to that extent.

Section 7 confers supreme authority on the Minister of the day not only in the context of accountability but also in the context of decision-making. This is a matter of concern to me. It is the reason we opposed the Bill on Second Stage and why we will be opposing it at the end of Report Stage. If the amendment were to be accepted, it would at least allow some opportunity for a meaningful input from the elected Members of Dáil Éireann and Seanad Éireann, for the time being. The Minister could decide to accept, reject, amend or ignore any input, but at least it would give us an opportunity to advocate on behalf of stakeholders in advance of decisions being made. On the cochlear implants issue and many others there are a plethora of stakeholders who are keen for their views to be put forward. Ultimately, it is up to the Minister to accept or reject them, as is his right, but at least we would have had the opportunity to present cases made by advocacy groups and political parties that might have a particular view on how health services should be delivered.

I have no wish to labour the point, but in the case of the reconfiguration of hospitals, the Higgins report was presented to the Cabinet and published. All the discussions since have been on the basis of reaction and there was no input from elected Members in discussing policy. Ultimately, the Minister will make the decision, but having an input in advance could be better than the Minister deciding that accepting arguments made by elected Members about reconfiguration or any other policy would be seen as a climb-down. However, if a matter is discussed in advance of a decision being made, it could be included in the decision rather than have us claim the Minister has done a U-turn on policy. That would be good for democracy and would bring decision-making nearer the people. Oireachtas committees meet advocacy groups day in, day out and highlight issues. Groups come to discuss their needs and wants and deficiencies in services. All of this should feed into the process before a decision is made, as opposed to hounding the Minister of the day afterwards for not including things and then, if the Minister makes a change, there are the usual political shenanigans in claiming he has done a U-turn. This is a worthy amendment which could avoid all of this.

From the point of view of my party, the Bill will confer absolute power on the Minister, in whom we proposed a motion of no confidence last year. I cannot say I have confidence in him now when I did not have confidence in him last September. I have no wish to personalise the matter, but the Minister has given me no reason to believe anything has changed. We are now proposing to confer considerable powers on him without any accountability, other than asking him questions in the Dáil. As Deputy Caoimhghín Ó Caoláin noted, this limits the ability of the Opposition to have meaningful engagement or to hold the Minister to account.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin The Minister of State has referred to seeing it from both sides, but the lessons from this side should be brought into the Government experience and they have not been. The lead Minister has totally and absolutely set aside all of what he learned as an Opposition voice and adopted the same approach as his predecessors, whom he condemned consistently from these benches.

What are we asking? We are trying to improve the workings of this institution and its various component parts and the Government suggests it is also seeking to improve them. The committee system needs to have its game upped, about which there is no question. We are not asking that members of the Joint Committee on Health and Children have a veto, a right to direct or a final say but to consult. The Minister will appoint advisers by the new-time and consult all and sundry. The only people with whom there is little consultation, or none in some instances, particularly on the service plan, are the elected members who act as health spokespersons for the various parties. The Minister of State may find herself in such a role again at some point in the future. It is an investment for any of us to make political interaction in the House better, with an eye on results. We should always try to reach the best possible place with legislation and measures to be introduced and implemented and service plans et al. Consultation does not strap the Minister at any point.

In amendment No. 21, as in the case of amendment No. 1, we are seeking a role for the Oireachtas Joint Committee on Health and Children.


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