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Health Service Executive (Governance) Bill 2012: Report Stage (Resumed) and Final Stage (Continued)

Wednesday, 12 June 2013

Dáil Éireann Debate
Vol. 806 No. 2

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  5 o’clock

(Speaker Continuing)

[Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher] However, this legislation will be very restrictive as to who can be appointed. The issue was raised by various advocacy groups who campaign for a better awareness of mental health issues and better mental health supports and services. The groups were concerned that the person best placed to be appointed is the person with the best experience and ability. This legislation confines the number of people who could be considered for this post or any of the other directorates. The specific area of mental health was raised with us by advocacy groups across the country. I do not understand why it is necessary to have a provision in legislation as to how appointments should be made. The Public Appointments Service is an appropriate body and there are other ways of interviewing and vetting candidates in order to choose the most suitable applicant. That process should be available to any person who wishes to put forward their credentials, undergo the scrutiny process and be appointed on merit as opposed to being appointed by virtue of the position he or she holds and that this is enshrined in legislation. I do not understand the logic of this being enshrined in legislation. Is it designed to enable the metamorphosis of the HSE into some other organisation by protecting those who have now been appointed? This is my concern. I am sure those individuals who have been appointed would not be afraid to go through an appointments system in which the applicant is assessed on his or her qualifications and experience and other criteria normally used in an interview process so that they could fill the posts when this legislation is passed. That is the issue that needs to be addressed.

On the issue of mental health, it should be stipulated in the Bill that there would be a director for mental health and that the selection process would be open to anyone. This is not to cast any doubt on the ability, or integrity or capability of those appointed under the current system. I do not agree with enshrining the process in legislation.

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I thank the Deputies opposite for their contributions. On the amendment, when performing their functions as members of the directorate, appointed directors will be acting collectively as part of the governing body of the HSE. This is distinct from their individual responsibilities as senior employees in the grade of national director relating to a particular service area.

As indicated on Committee Stage it is not feasible for me to accept this amendment with the specificity it involves which means singling out one service area, however vital. I am very happy to place on the record of the House that it is my view and it has been my view for many years that mental health services have been the Cinderella of the health services. I have often remarked upon the fact that the institution known as St. Ita's was put at the end of a peninsula and the original design was for it to be put on Lambay Island but this proved too expensive. It was a case of out of sight, out of mind. All of our health policy is aimed at destigmatising the issues around mental health and ensuring that the treatments take place in the same locations as all other health care provision, in primary care centres and in hospitals. These large institutions from the Victorian era should be closed.

I am happy to state that my intention is to appoint a new national director of mental health as a member of the HSE directorate. As I said on Committee Stage, I fully understand the good intentions and the reasons for this amendment and I share the Deputy's view on the importance of mental health services. However, as I have explained, I will not be in a position to accept the amendment and I ask the Deputy to consider withdrawing it.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin I ask if the Minister could clarify something that is not a small matter. I pointed out the difficulty at times in understanding - perhaps the use of language is part of the problem. In my view, language has to be clear and understandable so that we know exactly what we are dealing with because otherwise we are talking at cross purposes.

I made reference to page six of the Bill, subsection (3), lines 31 to 36, which are the subject of amendment No. 4 in which I seek their deletion. My understanding of this in the context of amendment No. 2 is that it absolutely restricts the appointments of directors to those who are employees of the executive holding the grade of national director or other grade within the executive of not less seniority than the grade of national director. Yet the Minister of State has responded already on this amendment stating that the filling of this post, or other posts perhaps, was open not only to HSE employees but also to other public service employees. Am I correct in saying that the prompt note which the Minister read into the record of the House earlier was particularly built around the fact that it is in the past tense - was open? Therefore, it is a distraction from the fact that we are dealing with legislation yet not enacted nor even passed as a Bill. It is important that we have absolute clarity and understand exactly what is being said and exchanged across this Chamber. I believe that what is in the Bill is much too restrictive. I seek an amendment No. 2, "In page 6, line 26, after "Act" to insert the following:", one of whom shall be a Director of Mental Health". This has been filled and has actually become a fact and this is welcome. I think it could be in the Bill which would give significant comfort to the many people who, like the Minister, have shown a concern for how mental health has been treated historically.

We will deal with amendment No. 4 presently. In subsection (3) on the same page there is a very defined limitation of access to compete for such appointments. I believe it should be open to the widest possible scope of expertise, both within the health service and externally. I do not think it is enough to say if they are successful and if they are appointed, then they will surely be part of it. That is not what this subsection requires; it requires that they are already in the service of the health service and that they already hold the position of a national director or a comparable grade. I think that is much too restrictive.

I would be disappointed that we are not able to make progress with some of these amendments for the very good reasons that we have argued. I think that the effort we have employed both on Committee Stage and now on Report Stage merits careful analysis and a weighing up of the arguments by the Minister. In this particular instance it would signal a mighty positive towards not only mental health reform but also the many other NGOs and those who are concerned about mental health services in our health service. These are concerns that have not been lessened over these two years of the Minister's stewardship. He should make no mistake about it that the €35 million just rings in our ears. We need a certainty for the future. There is a chance to do that in this legislation and I would hope that the Minister would reconsider and perhaps also explain what I see - if I am missing something, so be it and let me become aware of it - but from what I hear I believe there are conflicting messages with regard to what the Bill proposes and what the Minister of State has already responded regarding said appointments.

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