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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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(Speaker Continuing)

[Deputy James Reilly: Information on James Reilly Zoom on James Reilly] Moving this time limit could lead to unsatisfactory circumstances where an acting situation was allowed to continue indefinitely. I therefore withdrew the amendment and undertook to give it further consideration. Deputies will see that amendment No. 19 addresses absences of any duration and provides for the director general to designate and appoint a director to stand in for him or her during any absence. Some role is, however, retained for the Minister to take account of unforeseen circumstances where the director general is absent but had not made such a designation and is unable to do so due to ill-health as when taken suddenly ill or perhaps involved in an accident. With an organisation of national importance such as the HSE it is, I think we would all agree, essential that there is always someone with clear authority to perform the functions of the director general.

  The reference to a maximum of a six month duration for cover is not included. I appreciate the point Deputy Ó Caoláin made on this matter on Committee Stage and have given it some thought. The difficulty is that we have to try to anticipate various scenarios. It is possible, for instance, that the officeholder could be seriously ill but expected to be fit enough to return to work after treatment and recuperation and indeed could be well on the way to recuperation and suddenly suffer a relapse. With a serious illness this could take longer than six months and to deal with such circumstances we should not specify a maximum period for which someone can stand in.

  Turning to circumstances where a designation by a Minister is to fill the gap when the post is vacant I should clarify that this would always be a temporary arrangement. The Bill makes it clear that the Minister must take steps to fill the vacancy as soon as may be. This is covered in section 16L. I hope, therefore, that the Deputies accept the rationale behind amendment No. 19 and support it. The Bill currently provides in section 16K(5)(b), as a result of an amendment tabled at the Select Sub-Committee on Health and Children that the appointed director designated by the director general for the purposes of his or her absence or, in the case of a vacancy, the appointed director designated by the Minister if any has to be so designated, will, if present, chair meetings of the directorate.

  Amendment No. 20 maintains the situation and is consequential on amendment No. 19. The Bill already provides that the appointed director designated to stand in for the director general should chair meetings of the directorate when the director general is absent or the office is vacant. Amendment No. 20 is a technical amendment to cover the situation in which the director general is absent, and he or she has made no standing in designation and is incapable of doing so by reason of illness.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin I welcome the Minister's commentary following on from Committee Stage. I note that in the addendum amendments to amendment No. 19 he has twice changed the word "delegation" in sub-section (4) to "designation". I think those are the only changes in the subsequent amendment. The Minister has taken on board the arguments. What can and cannot be done will present in time and I accept that amendment No. 20 is technical as he describes it so I have nothing further to say on these amendments.

  Amendment agreed to.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly I move amendment No. 20:

In page 15, to delete lines 3 to 11 and substitute the following:
"(b) if and for so long as the Director General is not present, or if that office is vacant, the appointed director designated by the Director General or the Minister under section 16G(4) or, as the case may be, the appointed director designated by the Minister for the purposes of section 16G(5) shall, if present, chair the meeting, or".

  Amendment agreed to.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin I move amendment No. 21:

In page 19, line 45, after "Executive" to insert the following:
"and the Joint Oireachtas Committee on Health and Children".

  Amendment put and declared lost.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly I move amendment No. 22:

In page 26, to delete lines 10 to 26 and substitute the following:
"(2) In any legal proceedings, a certificate that—
(a) states that a specified function was on a specified day delegated or subdelegated to an employee of the Executive,

(b) states that the delegation or subdelegation of the function concerned remained in force on a specified day,

(c) specifies the limitations, if any, imposed on the delegation or subdelegation of the function concerned, and

(d) is signed by the Director General or an employee of the Executive who has subdelegated a specified function of the Executive delegated or subdelegated to him or her under section 16H,
shall, unless the contrary is proved, be evidence of the matters stated in the certificate.".

This amendment relates to section 20 of the Bill which itself amends section 77 of the Health Act 2004. This deals with certificate evidence regarding delegation and subdelegation of functions within the HSE in legal proceedings. The amendment is a drafting one to ensure that the subdelegation of functions is properly covered.

  Amendment agreed to.

  Bill, as amended, received for final consideration.

  Question proposed: "That the Bill do now pass."

An Leas-Cheann Comhairle: Information on Michael Kitt Zoom on Michael Kitt I call Deputy Ó Caoláin.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin I have no problem with speaking first but Deputy Kelleher has precedence because of his party's numerical strength. It is only a temporary matter but we will let it be.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher We are larger in numerical strength but equal in weight of argument.

To be consistent I have to oppose the passage of this Bill in view of the concerns that I have outlined previously. I believe it vests significant power in the office of the Minister and that is not a healthy situation. We can argue over the rights and wrongs of the establishment of the HSE, the amalgamation of the health boards and whether it was done in a way that brought about cost savings. It did not. Nobody was made redundant. I accept that it is the Minister's right and duty to set policy but my concern is that implementation of policy could be decided for political reasons. I know he argues that he wants to be accountable to the Dáil and he wants to make the health services accountable to the Dáil through the office of the Minister. That accountability could remain the case but I have concerns about decisions on the allocation of resources and the delivery of health care because it vests such huge power in him, in terms of his influence over the directorate, that it could politicise the health service. We have had this debate and I do not want to go back over it but we put down a motion of no confidence last year on that specific issue, with regard for example to primary care centres, Wexford Hospital and St. Luke's Hospital in Kilkenny and the prioritisation of funding to these hospitals.

The Minister can argue and can say, with justification, that it is his right to make representations to, or to receive representations from, other Ministers but when resources are scarce the fundamental principle of their being allocated based on need must surely apply and there is no check in this legislation that will guarantee that. That is my concern. I know that the Minister is talking about going through a transformative programme of taking the HSE and establishing hospital groups and moving to universal health insurance and all that flows from that. They are all policy decisions. It is the Minister's right and entitlement and duty to make policy decisions. I may oppose those policy decisions but he has an obligation to make them. At the same time I am very concerned that the delivery of and decisions as to where health care would be resourced and where funding would be allocated would be solely within the gift of the Minister of the day.

We have had difficulties in the past across all hues and colours of political parties in government where resources were concentrated and directed for political gain and advantage. I do not think that is acceptable. Yes, the Minister should be accountable in the Dáil in respect of policy and its delivery but surely there must be some separation so that key decisions with regard to provision of resources and the primary care centres are not made for political reasons. I hate bringing this up again and again but I feel very strongly about it. I did not lightly table a motion of no confidence in the Minister but it was based on the principle that we cannot have a situation in which resources are scarce and other areas may need them and their allocation is decided on for political reasons.


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