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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 Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall]  The standard practice in a public body is that an independent board operates at arm's length, provides oversight and accountability for the spending of public money and is accountable to the taxpayer for the spending of that money. However, unfortunately, in 2011 one of the early steps the Minister took, to make some kind of name for himself, was to abolish the board of the HSE, a board which was made up of very well respected public people, in the guise of doing something about the problems in the health service. As a result of that, a legal difficulty was created and this "makey-up" board was put together to tide the Minister over as a vacuum was created in the governance of the health service. Rather than now admitting that was a mistake and putting in a proper independent board, a convoluted structure is being proposed under this legislation to create a directorate where there will be no division between senior management and what is supposed to be the oversight body, which is the directorate. In corporate governance terms, that must raise very serious questions and concerns. I am surprised this legislation has got to the point it is at given the lack of proper procedure and given the fact that a type of circular arrangement is proposed under the legislation where the director general outside of the boardroom will be in charge of the other directors but when they go into the boardroom that position will be reversed and the director general will be answerable to his senior management team because they are directors in effect.

This is an extraordinary model for corporate governance. It is hugely problematic and does not provide the independent oversight that is required. This kind of lazy and unacceptable approach runs through the Bill. It also comes to the fore with the appointment of the first director general where there is no requirement to have a public open competition. The Minister will decide who will get that job, just as he decided who was going to be brought into the Department of Health to head it up both in terms of the Secretary General and the new layer he created with the special delivery unit. People were again brought in without there being a public competition and under very unusual remuneration arrangements where two people were paid through a UK company. It is quite extraordinary and incredible that a Minister with little political experience can get away with this kind of thing. I believe that we will pay a price for that in the future.

It is also quite indicative of certain disregard for proper corporate governance that when I raised the issue of the possibility of a person who has been adjudicated to be bankrupt continuing as a director or director general of the HSE and said that it would be wrong for a person with those kinds of pressures to continue in that job, the Minister said that it would not help the pressure if they lost their job. That is not the point, rather the point is that a person in that situation is required to be accountable for the spending of large amounts of public money and there is a legal and moral responsibility on Ministers to protect the public purse and ensure proper procedures are in place.

I continue to have serious concerns about this measure and the fact that far too much power is vested in one person, namely, the Minister and that there are none of the normal checks and balances required under modern day corporate governance standards. It seems incredible that this convoluted structure is being put in place for a very short period, as it has been stated that the HSE will be abolished completely by 2014. I challenge anybody on the Government side of the House to tell us what will replace the HSE. Who will deliver the services? I repeat my concern that this is part of a plan to dismantle the public health service and that we will end up in a situation, as the Minister has stated in replies to parliamentary questions, where insurance companies will be the principal purchasers of health care in hospitals and in primary care. It is not in anybody's interest that we have a health service that is determined and effectively run by insurance companies that become the principal purchasers of care at primary and hospital care level. That is the reason I have serious concerns about where the Minister is headed in regard to our public health service, and this legislation adds to those concerns. I am completely opposed to it.

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I regret that the Deputies opposite feel they cannot support the Bill. However, I will address some of the issues raised by them. Regarding the way the directorate will work, it will have collective responsibility as the governing authority for the HSE. In practice, the directorate model will involve a combination of a senior management team working together on major corporate issues but with the usual operational line of reporting to the director general for the specific service functions.

Regarding accountability, the HSE has responsibility for the organisation and delivery of health services and the directorate will be accountable to the Minister for the performance of the HSE functions. It will have to explain its decisions. As chairperson, the director general will account to the Minister on behalf of the directorate in regard to the way the HSE's functions are performed. He or she will do this through the Secretary General of the Department of Health.

The Bill builds on existing accountability provisions in the Health Act of 2004. It allows the Minister to issue directions to the HSE on the implementation of ministerial and Government policies and objectives relating to HSE functions where the Minister believes that the HSE is not having sufficient regard to such objectives or policies in performing its functions. The Minister will also be empowered to specify priorities for the HSE, to which the HSE must have regard in preparing its service plan. The Minister may establish performance targets for the HSE in regard to these priorities. Directions, priorities and targets will not be made in regard to individual patients or service users.

Comments were made about the Secretary General who was appointed in the normal way that all Secretaries General were appointed, namely, through the public appointments system and through competition and, ultimately, I, as Minister, am presented - as are all Ministers - with a choice of three different individuals to appoint.

Deputies spoke about protecting the public purse. Regarding the Department, we have seen our budget cut by €3 billion. We have reduced the number of staff by more than 10,000 in recent years, and there is still not just a safe service but an improved service. That is an improvement that is measurable and reproducible, as in the emergency department figures which show a 24% reduction in the number of people who have to endure long trolley waits at the end of last year-----

Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall That has nothing to do with protecting the public purse.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly -----and inpatient figures which show that we met our target of one year a year ago and our target of nine months last year, and we will meet our target of eight months this year.

Deputy Timmy Dooley: Information on Timmy Dooley Zoom on Timmy Dooley That will be a first.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly Deputy Dooley finds this highly amusing but he should be aware that we have measured for the first time the number of people waiting on an outpatient waiting list. That is something from which his Government ran away, would not acknowledge, examine or count and did not want anyone to know about.

Deputy Timmy Dooley: Information on Timmy Dooley Zoom on Timmy Dooley The Minister changed the parameters to make it look good.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly It is 386,000, which is an awesome number but when put in perspective is one with which we will deal-----

Deputy Timmy Dooley: Information on Timmy Dooley Zoom on Timmy Dooley Just like he dealt with the accident and emergency departments.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly -----because we see 200,000 patients in our outpatient clinics every months. We will deal with this in the way we have-----

Deputy Timmy Dooley: Information on Timmy Dooley Zoom on Timmy Dooley The trolley count.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly -----in regard to those who are urgent cases. Cancer cases are being dealt with first and other cases are being dealt with in chronological order. The real scandal is not the 386,000 people who are waiting but rather the 16,800 who wait longer than four years.

We have brought in hospital groups, which I believe will allow hospitals to make better use of their resources; reduce fragmentation and duplication; have greater autonomy locally; and give them greater control over budgets and recruitment and, to a large extent, procurement. In the area of community care, the integrated service areas are being reviewed with a view to bringing them into line with what is taking place in local government and the hospital groups.

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