Liz McManus (Wicklow, Labour)

I move amendment No. 1:

In page 3, between lines 31 and 32, to insert the following:

"(3) Notwithstanding subsection (4), insofar as this Act provides for the removal of elected representatives from membership of health boards, area health boards, or the Eastern Regional Health Authority, this Act shall not come into force until meaningful new arrangements to ensure democratic accountability are in place.".

I agree it would be helpful if, in terms of the grouping of amendments, we knew the position. However, this is all part of a grand stratagem. If we are issuing compliments, I commend the Government on teaching us how to railroad legislation through. I presume that the next move will be to railroad through legislation to get rid of local authority members. What do we need them for, if county managers can make all the decisions? The latter is the tenor of much of what the Government has been doing. Matters would be much neater if we removed any local accountability.

I wish to make the case in respect of this amendment for some understanding about what is important in terms of the operation of the health service. If there is no input from local communities, we will not end up with a better health service. Instead, we will create a service that will not appreciate or understand the needs of those communities. It is disturbing that, at a time when the Government has adopted a solely top-down approach, we are seeing the dismantling of a framework that was designed to serve local communities, particularly in terms of the provision of community and local hospital services. This is not being done for want of a reason.

The Government's intention is clear and is set out in the Hanly report. Regardless of the mumbo jumbo uttered by the Taoiseach on Leaders' Questions, it is clearly stated in the Hanly report that local hospitals will be downgraded and that accident and emergency services will be located in 12 centres. That agenda will be driven by CEOs in health boards who will be accountable to no one. These people will have significant powers and will be similar to despots. They will not be obliged to answer to anybody apart from the Minister for Health and Children regarding the disposal of property or the changing of services within their remits.

Everyone is aware that the existing system is not perfect. It is far from it. However, even Professor Brennan argued for the retention of democratically-elected public representatives on reformed health boards. However, the Government is not interested in that. Fianna Fáil and the Progressive Democrats are not concerned with democratic accountability because it gets in the way of their plan to ensure that the health service will operate on a centralised model that will be about value for money — a matter about which nobody argues — and because the agenda is being driven by the Minister for Finance, particularly regarding reducing funding. Never has the Department of Finance had an input into the management of the health service such as that envisaged under the health reform programme. There will be a great deal of accounting but no accountability.

The Labour Party is proposing, in the form of the amendment, to ensure the change will not come about until an alternative democratic framework is put in place. Such a framework has been outlined, in theory, by the Minister but he has never actually explained what is involved. A later amendment tabled in the Minister's name refers to CEOs presenting themselves in front of Oireachtas committees as if this somehow represents accountability. It is simply not tenable. Local democracy is about local communities, intensive scrutiny and the delivery of information and services at local level. No Oireachtas committee can deal with that kind of detail about local services in the same way that health boards can do so.

Everyone on the Opposition benches would agree that reform of the health boards is required. The Bill, however, does not represent reform. It will lead to the wiping out of an entire tier of democracy and local government which has sustained the health service, despite the various restrictions and limitations put in place by a Government which told many stories during the general election campaign but which, following the election, began to systematically cut back on services, to set embargoes on staffing and, by means of the ridiculous ELS requirement implemented by the Minister for Finance, to ensure that even where health boards were providing new services and facilities, they could not commission them.

We are losing something of value here. Something is being taken from the people by a Fianna Fáil Minister and the matter is not being dealt with in any satisfactory manner by an eleventh hour proposal by the Minister for Health and Children on Report Stage with regard to CEOs. As far as I can see, the Minister's proposal is all about let-out clauses for a CEO.

A CEO will be able to buy and sell property. On a daily basis a CEO will make decisions and determine the shape of the services the health board provides, but there will be no health board. It is like the Cheshire cat. The cat disappears and all that is left is the smile. The board disappears and all that is left is the name and the seal. This is nonsense, yet what is being proposed here is that somehow there will be an idea of a health board even though there will be no substance to the idea.

Local accountability and democracy are not easy and should not be treated with disrespect. They are about ensuring that where people do not have power at central level or influence in the higher echelons of Government, they can go to their local representative and tell him or her that their mother is dying because she cannot access care when she needs it, or that their grandfather needs services close to home but cannot access them because he lives in a rural area, or that children in a local school need dental services.

Whatever the issue, the rich, open access people had to representatives is being wiped out in a crude way by a Government which is bereft of ideas as to how to manage the health service, apart from presuming that, somehow, if financial accountants operate the system, everything else will fall into place. It will not. We may end up with good accounts but there is no guarantee that we will end up with a good health service. The likelihood is otherwise. The evidence is clear elsewhere, particularly in the example of New Zealand, which ended up returning to more health boards than ever with politicians and public representatives on them.

I urge the Minister, even at this hour, to take into account the concerns people have in communities about their health service and board and how they can ensure they are responsive to their needs.

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