Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I am concerned that the board will not have the requisite representation on it. I took on the health brief this time last year. I was shocked when I looked at the executive team of the HSE, and, as it had been for the previous few years, only recently had a clinical lead been added to the senior team, which is extraordinary for a healthcare system. Just as worrying, there was no patient advocate at all at a senior or junior level. If there is anything to be learned from what has gone on in healthcare over the past while, it is there must be strong patient representation and advocacy at the highest levels throughout the organisation. There must also be senior clinical representation, as one of the major failings of our healthcare system is that there are not enough clinical leads or clinicians' voices for doctors, nurses, midwives and allied health professionals across the board. They are rendered largely silent. It is interesting that at joint committee meetings there may be eight or nine people in front of us from the HSE and one might be a doctor. We hear almost nothing from the level of senior management representing nurses and midwifery, allied health professionals and so forth. That error is being replicated in this Bill putting the board back in place.

The amendment is important, as it would mandate that one of the board members would be a patient advocate. This does not mean that as well as other duties in a job, that person would happen to do some patient advocacy on the side but rather that the person would be a patient advocate or the voice of the patient on the board. I would like there to be two clinical experts on the board. I considered having one from the specialist register as a consultant and another representing nurses and midwifery but that is probably too specific for the legislation. I have provided for two clinical experts in order that the clinical community would be represented and not just doctors. Doctors need to be represented but there is a useful opportunity here, for example, to appoint somebody who represents nurses and midwives to the board. The final board position I would like inserted into the legislation relates to financial expertise for all the obvious reasons. We need serious financial oversight.

I looked at the Minister's appointments to the board but I will not comment on individuals. They are pretty mixed, however, and I took a look at the background and expertise of everybody that will be on the board. Some of the people have relevant expertise for the board of the HSE but some, to be frank, do not and I have no idea what they would be doing on the board. It is not a well-balanced board and it does not have the requisite financial expertise or clinical representation, including that of doctors, nurses and midwives. It does not have sufficient provision for patient advocacy, as one of the board members would have patient advocacy as one of a long list of responsibilities. The person in question is not there solely to represent the voice of patients and the advocacy is just one descriptor in a long list.

We need to mandate the membership. We cannot leave it to the Government, because we have done so and we can see the board that will be put in place. I am sure they are all fine people and they will do their best on behalf of the HSE but it is not a balanced board. Regarding some of the appointments, one would have to wonder what was driving their placement on the board other than politics. Some nominees are extraordinary. It is important to mandate clinical representation, financial expertise and, critically, patient advocacy on the board. I would be very much obliged if the Minister of State accepted the amendment.