Mary Harney (Dublin Mid West, Progressive Democrats)

I move: "That the Bill be now read a Second Time."

I am pleased to introduce the Second Stage of the Health Bill 2004 to the House. This is an historic piece of legislation. It provides for the most comprehensive reorganisation of our health services since 1970 which is long overdue and vital. It is a once-in-a-generation event. It is our generation's chance to put patients first in the design of the management of health services. It is our chance to put in place modern, effective management to make the best use of these tremendous resources we are applying to health and to get clear value and clear results for that money. It is our chance to create a system where money can follow patients and where outcomes can be measured. We are legislating for the start of the 21st century, for ten, 20 or 30 years in advance. There is no going back. We can no longer rely on outdated and ineffective legislation that may have met the needs of Ireland of the 1960s and 1970s.

We must bring sense to the patchwork of amendments we have made to health legislation over the years and to the growth of separate health agencies. We do not need 273 people on separate health boards in addition to 166 members of the Dáil and 60 senators to manage and account for public health spending. We do not need more than 58 separate health agencies. It has become a jumble and it has led to below-par results for patients and below-par value for money for taxpayers. Those are the two reasons we are proposing this legislation and the two ways Government policy should be judged: better outcomes for patients and better value for taxpayers' money. To achieve them, we badly need clarity of roles and accountability — political responsibility for the Minister and management responsibility for the management. The lines of responsibility and accountability are clear in this legislation, the clearest they will ever have been in health administration in this country. That will make a real difference to the quality of health services provided for our people.

The need for reform of our health management structures has been well known for a long time by anyone with an interest in public administration. The Government's policy behind this legislation is also well known. In this Bill, the Government proposes to implement our policy that has been widely communicated and debated since we first announced our health reform package on 18 June 2003. The Taoiseach, the then Minister for Finance, the Minister for Health and Children and I made that announcement together. We published in detail our plans for health reform. We proposed to replace health boards with a single Health Service Executive and to bring together 27 health agencies in the HSE. We said we would establish a Health Information and Quality Authority and re-focus the role of the Department of Health and Children. We published the Prospectus and Brennan reports that informed our policy. The Minister for Health and Children said the legislation would take 18 months to prepare. The media gave widespread coverage to all aspects of the reform programme. Opposition parties commented immediately, accepting, it is fair say, the thrust of the reforms while asking for more to be done. Some people asked for more funding and nearly €1.7 billion more has been provided since then.

Few people if any said the present situation was the best for patients. Few argued for the retention of the health boards or that we needed all the separate agencies with unclear or overlapping roles. The Department of Health and Children immediately set about a wide-ranging communications process that has continued up to this day. This legislation has arisen from a long deliberative process by many people, both before and after June 2003. I hope our debates in this House will bring this process to fruition by focusing on precise points of legislation. The Health Bill 2004 forms the main legislation to implement a single unified health service. The Bill provides for the establishment of the Health Service Executive on a statutory basis and provides for the consequential dissolution of the Eastern Regional Health Authority, the area health boards, the health boards and a number of other identified agencies. It sets out the functions of the Health Service Executive and outlines the accountability arrangements applying to it. The Bill also provides for the establishment of a national health consultative forum, regional health forums, advisory panels and a statutory complaints framework.

I will now outline the provisions of the Bill. Section 6 establishes the Health Service Executive on establishment day which is planned for 1 January 2005. The executive will be a corporate body and will be entitled, subject to the provisions of the Health Acts 1947-2001, to acquire, own and dispose of land and property.

The object and functions of the executive are set out in section 7. The object and functions of the agency responsible for the delivery of health and personal social services are being set out clearly in statute for everybody to read. This is of critical importance because in attempting to make an organisation responsible for the performance of its functions, one must first know what those functions are. The object of the executive is "to use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public". The executive is assigned the functions transferred to it of the bodies being dissolved on establishment day, which are those functions which were conferred on the ERHA and the health boards under the Acts listed in Schedule 3 to the Bill. A review of the functions in this schedule will give an idea of the breadth of the functions and responsibilities being taken on by the executive.

In delivering or arranging for the delivery of health and personal social services, the executive is required to integrate the delivery of health and personal social services. In requiring the executive to do this, we are seeking to address the criticism which has frequently been levelled at the health services that patients can get lost in the system when moving from one sector to another because of the lack of integration between the various settings. The executive is also being required to have regard to the need to co-operate and co-ordinate its activities with those of other public authorities if the performance of their functions could affect the health of the public. This is important for the executive in its role of protecting and promoting the health of the public.

Section 8 allows the executive to enter into agreements with other public authorities either on its own initiative or if requested by the other public authority to do so. Health boards have agreements with local authorities and local authorities with health boards to carry out functions on each other's behalf and we want to encourage the continuance of that co-operation, be it formally under section 8 or informally under section 9.

Under section 10, the Minister for Health and Children is enabled to give general direction to the executive on the performance of its functions under this legislation or other enactments. As it is, the Minister and the Government is responsible for setting overall health policy and it is essential that the Minister has the power to inform the executive of policy decisions made and to direct it to carry out its duties in compliance with Government policy. The executive is also required to provide the Minister with any information or statistics relating to the functions of the executive which may be requested.

Section 11 establishes the board of the executive. The board will have 11 members, including the chairperson, all of whom will be appointed by the Minister from among persons who, in the Minister's opinion, have the experience and expertise relating to the executive's functions to enable them to make a substantial contribution to the performance of the executive's functions. As with appointments to other State organisations, persons who are Members of the Houses of the Oireachtas, the European Parliament or a local authority are not eligible to become members of the board and should they be elected to either House of the Oireachtas, the European Parliament or a local authority during their tenure of office, they immediately cease to be members of the board.

The provisions relating to the operation of the board are set out in Schedule 2. The board's term of office is five years and members may serve two terms of office. Five members of the first board will serve five years and five members will serve three years. This is to ensure continuity of experience in the board so that not all members of the board leave at the same time. The board is required to meet as often as necessary to carry out its functions but must have at least one meeting in each of 11 months of the year. I do not consider this an onerous commitment as the board has responsibility for the management of an organisation with a budget of €10 billion, 100,000 employees and the provision of health services to approximately 4 million people.

In accordance with good governance guidelines, the board is the governing body of the executive. Section 12 confers on it the authority to perform the functions of the executive, other than those conferred in statute on the medical officer of health. The executive can then delegate any of those functions to the chief executive officer, CEO, who has operational responsibility for the day-to-day running of the executive under section 18.

The provisions of section 14 allow the Minister to remove the board if it fails to comply with specified obligations, including failure to comply with a direction of the Minister or any other requirement under this Act, or if the Minister is satisfied that it is not performing its functions in an effective manner. If a Minister is of the latter view, he or she can commission an independent review of the matter giving rise to that opinion. The board of the executive is required to give the person undertaking the review all reasonable assistance.

The responsibilities of the executive are diverse and wide-ranging. In recognition of this, section 15 allows the executive to establish committees to provide it with assistance and advice in regard to the performance of its functions. The members of the committees need not be members of the board, but may be persons who have the experience and knowledge required to advise the board.

Section 17 provides for the recruitment by the board of a CEO pursuant to a recommendation from the public appointments service. The CEO is responsible to the board for the performance of his or her functions and for the implementation of the board's policies. The board is empowered to appoint a deputy CEO in the absence of a CEO or if the position is vacant.

The Bill provides for a formal system of delegation of functions by the CEO to other employees and for subsequent sub-delegation by those employees of some or all of their functions to other employees. This formalised mechanism for delegation will provide clarity for employees in regard to their roles and responsibilities and aid accountability within the executive.

Section 20 provides that the CEO will be the accounting officer of the executive. This reflects the principle that the board is solely responsible for the management of the health services. This will mean that the CEO will be accountable, in the same way as a Secretary General of a Department, for the appropriation account and for the Vote of the executive. This is a very strong form of accountability for a public body and will give much greater clarity than before as to where responsibility for the management of public funds lies. A similar provision is found in the Garda Bill 2004 in regard to the Garda Commissioner.

The CEO will, under section 21, be required to appear before Oireachtas committees when requested by those committees to account for the performance of the executive. Political responsibility for the activities of the health services will rest with the Minister for Health and Children who, supported by the Department, will hold the executive to account.

The executive is allowed recruit its employees subject to the terms of the Public Service Management (Recruitment and Appointments) Act 2004. The overall numbers, grades and terms and conditions will be determined by the executive with the approval of the Minister for Health and Children and with the consent of the Minister for Finance.

Provision is made in section 63 for the transfer to the executive of the staff currently employed in the ERHA, area health boards and health boards, and the other dissolved bodies. These employees will transfer on establishment day on terms and conditions no less favourable than those they enjoyed prior to the transfer. Staff of bodies which will be dissolved at a later stage by order of the Minister will also transfer under similar terms. Provision is made for changes to the terms and conditions of such staff on an agreed basis following negotiations with staff representative interests.

The disciplinary procedures provided for in the Health Act 1970, which provide for appeal to the Minister in the event of a proposal to dismiss a staff member, will no longer apply. Instead, the Bill provides for the application of the employment protection legislation, namely, the Unfair Dismissals Acts, 1997 to 2001, to the employees of the executive. These provisions were extended to local authority employees in the Local Government Act 2001. A saver is provided in the Bill for persons who have initiated a process under section 24 of the 1970 Act which provides for the establishment of committees for certain removals, that where such a process is not completed on establishment day, it should continue until it is completed.

Section 23 requires the executive to prepare a superannuation scheme in respect of its employees which must be submitted for the approval of the Minister for Health and Children with the consent of the Minister for Finance. Members of either House of the Oireachtas or of the European Parliament are not eligible for employment with the executive and if employees of the executive are elected to any of those institutions, he or she will immediately be seconded from employment with the executive. The Bill, by way of amendment to the Local Government Act 2001, enables the Minister for Health and Children to designate certain grades or classes of employees who may not become members of a local authority.

Section 25 requires all members of the board, the employees of the executive and advisers engaged by the executive to maintain proper standards of integrity, conduct and concern for the public interest. This is vital in an organisation that deals with people on a daily basis and often when they are most vulnerable. The executive will be required to prepare and make available to all its employees and advisers engaged by it a code of conduct that will indicate the standards of integrity and conduct to be maintained by these persons in the performance of their functions.

Part 7 contains the main accountability requirements being imposed on the executive. It sets out a statutory framework of accountability for the executive by requiring it to clearly set out the plans it has for the provision of services over a three year period and the services it intends to provide for the level of funding it receives on an annual basis, and then to indicate the level and quality of those services provided for the expenditure it has incurred.

In view of the Government's decision to make the CEO of the executive the accounting officer of the executive, I will introduce a number of technical amendments on Committee Stage in regard to the provisions of this Part. These amendments will ensure that the executive will operate as a separate entity with full accountability for its own Vote.

In accordance with good governance practices, the executive is required, in section 40, to prepare and submit to the Minister a code of governance. This code will outline the guiding principles applying to the executive in the performance of its duties, its structure and the responsibilities of its board and the CEO, the processes and guidelines used to ensure compliance with the requirements of the Act and its internal controls, including procedures relating to internal audits, risk management, public procurement and financial reporting. The code will also outline how the executive intends to integrate the delivery of health and personal social services and the nature and quality of services that persons can expect when receiving those services. The executive is required to publish this report and to provide details in its annual report on its adherence to it.

In section 29, the executive is required to prepare and submit to the Minister a corporate plan for the subsequent three year period. The corporate plan, which must have regard to Government and ministerial policies, will outline the executive's key objectives for the following three years and the strategy for achieving those, and should detail how the executive intends to use the resources available to it in that period. When the plan is approved by the Minister, he or she is required to lay it before the Houses of the Oireachtas. The executive is required to provide the Minister with updates on its implementation of the corporate plan in its annual report or in any other manner specified by him or her.

Section 32 requires the executive, on receipt of notification of its funding, to prepare a national service plan, which must provide an indication of the type and volume of health and personal social services to be provided by the executive during the period of the plan and estimates of income, expenditure and number of employees for the period and the services to which the plan relates. The plan must also comply with the limits given with the approval of expenditure for the period, comply with directions from the Minister, be consistent with the policies and objectives of the Government and have regard to the corporate plan in place at that time. The plan must also comply with the limits given with the approval of expenditure for the period and with any directions from the Minister, be consistent with the policies and objectives of the Government and the Minister and have regard to the corporate plan in place at that time. The executive will also be required to prepare capital plans that will outline how it intends to use the capital funding available to it for that year. Under section 38, the executive is not permitted, without prior written permission from the Minister, to undertake or enter into an agreement to undertake capital developments that would exceed an amount determined by the Minister.

As the executive itself will be unable to provide all of the health and personal social services required by the public, it is empowered under section 43 to enter into arrangements with other service providers for the delivery of any of those services. These arrangements will be on such terms and conditions as the executive may determine and will be subject to the resources available to it and any directions issued by the Minister. As it is public finances that will fund these arrangements, service providers entering into these arrangements will be required to keep all proper and usual accounts and records of income and expenditure as specified by the executive. The service providers are also required to submit these accounts annually for audit and submit the audited accounts together with an auditor's certificate to the executive. The executive is also empowered to make whatever arrangements it considers necessary to monitor the expenditure incurred and the services provided under these arrangements and to request any information from the service providers it considers material to the provision of those services.

Section 41 requires the executive to prepare its annual financial statements in accordance with accounting standards specified by the Minister and to have them adopted by the board on or before 1 April in the year following the financial year to which they relate. It is also required to prepare and adopt an annual report not later than 30 April each year outlining its performance of its functions in the previous year. The report must be submitted to the Minister and he or she will then lay copies before each House of the Oireachtas.

The Bill provides for the establishment of three new mechanisms to enable public representatives and users to reflect their views on the delivery of health and personal social services to the Minister and the executive. I consider it very important that both users and public representatives should be able to have forums available to them to advise the executive of their views on how they perceive the management and delivery of health services as it affects them.

In section 46, provision is made for the establishment of a maximum of four regional health forums comprising members of city and county councils within the functional area of the forum. The forum will provide local public representatives with the opportunity to make representations to the executive on the range and operation of health and personal social services within the forum's functional area. This Government is very aware of the important role played by public representatives in representing the views of their constituents on developments in the health services.

Under section 47 the executive is enabled to establish such mechanisms as it considers appropriate, including advisory panels, to assist it in seeking the views of local communities or other groups on health and personal social services. Such panels may consist of users of the services, service providers or other groups which the executive considers appropriate. The establishment of these advisory panels meets the commitment in the health strategy for a more structured approach to community participation in decisions about the delivery of health services.

Under section 48, the Minister can direct the executive to establish an advisory panel for a particular purpose, should he or she think it appropriate, and he or she may appoint members to the panel.

The health strategy recommended that a statutory framework for complaints be put in place. This is provided for in Part 9. This framework will enable persons dissatisfied with an action of the executive or other service provider to make a complaint as allowed for in Part 9. It will provide for clarity and uniformity of approach in dealing with complaints. It seeks to provide that the complaint should be resolved at local level, but provides access for independent review if the complainant is unhappy with the decision reached by the complaints officer. Availing of this statutory complaints framework does not preclude a person from making a complaint to the Ombudsman or the Ombudsman for Children.

The executive will be required to establish complaints and review procedures for dealing with complaints about it or about other service providers. Service providers may establish their own complaints procedures providing the executive is assured that the procedures are of a comparable standard to those it established. If a person is unable to make a complaint because of illness or age or disability, certain specified persons may make a complaint on his or her behalf. Complaints must be made within 12 months of the actions giving rise to the complaint. Complaints cannot be made about certain issues which include matters which are or have been the subject of legal proceedings, matters relating to clinical judgment, matters relating to the recruitment and appointment of employees, etc.

The procedures relating to the operation of the statutory framework will be set out by way of regulations made by the Minister. The executive is required to provide in its annual report a general report on the number of complaints received, the nature of those complaints, the number resolved by informal means and the outcome of any investigations undertaken during the previous year.

Section 60 lists the bodies to be dissolved on establishment day. Provision is made in Part 10 for the transfer of their staff, property, liabilities, contracts, etc. to the executive. A number of bodies established under the Health (Corporate Bodies) Act 1961 were identified by Prospectus in its report, for dissolution with their functions, staff, assets and liabilities transferring to the executive. It is not intended to dissolve these bodies immediately but it is necessary to provide the Minster with the power under this Act to do so at a later stage.

As I said earlier, it is important to provide for a smooth transition from the health board structure to the executive structure. With this in mind, the Bill contains a number of transitional provisions to provide for continuity between the structures in place within the health boards pre-establishment day and the structures within the executive from establishment day. Section 62 provides for the transfer of functions from those bodies dissolved on establishment day to the executive on that day.

Provision is made in section 79 to continue the delegation of functions made by the health board CEOs and the regional chief executive of the ERHA prior to the establishment day to continue across into the executive structure on and after establishment day, and until the executive varies such delegations. Appointments as authorised officers, for example environmental health officers, made prior to establishment day, will also continue in force until such time as such authorisations are varied by the executive. These continuation provisions are important as the executive will not be in a position on establishment day to put in place delegations and to issue warrants of authorisation to employees throughout the country.

Provision is also made to deal with the transfer of financing and accountability from the health board structure to the executive structure. Under the current legislation, the Minister is required to issue letters of determination to the ERHA and the health boards within 21 days after the publication by the Government of the Estimates for supply services for that financial year. The ERHA and health boards are then required to prepare and submit to the Minister within 42 days a service plan outlining the services they propose to provide for that determination. This process must be followed up to 31 December 2004 as the provisions of the new legislation will not take effect until 1 January 2005. The provisions in this Schedule allow the service plans of the ERHA and the individual boards to be amalgamated after establishment day to become the executive's national service plan, if the Minister so decides. The individual determinations issued to the bodies dissolved on establishment day are allowed to be aggregated to become the determination for the executive for 2005.

As the House will see, this is a very comprehensive Bill designed to provide the executive with operational independence in the management and delivery of health and personal social services for our country for many years ahead. To complement that independence, strong accountability mechanisms are in place to ensure that the object of the executive is met. This legislation is just the enabling mechanism to allow the reform process to get under way. There remains much hard work ahead to streamline processes from the eight health boards and the ERHA into one cohesive unit while continuing to deliver quality front-line services to the public. There are many more reforms ahead — in the way we deliver and pay for health services, in the way we pay for and use drugs and in the way we respond to people's needs, all with the aim of providing top quality health care based on need. I commend this Bill to the House.

See this speech in context