Liam Twomey (Wexford, Fine Gael)

Fine Gael supports the reform of the health service. However, it is not interested in the perception of reform because this issue is too important to both patients and potential patients. Earlier I pointed out that we need to know the qualifications of the new board of the HSE to have an informed opinion on their ability, we want clarity on the issue of accountability and that we want lines of command and delegation of roles that are clear for everybody to see when the HSE comes into operation.

The risk of all these changes not working is extremely high. The opportunities for patients to express their concerns through the consultative and regional fora are unclear and are not binding on Government. The opportunity to dismiss, elude and even hide patients' complaints is a significant possibility. The patient is not fully protected by this legislation. On those grounds alone Fine Gael must oppose this legislation.

The view of workers must be respected. Although the Minister said there will be no forced redundancies, many of the employees of the health service are extremely concerned about what their roles will be. We must be crystal clear as to the role of advisers, consultants and committees established by the HSE if it is not to contribute to the difficulties we have seen in the health boards up to now, with no rationalisation of the administration of the health service and another tier of administration simply added in place of one we have removed.

There are two major points I did not reach before Private Members' business that I want clarified. The former Minister for Health and Children, Deputy Martin, and the current Minister, Deputy Harney, have stated that the HSE will be accountable to the Minister for Health and Children. I do not see undisputed evidence that this is the case. My reading of this legislation is that the Minister will be able to avoid difficult questions on the health service after 1 January 2005. This is not the way to deal with a crisis in the health service. If we have failed the public over the past five years, covering up is no solution.

Earlier the Minister stated: "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." She continued: "Political responsibility for the activities of the health service will rest with the Minister for Health and Children who, supported by the Department, will hold the executive to account." The legislation does not refer to that. The only reference to a Minister is in section 9 where it is stated that in carrying out the duties under this section the CEO shall not question or express an opinion on the merits of any policy of the Government, or a Minister of the Government or on the merits or objectives of such a policy. There is nothing to indicate that the HSE will be accountable to Dáil Éireann. This is, therefore, another agency similar to the National Roads Authority, which is an unaccountable statutory body from which we will get very poor answers when we request them after 1 January.

Section 20 provides that the new CEO, and not the Secretary General of the Department of Health and Children, will be the accounting officer of the executive. The Minister believes this is a very strong form of accountability for public funds and will give much greater clarity than before, but I disagree. Accountability could be worse than before given that the only information we might get will be what the CEO and the HSE decide to give and we will have no way of finding out for ourselves the details we now get from the health boards. When we have questions regarding what is happening to our patients, what is happening in the health boards, how money is being spent, we can get relatively detailed answers at present. I am afraid that soon this will no longer be the case.

I have read the reports that have been published. I have read the health strategy, and I have read the Prospectus and Brennan reports. They are fairly nebulous. They do not set out clearly what will happen regarding the administration of the health service after 1 January. Nothing in this legislation makes me comfortable about voting for it. There is still much that needs to be changed in the primary legislation. There is a huge amount of information that could still be put out into the public domain by the Department of Health and Children. The role of the Department after 1 January is not clear. The people who work there are a great source of advice for Members of this House, but we are not sure what they will be doing after 1 January.

There are so many ifs, buts and possibilities. As both a politician and a medical doctor, this is creating the fear that we will not know what is happening in the health service after 1 January and that in some respects this legislation is letting the Government off the hook on significant issues that are continually raised in this House. These issues must be clarified even if the amendments Fine Gael will be tabling on Committee Stage are passed.

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