Mary Harney (Dublin Mid West, Progressive Democrats)

It is fair to say that financial expenditure and value for money issues have dogged the health system for many years. I wish to discuss another issue which is not directly relevant to the motion but which is topical and deals with value for money issues, namely, the PPARS system. This is the latest saga in respect of value for money in the health services.

This summer, I became aware there were growing concerns in respect of the PPARS system. I discussed the matter with the Secretary General of my Department who shared my concerns and I asked him to investigate the issue. He convened a meeting between himself and the acting director for ICT and human resources of the Health Service Executive on 16 July. At that time, it was apparent that costs were escalating and that staffing and consultancy accounted for the bulk of the costs incurred. The Secretary General asked the Health Service Executive to review the project and to report back after the summer. He made it clear that no extra staff should be assigned to the project in the meantime. At that meeting, it was agreed the Health Service Executive would examine ways of minimising immediately the consultancy-related costs. A small management group was appointed to consider the issues and the outcome of its deliberations will be considered by the full board of the Health Service Executive tomorrow.

I welcome the fact the Health Service Executive will address this issue. It is entirely proper that it should decide what is appropriate for a single organisation. No large modern organisation employing 140,000 people can operate without a sophisticated information, pay and personnel system. However, for many years, the biggest problem in the health service was the continuation of the old health boards. Effectively with the Eastern Regional Health Authority, there were 11 different organisations with incoherent policy, inconsistent services, overspending, hidden spending and unsanctioned spending. The Brennan report, published in 2003, stated:

the Commission found problems in the existing systems, including the absence of any organisational responsibility for managing the health service as a unified national system. Systems are not designed to develop cost consciousness among those who make decisions to commit resources and provide no incentives to manage costs effectively. Insufficient evaluation and analysis of existing programmes and related expenditure [is widespread].

The commission went on to state that no single institution or person was responsible for the day to day management of the service as an integrated national entity and that management and control was far too fragmented.

The Government took that analysis on board and shortly afterwards it decided to abolish the health boards and establish a single entity to manage and control the health services for 4.1 million people. That was the correct decision and is the only decision that can lead to appropriate control in health spending. Eighteen months later, I steered comprehensive legislation through the Oireachtas in the most fundamental overhaul of the health system in a generation. Notwithstanding that we were creating a single entity, Opposition Deputies opposed our abolition of 53 agencies and 11 boards with 253 members. That jumble of waste and incoherence caused many of the problems. The Brennan commission also noted there was inadequate investment in information and management systems in the health system and that they required significant development.

Everyone was aware that investment was needed. The problem was, when five chief executive officers of health boards and one hospital decided to introduce new technology to replace their outdated systems in the late 1990s, it was very difficult to anticipate what was appropriate to a fragmented health system with incredible variations, work practices, terms and conditions. In conjunction with the Department, they made an honest attempt to do so. However, it became clear that because of the complexities on the ground, the system they had initially envisaged would not meet the requirements of the technology being devised. Thereafter, a decision was made to move to the PPARS system, which was not what was originally anticipated in the late 1990s. Subsequently, Hay Consultants were appointed and it identified the technology that was necessary because of the complexity of the system requirements. At the time, Hay Consultants estimated the cost to be €100 million.

I want to give Members an idea of what the system was trying to deal with. Currently, only 40,000 staff are on the system. It has been discovered that there are 29,972 work schedules and rosters, 1,163 local variances from core Health Service Executive practices and 979 different wage types including rules and conditions. In some places, a holy day of obligation is regarded as a bank holiday and staff are remunerated appropriately. No computer system could possibly deal with the complexities and irrationality of what was happening on the ground. Had we maintained the 11 health boards, we would never be able to bring financial coherence to the day to day spending pertaining to health.

However, the real difficulty remains as to whether we should have attempted a significant rationalisation in advance of attempting to build a computer system. How long would that have taken? How could it be done? In the meantime, what would one do with the creaking IT system? We must have an appropriate technology system in place, not just as far as payroll, personnel and roster issues are concerned, but also in respect of financial management and the two functions must be compatible. There are thousands of variations and many different methods for remunerating staff. People doing the same job are remunerated in different ways. Indeed, the hours of work appear to differ, with individual arrangements being made in many cases.

Ideally, one would have a computer system that never made an error. However, the Inland Revenue service in the United Kingdom deleted 1 million taxpayers over a three year period without anyone noticing. Similarly, the United Kingdom's Child Support Agency, which spent £670 million on its computer system, was obliged to postpone the transfer of client files to its new computer system because problems were identified. A total of 400,000 payments have been made in the first half of this year. A small number of errors occurred. The largest error affected 2,000 people, whereby a small sum of additional tax was deducted. This was rectified in their next pay packet. Otherwise, the problems have concerned individual cases. However, it has recently been brought to my attention that elsewhere, a manual system has also made a rather large error in respect of an individual pay cheque. Hence, both manual and human errors occur. A system without errors is an ideal.

The real issue for the House and the health service is how to ensure we have appropriate responsibility and accountability in the future. When establishing the Health Service Executive, I was determined to ensure its chief executive officer would be responsible for both the day to day running of the organisation and would be financially accountable. He is the Accounting Officer and is accountable to the Oireachtas. This was a fundamental departure from the norm, in which the Secretary General of the Department of Health and Children would remain as the Accounting Officer. One cannot have responsibility if one does not have financial control. That decision was opposed by the Opposition Deputies. Deputy Twomey stated that we should have dual responsibility in respect of the Accounting Officer. In other words, two people would be financially responsible. That system would not work and is the kind of system that leads to errors.

I am delighted the Health Service Executive is examining this matter tomorrow. I want to express a number of concerns. The first is in respect of the very large bill paid to consultants. It seems to me that it was extraordinary and excessive. Now that a single organisation is in place, consultants should only be engaged where there is no in-house expertise. An organisation as large as the Health Service Executive, with 100,000 employees, must have its own in-house expertise in information technology and many other areas. The hiring of consultants should be the last resort. The norm should be to operate without them and to do so should be exceptional. Unfortunately, in recent years the hiring of consultants has become the norm. In a sense, it often gives the illusion that one has a golden cover if one has consultants to say what is appropriate. Frequently, public servants are not respected or trusted in this regard. We have outstanding expertise and we need to use it more.

In this House and in the media, people have referred to the Comptroller and Auditor General drawing attention to this matter in a report two years ago. That is not true. The only reference to PPARs in his report was an account given by the Secretary General of the Department of Health and Children to the Comptroller and Auditor General, explaining the new costs for the IT system. The Comptroller and Auditor General is currently examining this issue. He will have to decide whether the system was appropriate and whether we got value for money. He is the officer charged under the Constitution with carrying out value for money audits on these matters. I look forward to hearing the deliberations of the Comptroller and Auditor General. I am sure Members will be more than prepared for the outcome of those deliberations. Any spending on technology systems should be put on hold and reviewed, so that we can make sure that we are putting the appropriate system in place and that we are getting value for money. Trying to marry a system that might have been appropriate for a small health board into a big national organisation may not satisfy the needs of that organisation. It is appropriate that all of these matters will be thoroughly examined and I have every confidence in the management team, in the director of ICT, Mr. Seán Hurley, in Professor Brendan Drumm and in the board of the Health Service Executive.

If this system is not appropriate, we must be honest enough to stop throwing good money after bad and to put in place whatever is appropriate. I know that some staff at ground level were annoyed with PPARs because it showed up extraordinary practices. I was not aware that in some places in Ireland, a holy day of obligation was regarded as a bank holiday. I was not aware that some people had to work for 35 hours a week, while others doing the same job only had to work for 32 hours a week on the same pay. I was not aware that people doing very similar things got very different rates of pay and in some cases individual arrangements were made. That was the hangover from the existence of 11 health boards that so many Members wanted to retain. They still shout at me and claim, as Deputy Twomey did, that I am a control freak. We want to get rid of all of that incoherence and that waste of money.

We wish these matters did not arise in this way. However, this matter had been under investigation over the summer, as soon as the Secretary General of my Department, of the Department of Finance and I became aware that there were real concerns emerging. We wish to see a system in place where all of the rosters and all of the staff are recorded on a single system. We would then know who is employed by the health service, what he or she is supposed to do, what is his or her pay and remuneration and so on. Absenteeism in the HSE is estimated to cost about €350 million per annum, representing 5% of the pay cost of €7 billion. We need a system in place that can identify work practices, that can ensure that we create rationalisation, that we pay for what we are getting and that we have greater accountability. In particular, we need a system to ensure that patients get a better deal than that which they got for years under the incoherent health board system. That is the system that led to the chaos that may well be the story of PPARs. I welcome the fact that it will be evaluated and I understand the board will recommend to suspend it tomorrow until we have a thorough evaluation. It is correct to pause and reflect. If the system is wrong, we can move on to something else and if it is right, we can continue with it.

The jury is out on whether the system is flawed. I am not an IT expert and I have had hundreds of such experts call me over the past two days with all kinds of extraordinary stories. I am as confused as anyone else. From the analysis done on our health system, ordinary common sense would dictate that unless we have sophisticated personnel and human resource systems in place, we will not get the kind of value for money and the delivery of health services that are appropriate for 2005 and beyond.

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