James Reilly (Dublin North, Fine Gael) | Oireachtas source

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

I note there is no member of the Opposition present but so be it. I welcome the opportunity to bring the Health Service Executive (Governance) Bill 2012 before this House. There was a good debate on the Bill in the Seanad and I am sure it will be similarly debated in this House.

The programme for Government commits to the most radical reform of our health services in the history of the State with the goal of a single-tier health system, supported by universal health insurance. That reform programme requires significant change across the entire spectrum of our health system not only in structures but also in attitudes and cultures. A core element of the process overall is to identify the building blocks that are necessary to bring us from where we are now to where we want to be in terms of our vision for a new health system. The vision which springs from the programme for Government is set out in Future Health: A Strategic Framework for Reform of the Health Service 2012-15. It charts the Health Service Executive (Governance) Bill as one of those building blocks.

I am taking a hands-on approach to transforming the health service and that is delivering real results such as 3,706 adults who were waiting more than nine months for inpatient and day case surgery at the end of 2011 now having that list reduced to just 89 adults. That is a reduction of 98% in a single year at a time when we were told by Deputy Caoimhghín Ó Caoláin that we would not be able to maintain a safe service because of the reductions in numbers of staff and in the budget. There were 1,759 children waiting over 20 weeks for an inpatient or day case surgery at the end of 2011. Within a year that list has been reduced to 89 children, which is a 95% reduction in a single year. There were 4,590 patients waiting over 13 weeks for a routine endoscopy procedure at the end of 2011. Within a year that waiting list was reduced to 36 patients. That waiting list has been cut by 99% in a single year. These are real and measurable results, and we reduced the number of people lying on trolleys by over 20,000 but more needs to be done, and it will be done. This Bill is an integral part of that.

Deputies will be aware that the programme for Government envisages that the Health Service Executive, HSE, will eventually no longer exist as its functions move elsewhere under the health reform programme. The HSE is a large, complex organisation providing services that are of fundamental importance to the individuals who receive them. Accordingly, its abolition as an entity will take careful planning, sequencing and complex further legislation. It must be done right and at each step it will be crucial to ensure that there are robust governance, management and accountability arrangements in place to drive, manage and monitor implementation of the reform programme.

It is important to remember that the HSE was formed under Deputy Micheál Martin's stewardship of the Ministry of health. It certainly was not formed in a manner that was remotely ideal. The welding together of 11 different health boards and a shared services unit, ensuring that everybody not alone kept their job but stayed in the same job as part of the conditions, was always destined for failure because no attempt was made at real reform. No opportunity was taken in those years, when the country had money, to reorganise the health service, reorganise the administration and grow the necessary management.

This Bill is intended as a transitional measure. It does not abolish the HSE or change its legal status under the Health Act 2004 which established the executive. Its main objective is to bring greater focus on service delivery and ensure more accountability during the time the HSE continues in existence. While it is a transitional measure, it is nonetheless fundamental as a key step in the reform process. To correct any misapprehension, the board of the HSE has not been abolished but this legislation will abolish it.

Under the Health Act 2004, the HSE board is the governing body of the HSE. In 2011, I made changes to the composition of the board designed to facilitate greater co-ordination and integration between the senior management teams in my Department and the HSE. I believe this has facilitated a greater unity of purpose. That unity of purpose between the HSE and my Department will continue. However, when making changes to the board, I signalled I would be introducing legislation to abolish the board structure and establish new governance arrangements for the HSE, pending its eventual dissolution. These changes are in the Bill now before the House.

The Bill abolishes the board structure of the HSE under the Health Act 2004 and provides for a directorate, headed by a director general, to be the new governing body in place of the board. This new structure is designed to help prepare service delivery for the next phase of the health reform programme. The Bill's other purpose is to provide for further accountability arrangements for the HSE. In line with health reform policy, the Bill is intended to make the HSE more directly accountable to the Minister for Health, who in turn is accountable to the people through the Oireachtas.

Several necessary technical amendments are also being made to the Health Act 2004 to take account of the replacement of the board structure by the directorate structure. The HSE has legislative responsibility for the organisation and delivery of health services. Under the Bill, as the governing body, the directorate has authority to perform the HSE's functions. The directorate will consist of a director general and other directors. A director is appointed to the directorate by the Minister and is known in the Bill as an appointed director to distinguish him or her from the director general. To offer flexibility and allow the size of the governing structure to adapt to changing circumstances, the Bill does not specify a fixed number of members for the directorate but instead provides for a maximum of seven and a minimum of three members, including the director general, who is automatically a member and the chairperson of the directorate.

The Bill provides that other members of the directorate - the appointed directors - must be HSE employees in the senior grade of national director. To clarify, this means that appointed directors may be drawn from among any HSE employees holding the position of national director, irrespective of when they took up that grade. My officials and the director general designate are exploring whether the membership of the directorate might be widened to include other members of senior management, such as the chief financial officer. Such a proposal, if adopted, would have no financial implications.

Separately from the Bill but in support of the new directorate structure and new administrative structure, the HSE has already initiated the process of putting in place the new HSE directorate management and leadership team. The recruitment process for five new national directors has now commenced through a competitive process to be run by the Public Appointments Commission. The five new national directors will be responsible at national level for the delivery of services in the relevant service domain for hospitals, primary care, mental health, social care and health and well-being. They will lead the development of national service plans associated with their sector, manage performance and, in time, develop strategic commissioning frameworks for their areas as appropriate. In addition, arrangements are being made to establish three other key senior positions: chief operations officer, chief finance officer and director of shared services.

The HSE will continue to have operational responsibility for running the health service, but accountability is strengthened. The Bill provides that the directorate is accountable to the Minister for the performance of the HSE's functions and its own functions as the governing authority of the HSE. The process will be that the director general accounts on behalf of the directorate to the Minister through the Secretary General of the Department. In this way, the HSE will be required to account for its actions and decisions. This adds to existing accountability arrangements under the Health Act 2004 for service plans, annual reports, codes of governance and the provision of information to the Minister.

The Bill also strengthens accountability arrangements in the 2004 Act by providing that the Minister may issue directions to the HSE on the implementation of ministerial and Government policies and objectives relating to HSE functions where the Minister believes the HSE is not having sufficient regard to such objectives or policies in performing its functions. In addition, the Minister will be able to specify priorities for the HSE to which the HSE must have regard in preparing its service plan. The Minister may establish performance targets for the HSE in regard to these priorities. However, directions, priorities and targets may not be specified with regard to individual patients or service users.

As is the case currently for the chief executive officer, the Bill provides that the director general will be the accounting officer for the HSE. This is a temporary arrangement, as my intention is to return the Vote to the Department of Health from 1 January 2014. At that point, the director general will no longer be the accounting officer. This will require further legislation to disestablish the HSE Vote and fund the HSE through the Vote of the office of the Minister for Health. In the meantime, the Bill has new provisions for a statutory audit committee, which will report in writing to the director general and provide a copy of that report to the Minister.

Part 1 contains the standard provisions dealing with the Short Title, commencement and definitions. It also provides for the repeal of those parts of the Health Act 2004 providing for the board and chief executive officer structure. Part 2, sections 4 to 22, inclusive, contains provisions to amend the Health Act 2004 to reflect the new directorate structure and accountability arrangements. Some of the key elements are sections 5 to 7, inclusive, 12, 14 and 17. Section 5 amends section 10 of the Health Act 2004, dealing with directions from Minister. The section in question currently allows the Minister to give general written directions to the HSE regarding the Act. The Minister can give specific directions in regard to the submission of reports and the submission of information on the performance by the HSE of its functions. That section is amended to provide that the Minister may also give general written instructions to the executive concerning the implementation of any policy or objective of the Minister or the Government which relates to a function of the HSE, where the Minister is of the opinion that the HSE is not having sufficient regard to such policy or objective in the performance of its functions.

This new power in section 10(1)(c) balances the Minister's responsibility for policy with the HSE's responsibility for operational matters. The HSE has responsibility under the Health Act 2004 for the provision of health and personal social services. However, the HSE also has a statutory obligation to have regard to ministerial and government policies and objectives when performing its functions. Directions under section 10 may not be made for individual patients or service users.

Section 6 inserts two new sections, section 10A, setting of priorities by Minister, and section 10B, limitations on the exercise of power under section 10 and 10A, into the Health Act 2004. Under section 10A, the Minister will be empowered to determine priorities to which the HSE must have regard in preparing its service plan and also to establish performance targets for the HSE. Before specifying priorities or performance targets under this section, the Minister must have regard to best practice for the service that is the subject of the priority or performance target, outcomes for patients and recipients of services likely to be affected by the priority or performance target, and the effect that specifying the priority or performance target would be likely to have on other services provided by or on behalf of the executive. Again, priorities and targets will not apply to individual patients.

Section 7 inserts a new Part 3A into the 2004 Act to provide for the establishment of the new governing authority for the HSE, the directorate. This new Part will form sections 16A to 16M, inclusive, of the Health Act 2004. Section 16A provides that the directorate will consist of a director general and other persons referred to in the Bill as appointed directors.

Section 16B sets out the detail relating to the term of office of an appointed director. The term of office for a member appointed to the directorate is three years and he or she may be reappointed by the Minister for a second or subsequent term. I have outlined that appointed directors will be drawn from employees in the grade of national director in the HSE. An appointed director will cease to be a member of the directorate if he or she ceases to be a national director in the HSE.

Section 16L makes arrangements for the appointment of a director to the directorate on a temporary basis to cover the extended absence of an appointed director, because of illness, for example. As the Bill stands, if the national director for hospitals was an appointed director and he or she was on extended absence owing to illness, the Minister would not have the flexibility to appoint that national director's second-in-command to act as a temporary member of the directorate under section 16L, even where it made sense to do so for the duration of the absence. I will table an amendment on Committee Stage to address this issue.

Section 16C sets out the role of the directorate which will have collective responsibility as the governing authority for the HSE and the authority to perform the HSE's functions. Subject to directions of the Minister, the directorate may delegate HSE functions to the director general. The section also sets out the accountability arrangements to the Minister, to which I referred.

Section 16D sets out eligibility requirements for appointment and reasons for removal from office of persons appointed to the directorate. These are similar to the provisions in other legislation on board appointments and removals.

Section 16E provides for the appointment by the Minister of the director general. Under section 16E(4), the first director general is appointed by the Minister and subsequent directors general will be appointed by the Minister following a recruitment process under the Public Service Management (Recruitment and Appointments) Act 2004. Section 16F sets out the eligibility requirements for appointment as director general and the circumstances whereby the director general may be removed from office.

Section 16G provides for the general functions and role of director general. These include managing and controlling the business of the HSE. In the operational aspects of his or her role, the director general is answerable to the directorate as the governing authority of the HSE. On a day-to-day basis, national directors, even if appointed as members of the directorate, will be accountable to the director general for the performance of their functions as employees of the HSE.

Section 16H sets out the arrangements for the delegation of functions by the director general. This will be subject to directions from the directorate. A key objective of the new HSE governance arrangements is to facilitate a system whereby authority to make operational decisions is delegated as close as possible to the point of service delivery. To that end, delegated functions may be sub-delegated, as set out in section 16H.

Section 16I provides for the attendance by the director general before Oireachtas committees. Other aspects of section 7 deal with procedural and related matters for the directorate.

Section 12 amends provisions in the 2004 Act with regard to service planning. Currently, the HSE prepares a service plan in line with certain requirements, adopts the plan and submits it to the Minister for approval. The Minister must either approve the service plan or issue a direction to amend it if requirements are not met. The 2004 Act is being amended to provide for the HSE to prepare a plan in line with current criteria and take account of priorities determined and targets set by the Minister. While the Minister may direct the HSE to amend the plan if requirements are not met, the Minister may now amend the plan following consultation with the HSE also. Section 14 provides for the 2004 Act to be amended in order that the Minister may direct the HSE to take specified measures on implementation of the plan.

I have referred to section 17 which provides for the director general to be the accounting officer and sets out provisions for a new statutory audit committee. Other sections in Part 2 deal with technical amendments to the Health Act 2004 consequential on the establishment of the directorate.

Part 3 has the standard provision for savers following the repeal of sections relating to the board and chief executive. There is express provision in the Bill for the Minister for Health to consult the Minister for Children and Youth Affairs before specifying priorities or performance targets in respect of functions of the executive that relate to the functions of the Minister for Children and Youth Affairs. There is also reference to the Minister for Children and Youth Affairs in the provisions dealing with service planning. These are transitional provisions pending the establishment of the Child and Family Support Agency and the transfer of certain HSE functions to that agency.

At the beginning I spoke about building blocks. The Bill is only one element of a major legislative and administrative reform process under way aimed at ensuring a better health service for everyone. Ultimately, the reform programme is about the patient and a health service that delivers quickly and effectively for that patient according to his or her needs. As long as the Oireachtas keeps the focus on the outcome for patients, we will not go too far wrong in our aspirations to realise the health service to which we all aspire, one in which every service user can feel safe and of which every worker can be proud. I commend the Bill to the House.

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