Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

On the issue of accountability, we had a taste of so-called accountability here yesterday in the course of the Topical Issue debate. This is very relevant to the Bill before us, because it is about the relationship between the HSE and the Minister. This Minister, like his predecessor Mary Harney, hides behind the HSE when it suits and pushes the HSE aside when it suits. He hid behind the HSE when it made the announcement last August of a further €130 million in health spending cuts, cuts for which he and his Government colleagues were directly responsible. These cuts included the cuts to personal assistant services for people with disabilities, which the Government was embarrassed into reversing by disabled people camped outside Government Buildings. Well done to them.

The Minister pushed the HSE aside when he fast-tracked hospital capital projects at the behest of his Cabinet colleagues Deputies Howlin and Hogan. The explanatory memorandum for this Bill claims it is essential that the HSE be properly accountable to the Minister for its performance. We are all for more accountability from the HSE, but what about the accountability of the Minister to the people and to the Oireachtas? Yesterday, the Minister was asked repeatedly by me about how the decision was made on the capital projects in Wexford and Kilkenny, but he doggedly refused to reply to the questions I posed. He refused to account for the fact that the Ministers in these constituencies, Deputies Phil Hogan and Brendan Howlin, announced the commencement of the hospital projects before the HSE board met or before the board was even aware that these projects were going to leapfrog others. The Minister simply ignored my question about what contact he had with his two Cabinet cronies before they so confidently made their announcements. It may be a case of "If there is no written record, it did not happen." However, I believe accountability requires that the Minister respect the words he put on the record of the House this evening when introducing this Bill, when he spoke about accountability to the people through the Oireachtas. Those are the words he used. He said the Minister was accountable to the people through the Oireachtas. However, we have no evidence of any acceptance, let alone adherence, to the spirit - never mind the letter - of the words he uttered here this evening.

I hold no brief for the HSE and its current structures - quite the opposite. It is top-heavy and over-bureaucratic. The passing of the HSE board under this legislation will be lamented by few and I will not oppose its abolition. However, the hospitals controversy raises an important question. It came to light because journalists were able to obtain minutes of board meetings under the Freedom of Information Act. Will the new directorate appointed by the Minister have the same transparency and accountability?

Section 12 of the Bill gives the Minister increased powers to amend HSE service plans. In principle that is not objectionable but, based on all the evidence over the past two years, we have no confidence in how it will be used in the hands of the Minister. The issue is not the procedure for formulating the plan; what is important is its content, the strategy and the policy that guide it. In the case of the Government, it is the fundamentally wrong economic strategy of austerity and the fatally flawed health policy of Fine Gael which clearly hold the whip hand as far as health is concerned in the coalition.

On 10 January the Minister approved the HSE's national service plan, which I have described as a plan for slashing services. The plan implements the savage cuts to public health services imposed by the Fine Gael-Labour coalition in budget 2013. Of the total of €721 million in cuts in this plan, a massive €323 million is cut from primary care. This makes a mockery of the Government's so-called reform programme, which allegedly has primary care at its centre. The Minister has signed off on a plan that will deprive a further 40,000 people of medical cards in 2013, and many more thereafter as the income criteria for receiving a medical card are changed. This is a further attack on people on low incomes. It is scandalous that the plan imposes a cut to disability services of 1.2%, which is four times what was expected by the sector. There should have been no cuts to this sector, but it was expected that cuts of the order of 0.3% would be made. There was a shock when the real figures were revealed. These cuts will severely affect disability services, which are already reeling from cuts in previous years.

The plan also implements the increase in medical card prescription charges and the reduction in the monthly subsidy for medicines under the drugs payment scheme. I have put a parliamentary question to the Minister on this issue. I now have evidence of double-charging for prescription items. Patients are not just being charged €1.50 for prescription items but in many instances are being charged €3. This is happening because the prescribed items are not available in the milligram amounts prescribed by the general practitioner, so two tablets must be prescribed to meet the prescription. Hence, people must pay twice. This is absurd. These are people on medical cards and very low incomes. The Minister must address and correct this issue if he is not prepared to abolish the prescription charge entirely. The plan also implements the reduction in the monthly subsidy for medicines under the drugs payment scheme.

This plan will deepen the staffing crisis in public health services. The HSE admits in the plan that in the light of the staff reductions of recent years and given that a further 4,000 staff are due to be cut this year, the planning of services is "particularly difficult in 2013". That must be the understatement of the year. The staffing crisis will be compounded by the Government's decision to attempt to introduce a cheap labour scheme for nurses which has been rejected by the nursing unions and the overwhelming body of newly qualified nurses. I emphasise that the nurses in question are qualified. It almost beggars belief that the Minister is proposing to extend this yellow pack scheme to other professions in public health services, even though it is so grossly unfair. Given that the boycott by the nursing unions is being widely adhered to and has broad public support, it is clear that the scheme is a hopeless failure from the Minister's point of view. I call on him, once again, to withdraw this totally unacceptable scheme and sit down at the table with the nursing unions which have proposed alternative ideas for savings which would respect the existing salary scales of nurses and midwives.

I invite the House to compare the slashed salaries the Minister expects graduate nurses to work for with the salaries at the top of the HSE. The Bill will not address the issue of excessive salaries in the top-heavy upper and middle management layers of the HSE. Some 129 managers and administrators receive salaries of over €100,000 per annum. That is obscene at a time when older citizens' home help hours and home care packages which were already inadequate have been cut again this winter. Bureaucratic change of the kind set out in the legislation is meaningless in the absence of real policy change and a change in the culture of privilege at the top. The resignations of the former chief executive of the HSE, Mr. Cathal Magee, whose departure I greatly regret, and the former Minister of State, Deputy Róisín Shortall, exposed the deep dysfunction at the top of public health services. There are three aspects to this problem - the unsuitability of the Minister for the office he holds; the fundamentally flawed policy approach of the Government, as evidenced every day on the floor of the Dáil; and the unreformed structure of the HSE and the health service.

Nothing the Government is doing in the Bill equates to reform. Last year marked the centenary of the tragic sinking of Titanic. The Bill represents no more than a rearranging of the deck chairs in the context of the crisis in public health services which are struggling from day to day. Even before cuts of €721 million were announced in budget 2013, public health services were reeling from the cuts of €130 million announced last August, the €750 million cut announced in budget 2012 and the €1 billion cut imposed in 2011. Last week the Joint Committee on Health and Children heard from nurses - front-line service providers - who described the reality of reduced services and increased risks in hospitals as a result of short-staffing. The recruitment ban, the further restrictions on overtime and the hiring of agency staff are having a dire effect. The increased flexibility and potential productivity from hospital consultants achieved in last year's talks were welcome, but all of this could be scuppered by these other cuts. If an insufficient number of nurses and other staff are on duty, insufficient theatre time is available and insufficient inpatient beds are open, many consultants will not be able to provide the extra treatments and perform the extra operations and procedures required of them.

The Minister's lack of transparency and accountability is central to the issue of governance addressed in the Bill. I raised his failure to fill 64 vacancies on nine boards within his remit, including the Food Safety Authority, during a Topical Issue debate last week. Twenty-five people applied under the new open procedures for a position on the board of that authority. The Minister continues to hold off on these appointments, even though, according to reliable information we have received, an overwhelming number of the applicants are suitably qualified and eminent to take on any position of responsibility required by the board. All of this raises questions about the future of the various authorities and boards and undermines public access to the appointments system. People can hardly have much faith in this so-called new approach. It is clear that the Minister is refusing to address their concerns. When I raised this matter last week, the Minister of State, Deputy Kathleen Lynch, was sent in to reply in the absence of the Minister and it was clear that she was embarrassed. The Minister can take a look at the tape if he does not believe me. The Minister of State admitted her view was that the reply she had been given to read did not shine "any light on the question raised." So much for accountability.

I want to mention an important issue that has been raised by Mental Health Reform regarding the Bill. The organisation in question has welcomed the Government's intention to improve the accountability of the HSE through the Bill, but it has expressed concern that the current draft does not ensure a director of mental health with the competence to drive implementation of the Government's mental health policy will be appointed. I ask the Minister to note this most seriously. Mental Health Reform is concerned that the Bill limits the recruitment of the new directors of the HSE to those who already hold the position of national director within it. It believes the appointment of the best person for the job, whether that person is internal or external to the HSE, is vital. The new director for mental health must have a proven track record of leading change in mental health services and competency in the recovery ethos that underpins A Vision for Change. This is extremely important. I urge the Minister and the Government to introduce appropriate amendments to rectify this matter, or to support amendments that may be tabled by me or other Opposition voices to achieve that end.

I look forward to having an opportunity to address improvements to this legislation that might be possible on Committee and Report Stages. I accept that the Bill will make its way through the Houses. While it falls far short of what we really need in terms of reform, it is all we have to work with, at least for now.

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