Paul Connaughton (Galway East, Fine Gael) | Oireachtas source

The abolition of the current board structure of the HSE and its replacement with a system of directorates, with a provision for the Minister to give policy directions to the HSE, is most welcome. I acknowledge that the directorate structure is an interim measure pending dissolution of the HSE, a policy to which the Government committed as part of the move to universal health insurance.

Under the provisions of the Bill, the director general will be accountable to the Minister through the Secretary General of the Department of Health. The Minister may issue written directions to the HSE on policy implementation if he or she believes insufficient regard is being paid to a policy or objective. It also allows the Minister to give specific priorities to the HSE which must be taken into account in the service plan. An audit committee will advise the director general on financial matters and this report must be provided for the directorate and the Minister.

In many respects, the HSE, established in January 2005, has proved to be a runaway train. It is hoped the Bill will provide welcome direction for the executive in terms of priorities and make the HSE more accountable. In too many instances, important decisions are being taken by middle management within the HSE, without proper recognition being given to the long-term impact on the service. When the HSE was established, it was hoped a centralised service would prove more competent than the individual health boards which it replaced. The Brennan and Prospectus reports in 2003 criticised regional decision-making and called for the health service to be managed by a single entity. The setting up of the HSE in January 2005, on foot of legislation passed in 2004, reflected the recommendations made.

Much criticism had been levelled at the holding of health board meetings which took place around the country. However, these meetings provided an opportunity for public representatives to hold health service personnel to account for decisions. The regional health fora which replaced the old health boards were given representative rather than executive functions. They became toothless bodies and thus an important element of regional accountability was lost.

The per capita spend of the HSE has been reduced by 11% in the past two years, a very significant sum. It is increasingly important that every cent spent in the health service is spent wisely for the benefit of patients, be they in hospital or the community.

A key mistake made at the time of the creation of the HSE concerned the lack of action in amalgamating management positions. This resulted in hugely increased management numbers and a bloated and costly bureaucratic set-up which hoovered up millions in budgets, without providing real benefits where they wre needed most, at the coalface. Successive Governments have failed to grasp this nettle and until such time as the numbers of administrators in the system are reduced, we will continue to have an overly bureaucratic system in which too much of the salary cost is associated with administrators as opposed to doctors, nurses and other front-line health care staff.

Issues also arose in the context of transparency. Politicians of all hues have found it very frustrating in their efforts to obtain answers from the HSE. Unlike all other State bodies, the HSE has proved virtually opaque in getting answers to even the most simple of questions. I hope the regime to be ushered in with this legislation will allow public representatives to have questions on health matters answered in a more timely and constructive fashion.

The issue of the money following the patient is also an important part of Government policy which will be implemented through the new governance structures, an important element of which is the measure that HSE hospitals will become autonomous providers of care.

I acknowledge the changes in County Galway where four hospitals have been merged - Merlin hospital, Portiuncula hospital, UCHG and Roscommon County Hospital. This change was implemented by the Minister and the Government. The four hospitals are now more cost-effective and working more efficiently, with more patients. I commend the staff of the hospitals and Mr. Bill Maher, the chief executive officer of the hospital network. It is a case of allowing hospitals to do what they do best. UCHG is a status four hospital; Portiuncula hospital is a status three hospital; while Roscommon County Hospital and Merlin hospital are status two hospitalsd. This reform has been implemented in the past two years and is very welcome. The hospitals are working better together and this process needs to be replicated in other areas.

I sincerely hope the regime ushered in through this legislation will result in a more coherent and cohesive health service, where important elements of Government policy will be acted upon and the service plan will reflect the priorities of those appointed by the people to steer the country on a particular course.

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