Damien English (Meath West, Fine Gael) | Oireachtas source

I welcome the opportunity to contribute to this debate on the Health Service Executive (Governance) Bill 2012. It is an important stepping stone on the road to this Government's commitment given at the beginning of its term to abolish the HSE.

I might not agree with everything Deputy McGuinness said but I certainly agree with his last comment about the change masters. I had a conversation with the late Brian Lenihan when he spoke about all the changes the Croke Park agreement would drive through and I made the very same point to him that Deputy McGuinness made. If we do not put in place the experts, the change masters and the cost accountants in every Department to drive the change we will not succeed. Deputy McGuinness is right in that. That is the same for this Government. There are a number of people in the Department of Public Expenditure and Reform who can drive this change but we probably need more in every Department. Deputy McGuinness is right in that regard and I strongly agree with that. Good managers were driving all the areas where the Croke Park agreement has been successful. It will not work unless it is driven, and we must stress that.

During 2004, both inside and outside this House, I and many others warned the Ahern Government of the potential dangers in creating such a massive bureaucracy as the HSE.

Sadly, little did I realise at the time how right I and others would be. Deputy Olivia Mitchell was Fine Gael health spokesperson when the Health Act 2004 was introduced. In the Dáil during the Second Stage debate, she stated:

It abolishes a framework of accountability within the system without giving us any idea of what will replace it or if it will be replaced. That is a leap of faith which Fine Gael is not willing to make. My main reason for opposing this legislation is that it removes all accountability from the system and fails to replace it with an alternative or even give us any idea if it will be replaced.

Deputy Martin was the Minister for Health and Children at the time. A few months later, after a reshuffle, Mary Harney was at the helm of the Department. Considering her previous portfolios, I thought this might have been good for the Department. She took up Deputy Martin's Health Act 2004 to establish the Health Service Executive and told the House it would be the be-all and end-all despite the fact that I and many other Members told her it would not. The legislation stated that the new chief executive officer of the HSE, which would deliver health services, could not question government policy. This was an illogical move. All the legislation did was to take away accountability to the House.

My experience working in the North Eastern Health Board in the late 1990s gave me some insight into how depressing and impeding a bureaucracy can be, even when staffed with good and well-intentioned people. Bureaucracy smothers innovation. It resents individual freedom and often cannot get its head around new methods and new ideas because these threaten the existence of the bureaucracy. Serving the system becomes the mantra rather than the system itself existing to serve others.

In 2005, with the establishment of the HSE, rather than a rationalisation and slimlining of the system of ten regional health boards, we got instead a very costly mutation. The then Minister for Health and Children became a token presence in the House because she and her Department seemed irrelevant to the day-to-day running of the health service. It was almost as if the health service train had been hijacked and she, like us, was one of its scared passengers. This is not just backbench blues talking; it was also the considered opinion of many external reports, including an OECD report in 2008 and the Ruane report of 2010.

The Health Service Executive (Governance) Bill 2012 is the first of many steps in putting the train back on the tracks. Like many Oireachtas Members, I used to dread the lack of any answers on the running of our health service during the Ahern and Cowen Administrations. We politicians and our constituents became all too used to the stock reply from the Minister that the matter raised was a matter for the HSE and the query had been forwarded to its headquarters in Naas. While nobody expects a Minister to be involved in every decision made in a multi-billion euro health service, they should at least be able to source the relevant answers for this Parliament whose Members vote through some €13 billion for health each year. I am hopeful this new Bill will increase the accountability of the HSE to the Minister and, through him, to this House.

I recently heard Deputy Martin on the radio talking about all he had done when he was Minister for Health and Children. He did not do much, in my opinion, apart from increasing the budget from €3 billion to €15 billion and doubling the numbers working in the health service, although not the outputs or services. It was not the people's fault but the system's. Deputy Martin brought in the HSE for him and his Government to hide behind. He and his successors would not answer basic questions in this House on simple matters concerning the health services.

I note in the Bill the establishment of an audit committee which will advise the new director general on financial matters. This committee will report in writing to the director general and to the Minister. I feel, considering the role of this House in voting through 27% of total current expenditure per year to the health service, that it deserves to see, review and debate this advice also. At the very least, its health committee or the Committee of Public Accounts should do so.

As someone who has called in this House for the focus of our health care system to move away from personal health crisis management and towards proactive care of good health that already exists, I note with interest the creation of a new national directorate on health and well-being, as indicated by the Minister, Deputy Reilly, on Second Stage in the Seanad last September. I hope this signals a greater emphasis on health promotion and general health screening. With our still growing but also aging population, this has the potential to save us many billions of euro in the future.

Mental health has often been described as the Cinderella of the health service. It is right and proper that it should receive a full national directorate also, as indicated by the Minister, Deputy Reilly, on Second Stage in the Seanad last September. Mental and physical health are essentially two sides of the one coin. We cannot have one without the other. With the recent death of our own colleague, Deputy Shane McEntee, and other tragic deaths across the country, we must redouble our efforts in suicide prevention. As my party colleague Deputy Neville often reminds us, we achieved a reduction in road deaths over the past decade, and we must now do the same for suicide.

The Minister for Health, Deputy Reilly, is a man with a vision who is on a mission. Universal health insurance is the destination to which he wants to take us. He wants to create a system in which money will follow the patient and excellence will be rewarded. It is a system that will allow smaller hospitals, such as my own local hospital in Navan, to find their niches and thrive. I welcome the significant investment in Our Lady's Hospital, Navan, in spite of much negative publicity. The money-follows-the-patient concept has worked very well for the orthopaedic unit there, proving it can be a major success.

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