Áine Collins (Cork North West, Fine Gael) | Oireachtas source

The way the HSE was set up in the first instance - abolishing the regional health boards and amalgamating them into one huge bureaucratic nightmare - caused serious problems for the health service. As no steps were taken at the time to rationalise management structures and achieve efficiencies in administration, the result has been catastrophic. No savings were made and a monumental organisation was created. Overstaffed from a management and back office point of view, this resulted in a situation where it was very difficult to know who was responsible for what. No investment was made in processes and systems to measure efficiency and effectiveness. It is difficult to manage any organisation, be it public or private, without timely and accurate information. There were particular political reasons for this. The then Minister for Health needed day-to-day management to be at arm's length from the Department of Health. The Minister at the time did not have to take direct responsibility and was not directly responsible to the Oireachtas for the total mismanagement of the health service.

The Government came to power with an ambitious plan for the health service. It involved free GP care for all and a plan to introduce universal health insurance. One of the major obstacles to this plan was the hugely expensive cost of running the HSE and the inefficiencies associated with bringing it into existence in the first place. The Minister made changes to the composition of the board immediately which were designed to facilitate greater co-ordination and integration between senior management teams in the Department of Health and the HSE. At that stage, the Minister committed to introducing legislation to abolish the board structure and establish new governance arrangements for the HSE which would permit its eventual dissolution. Provisions to make these changes are included in the Bill.

The reorganisation of the health service is a significant task, made more so by the fact that previous Ministers for Health did not deal with the problem. They tried to protect themselves from problems that arose in the service by putting in place very complicated and extremely bureaucratic structures. This meant that, legally, the Minister evaded responsibility for being directly accountable to Members of the Houses of the Oireachtas.

The Minister is determined to abolish the HSE in order that he can implement the programme for Government, in particular, achieve the ultimate goal of having an efficient and effective health service. Very few realise the significant task facing him. He must unwind an ineffective system put in place by previous Ministers. This involves significant change management of staff. Retraining of staff needs to take place, which is time consuming and costly. There is no simple solution. For the moment the HSE will be responsible to the directorate headed by the director general. This directorate will be the new Government body in place of the board of the HSE. The Bill provides that the directorate will be accountable to the Minister for the performance of the HSE's functions and its own functions as a governing authority. The Minister will in time be accountable to the Oireachtas.

The Bill is only one step in dismantling the HSE and putting structures and processes in place that will allow the Minister to implement Government policy. It begins the process of returning responsibility for the health service to the Minister and the Oireachtas where it rightly belongs. It will be a long and difficult process, but the Minister is trying very hard to unravel a deliberately complex structure put in place to avoid a situation where anyone would have to take responsibility for their actions. The fact that this must be done in stages shows the complexity of the process. It should be noted at this stage that there are some very good people in management and administration in the HSE. The facts are that previous Ministers failed to face up to the changes that were necessary and did not provide the leadership and investment in new ways of management and technology that were required. The new structure is designed to help to prepare for the next phase of the health reform programme. More importantly, the Bill will make the HSE more accountable to the Minister for Health who, in turn, will be more accountable to the Oireachtas and the people. While the HSE will continue to have operational responsibility for running the health service, the Bill sets out parameters which will lead to a more integrated care system and governance with a clear line of responsibility from the HSE to the Minister.

In his concluding remarks in the Seanad the Minister continued to use statements reflected in the programme for Government, stating the reform programme was about the patient. He also believes these changes will make sure the patient is at the centre of the service and that the health service will be reminded continually about its obligation to serve the patient. Despite the continuing criticism of the health service, it should be noted that, as Senator Colm Burke said in the Seanad, much progress has been made in outpatient care services. The number of appointments has increased from two million to 3.5 million in the past ten years. The number of day case procedures has increased dramatically. These increases have taken place because of the reforms and reorganisation in the HSE that the Minister has already undertaken. As money is extremely important in the current economic environment and the Minister's theme is that the patient comes first, it is essential that the taxpayer also gets value for money.

I wish the Minister the best of luck in this necessary and difficult programme and his endeavours to drive reforms which will lead to measurable outcomes. I have every confidence that owing to the willingness of the many great people who work in the health service, this programme is achievable and commend the Bill to the House.

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