Peter Fitzpatrick (Louth, Fine Gael) | Oireachtas source

The programme for Government commits to the eventual dissolution of the HSE as the health care reform programme advances. It will be replaced with a system of directorates headed by a director general. The directorate structure is intended to be an internal measure pending the ultimate dissolution of the HSE which will require further legislation. The Bill is, therefore, intended as a transitional measure designed to prepare the health system for the changes ahead, while also making the HSE more directly accountable to the Minister for Health who, in turn, will be accountable to the people through the Oireachtas.

The Bill does not change the legal status of the HSE under the Health Act 2004. It amends the Act by abolishing the current board of the HSE and replacing it with a directorate structure comprising a director general and other directorates. 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, including the director general who will automatically be a member and the chairperson of the directorate.

Under the Bill, the directorate will have the authority to perform HSE functions. However, the Bill does not provide the details of the administrative structure of the directorates such as how particular service areas ought to be assigned among the directorates. The HSE will continue to have operational responsibility for running the health service. The broad structure of accountability is built on existing provisions in the Health Act 2004, but the Bill contains provisions which will extend the Minister's powers to direct policy and clarify parts of accountability. In particular, the director general should account to the Minister and the Secretary General of the Department of Health. The Minister may issue written directions to the HSE about policy implementation if he believes insufficient regard has been paid to a policy objective. These directions may not relate to individual service users. However, the director must inform the Minister about what measures have been taken to comply with ministerial directions on policy implementation.

The Minister can specify priorities which the HSE must take into account when preparing or amending a services plan. The Bill provides for the establishment of an audit committee which will advise on financial matters and report at least annually to the director general and the Minister.

Health care in Ireland accounts for 27% of total government current expenditure. After social protection, it is the largest spending programme. The HSE's expenditure for 2011 was €13.588 billion, of which 37% was spent on hospital services and 34% on community services. At the end of 2011 it employed 104,392 whole-time equivalent staff, a reduction of 3.3% compared to the end of 2010. Of these staff, 46.7% worked in hospitals and 47.6% were in community settings. More than 75% of the population, or 3.4 million people, availed of services through 425 primary care teams. Some 1.694 million people were covered by medical cards, representing a net increase of 78,254 people since December 2010. Over 370,000 emergency admissions were made to acute hospitals over the year, which was 3,000 more than during the previous year.

The programme for Government commits to a programme of health reform aimed at achieving a single tier health care system based on universal health insurance. As part of the reform process, the Health Service Executive will cease to exist and its functions will return to the Minister or be taken over by the universal health insurance system. In December 2011, Government approval was given for drafting this Bill as part of the reform process culminating in universal health insurance. Provision is made 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 relating to the functions of the latter. These are transitional provisions pending the establishment of the child and family support agency and the transfer of certain HSE functions to that agency. The legal status of the HSE under the Health Act 2004 does not change under the Bill and HSE employees will remain the employees of the HSE.

See this speech in context