Liam Twomey (Wexford, Fine Gael) | Oireachtas source

I was a Member when the HSE was established and, at the time, we had high hopes for what it might achieve. Unfortunately, the former Minister for Health and Children, Mary Harney, did not have great clarity of purpose as to what she wanted the HSE to achieve. The HSE ran into several problems in subsequent years which the then Minister was able to deal with by increasing the budget by €1 billion a year. However, she never dealt with the basic problems.

As a general practitioner and having worked with people in the HSE, I know there is no lack of commitment and drive at every level. This legislation will be the start of the changes we have proposed to make in the HSE. However, I am under no illusion as to what could go wrong with this and that there will be people who will try to obstruct what we are trying to do in the health service.

This legislation adds to the picture by making the health services responsible to the Houses of the Oireachtas again, which is important.

Another important aspect of the legislation is the statutory audit committee. I am a member of the Joint Committee on Finance, Public Expenditure and Reform. Recently, we wrote to the Minister for Finance, Deputy Noonan, and the Minister for Public Expenditure and Reform, Deputy Howlin, with regard to ensuring that the way we in the Houses of the Oireachtas legislated for spending was realised. All too often we make a reduction to a Vote or we direct that certain services should be reduced in health or education, but the directions are not carried out and cuts are made to some other service without the approval of the Minister or these Houses. This ends up with the public believing we are heartless and uncaring because of the cuts made by the HSE. There is a need for strengthening to an even greater extent what is planned under this legislation and the way in which the money the House has voted for is spent to ensure that if reductions are to be made in administrative sections of the HSE, then that is where the reductions will be made, rather than cuts to home help or carers.

The Minister has acknowledged that this is the first step in a range of changes that will take place within the HSE. It is important that this debate is widened as much as possible because there is an absolute need for clarity with regard to what we do with the HSE. Thus far, it is crystal clear that the HSE is an organisation for the delivery of health services. If we are to change the overall mission statement of the HSE, it is important that we clearly outline what those changes will be. At issue is the administration of €15 billion which we spend on health services.

Often we hear from contributors who are keen to get a soundbite. It is easy to demonise the HSE as a faceless organisation, but there are many aspects of the organisation that work well and many aspects that do not work well. For the ordinary man or woman on the street the major issues include what will happen to small hospitals, hospital groups and primary care, how to integrate the HSE with the work of general practitioners, how to genuinely look after patients in the community, how to deal with chronic care and how to set up all the associated structures. All of these questions are vital. These are the tangible questions that patients in the community understand. How to pull all of this together is relevant for the administration of the health service and how we deal with it in future.

It is not possible within ten minutes to go through everything, because we must untangle some of the remarkably inefficient reforms made during the history of the HSE. The HSE is not all bad. In the beginning, because of the way the organisation was thrown together, staff did not really understand their function, and there was poor leadership coming through many levels of the organisation. This gave the sense that the whole organisation was chaotic. However, I have found that a corporate structure has begun to evolve within the HSE such as one would expect of any organisation. It is important that we keep the best parts of what has been evolving and get rid of the worst parts. There is still too much management. Many management structures were created not only within the HSE as an administrative organisation but also within hospitals and at primary care level. Many management structures were set up almost to provide a career pathway, mar dhea, for people involved in the services rather than actually providing efficient management of our health services. It will be difficult to unpick many of these superfluous layers of administration and management during the coming years without affecting front-line services, and it will require remarkable clarity of purpose not only from the Minister but from everyone who provides health services or who is involved in or has an interest in health services in the country. No one is under any illusion about how difficult this will be.

I call on the Minister to clearly state, as far as he can, what is going on. A constantly changing structure without any clear plan relating to what is going on will increase the confusion and fear and this does not get people to buy into what is going on. That is what happened during the establishment of the HSE. Communication will remain vital. We must clearly outline to people what changes are coming about in the health services. Given the reductions in pay for those who work in the health services, the expected efficiencies and the reduction in staff numbers, there is, no doubt, reduced morale within the health services. There is a need to communicate at every level with people in the health services to keep people on board and working with us for the betterment of the patients we are looking after.

It is important that not only those who are delivering health services but those who will benefit from any changes to health services are fully aware of the changes we are bringing about, and we must communicate fully with them. This will be a difficult task in the coming years. The HSE, as it was first established, went through a remarkable number of rapid changes. I recall when Professor Drumm was in charge. At the time the HSE published changes to the management structures and the various pillars it used to deliver health services in the country. The executive changed the structure so often that when we sought information from staff in Professor Drumm's office in Naas, they often provided us with an old structure which was out of date. The people there were so confused about what was taking place that they gave out-of-date information about their own organisation. Such rapid change and messing around with the system reached the point at which I could see the stagnation present at the lower, county level. People were becoming afraid to make decisions and were unsure about the type of decision they could make, which had a negative impact on health services at the time.

This legislation will make the HSE accountable to the people again, which is important. The changes include the setting up of a statutory audit committee, which must be robust to keep the checks and balances in place with regard to how taxpayers' money is spent in the health services. We need to communicate in a crystal clear way to everyone who requires health services and everyone who works in health services about the next steps we must take with the HSE, not only with regard to the gross administration but also with regard to everything else, including small hospitals, hospital groups and primary care. I wish the Minister the best of luck in this regard because it is a remarkably difficult task.

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