Róisín Shortall (Dublin North West, Independent) | Oireachtas source

I am glad to have an opportunity to speak on the legislation. One must ask what the purpose of the Bill is because it is not clear. While there has been a lot of talk about different aspects of the health service in press statements and in some of the contributions to the debate in the House last night and today, it has not specifically been about the Bill. It is important to ask why the Bill is before us today.

There has been a lot of talk about the manner in which the HSE organises its services. I certainly do not carry a flame for the HSE and am very conscious of its shortcomings as an organisation and the flawed structure it has been. From the very start, it was clear that the body was established by people with very little understanding of how the health service worked and what its needs were. We have a huge, amorphous body with no clear lines of responsibility, no clear demarcation between service areas and a lack of transparency in its functions and as to how funding is handled. One often gets the impression that the HSE is a kind of black hole into which money disappears.

It is very difficult to get hard information on the numbers of staff employed in different parts of the service and where exactly the funding is going. There is no doubt about the need to reform the administration of the HSE and to put in place separate directorates. While there are flaws and dangers in creating the directorates, they are necessary. There is also a need for greater clarity as to the different aspects of the HSE. Like most Members, I am concerned about that issue.

Legislation is not necessary to improve the organisation of the HSE. Deputy Liam Twomey made very sound points which displayed a very good understanding of the health service. All of the things he referred to could have been done by now and can be done at any stage without legislation. They concern good administration and the operational and service structures within the HSE. We should be doing those things to make the HSE much more responsive to the needs of citizens and patients.

As an organisation, the HSE has two elements. It has an operational structure and a governance structure. The governance structure is the legal basis on which the organisation spends money, employs people and provides services. It is of critical importance that the HSE's governance structure is soundly based. It must be borne in mind that the HSE is the premier public body in the State. It is responsible for a budget which is larger than the combined budgets of several other Departments. It employs approximately 100,000 people and has a budget of €13 billion. It is the major public body which is why it is critical that its corporate governance structure is a proper one which adopts good practice and, from a legal perspective, is soundly based.

It is normally the case that a public body has a chief executive and senior management team and, separately, to ensure the proper checks and balances are in place, an independent board which oversees its operations. This is the general corporate governance structure to which we are used and which is in place in most public bodies. This structure keeps the operation of a public body at arm's length from the political system which is very important to ensure we do not have political interference. It provides an assurance that there is a certain level of accountability and transparency in an organisation.

There is a serious corporate governance problem in the HSE as it is. The problem has arisen owing to the actions of the Minister for Health, Deputy James Reilly, at an early stage in his ministerial career.

We remember what happened on 28 April 2011. Where there are serious problems in the health service, a Minister will naturally look to blame somebody for those shortcomings. The difficulties in the HSE make it very easy to blame it for everything and use it as some kind of whipping boy. We remember the spectacle of the Minister marching down to the HSE in April 2011 and demanding the resignation of the board. He sacked the board, an act that could be regarded as a media stunt. He never explained why he sacked the board, which was made up of very public and well-known people who were of good standing. We are still waiting for an explanation as to why he sacked the board. That then caused the problem whereby we had a major public body with no board. The Minister had to appoint an interim board, which was a very strange board made up of seven senior people from the Department and four senior managers from the HSE. The HSE needs a proper governance structure but it was denied this because of the actions of the Minister. The HSE needs an independent board but to turn around and appoint one now would be an admission of the folly in which the Minister engaged in April 2011. In many respects, this legislation is a face-saving exercise for the Minister. This gets to the heart of what this legislation is about. It is not about reorganising the HSE or making it more responsive. It is about putting in place a corporate governance structure which the HSE does not have as a result of the Minister's action.

What is being proposed in this legislation is that instead of a board, which most public bodies would have, the HSE is to have a directorate. This directorate will be made up of the director general and between two and six directors who will be appointed by the Minister. The director general is to be recruited in accordance with the Public Service Management Act, which is standard. It is also important to highlight the fact that the first director general can be appointed by the Minister and, of course, that is what has happened. The Minister has appointed a director general designate in advance of this legislation. I want to be clear that the point I will make in respect of that is no reflection on the present incumbent but relates to the procedures followed in this regard and the procedures provided for in this legislation.

It is important to cast our minds back to how this situation arose and recall that on 18 July 2012 the Minister published this legislation. Section 7 proposes to insert Part 3A into the Health Act 2004. Section 16C(4) of Part 3A allows the Minister to appoint the first director general without regard to the normal recruitment procedures. There was understandable criticism of this provision when the Minister published the legislation in July. What has been given far less attention is the fact that the Minister, in seeking the approval of his Cabinet colleagues on 17 July 2012, sought and received approval for this power while withholding from them the fact that the incumbent chief executive of the HSE, Cathal Magee, had already tendered his resignation. Allowing a Minister to appoint his own man to one of the most senior public offices in the country is wrong to begin with. Allowing the Minister to provide for this in law when he failed to reveal news that was material to the content of the Bill he was presenting to his Cabinet colleagues is highly questionable. It should never have been allowed to happen and sets a very dangerous precedent. Of course, a pattern has been developing. Many of the senior people appointed by the Minister have been appointed without open competition. That applies to very senior people who were brought in under quite unorthodox employment arrangements to take up very highly paid posts and indeed other posts were created. Three new posts are provided for in this legislation where there is no clarity about the recruitment process. Again, this is a very dangerous and unhealthy system to allow from a corporate governance perspective. It is simply not following proper procedures.

The new governance raises significant concerns. We have a director general and directors and the number of directors depends on the whim of the Minister who can appoint between two and six directors. In respect of the corporate governance structure of our premier public body, we do not know how many directors will be appointed. The legislation provides for two, three, four, five or six in addition to the director general. All of those people are appointed by the Minister. The only real stipulation in this legislation regarding the appointment of the directors is that they will be drawn from the pool of national directors within the HSE. These are the people who are responsible as national directors for service provision. Those five posts have yet to be filled. Obviously, that provision has implications for the existing national directors with which I will deal.

Under this legislation, the Minister will appoint the directors. Therefore, we will have a new governance structure within the HSE and the composition of that directorate will be a director general and directors, all of whom are appointed by the Minister. I have a serious concern about this structure in respect of the circularity of the corporate governance involved, which is highly questionable. With a normal governance structure, the management team reports to the CEO and the CEO reports to the board. In the very unusual arrangement regarding the governance of the HSE, the director general is answerable to the directors in the boardroom of the HSE but when they go outside the board room, the accountability is reversed because the appointed directors are part of a management team and are answerable to their director general. It is absolutely unworkable because it is one way inside the boardroom and the reverse outside it. It is not only unworkable but unacceptable and highly unorthodox. We are told that this is only a temporary arrangement. We are talking about a significant upheaval in the governance structure and what has been said about reorganising the way in which the services are operated. Deputy Liam Twomey outlined very clearly the significant problems caused in the transition from the old health boards to the new HSE. In any major change like that in an organisation, one is talking about a four to five-year period before the thing is bedded down. The Minister is proposing to introduce major change and upheaval in the HSE and for what? For one year? When he published the Bill, he also published a number of diagrams, including this extraordinary diagram which is the timeline for the abolition of the HSE. It shows this arrow jumping from the end of 2012 to 2014 when the HSE will be abolished. Over next year the Minister is proposing to have all of this significant change take place within the HSE in order for it to be abolished at the end of that process.

Does anybody in the Cabinet or on the Government backbenches know what will happen to the health service in 2014? What will be the delivery structure if the HSE is being abolished? It is easy to say the HSE should be abolished; we all know serious problems have arisen with it, but it is difficult to build a meaningful structure to replace it.

A pattern is developing whereby in the absence of a clear vision for the health service or the structures that could deliver a responsive and fairer health system, there is scapegoating of the people working in the service. The Minister decided to abolish the board and replace it with this strange directorate. Then he sacked the CEO and put his own man in the post. Now he is proposing to abolish the HSE next year, followed by what? My real fear is that the experimentation in which the Minister is engaging in the absence of a clear roadmap for the coming few years will, in effect, dismantle the health service as we know it without providing clarity on what is to replace it. I am concerned that he is engaging in an exercise which will completely dismantle the public health service and send it into free fall.

How are primary care and hospital services to be delivered? How are the hospital groups to be constituted? Will a paid board be appointed for each of them? How will we deliver primary care services if the HSE is abolished? How are public health nurses going to function? They are the mainstay of the health service, performing the critical functions of looking after older people, supporting families and providing vaccination services. They are on the front line of the health service. Who is going to employ public health nurses or the 100,000 health workers in 2014 after the Minister abolishes the HSE? We do not have the answer to any of these questions and I firmly believe the Minister does not have the answers either.

The second purpose of the legislation is to give the Minister direct control over the operations of the health service. His role will no longer be specifically confined to policy direction but will include operational matters. This might be acceptable if the Minister's directions were to relate to principles such as setting out citizens' rights to health services or criteria for prioritising the provision of health services. We know from bitter experience, however, that neither the Minister nor his Cabinet colleagues operate on the basis of transparency and prioritisation when it comes to health spending. From a funding point of view, the €13 billion Vote for the HSE will transfer to the Department of Health next year and the HSE will no longer be answerable for that money. The Minister will have complete control over the health service and its €13 billion budget. There will be no checks and balances in ensuring proper procedures and good governance arrangements.

I oppose the Bill because, whatever about transferring powers when the Minister and the Cabinet display sound judgment and prioritise the patient in health spending, in current circumstances it would be the height of folly and highly irresponsible for the House to give these wide-ranging and unfettered powers to a Minister whose track record already concerns many of us.

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