Joe Carey (Clare, Fine Gael) | Oireachtas source

I welcome this opportunity to speak on the Bill. This legislation provides for three elements, the first of which is the abolition of the board structure of the HSE and for a directorate to be the new governing body for the HSE in place of the board, headed by a director general. The second element is further accountability arrangements for the HSE, with the third element being related matters, including a number of technical amendments to take account of the replacement of the board structure by the directorate structure.

The HSE was established in 2005. It is a large organisation providing a broad range of services which are essential to the individuals who are in receipt of them. The programme for Government commits to the abolition of the HSE but the abolition, as the Minister said in his opening statement on Second Stage, will require careful planning, sequencing and complex further legislation. This Bill is an important step on the road to replacing the HSE with a new health governance structure that places the patient at the centre.

When the HSE was set-up by Fianna Fáil it was believed that a centralised health service would perform much better than the previous health board structure. The health boards were much criticised but gave public representatives a meaningful role in holding the health authorities to account. We currently have health regional fora for elected members, which were effectively established as an afterthought. In recent times, fora members have complained about ineffectiveness and the lack of accountability from the HSE. One of the main areas of concern for the public is the amount of administrators within the HSE structure.

The HSE created these positions following the amalgamation of the health boards. Effectively, an increasing number of management positions were created on the establishment of the HSE to the detriment of front-line staff, such as nurses and doctors, and ultimately to the detriment of patients.

The Government has a mandate to reform and reorganise our health services fundamentally in a way that places the patient at the centre. This Bill is an important building block on the way to the introduction of a universal health insurance system where money follows the patient.

The creation of six national directorates is to be welcomed. They will focus on the areas of hospital care, primary care, mental health, child and family care, social care and public health. We need to bring services closer to people so that they can be treated in their own communities. Day care services, for example, are an important component of our health system. In my community, Clarecastle in County Clare, we have a thriving district day care service which serves a catchment area with a ten-mile radius. Fifty people attend the centre daily and they are provided with a broad range of health services and social activities. This community-led day care centre represents exceptional value for money and has dramatically improved the quality of life of those who attend and their families. In a nutshell, the centre enables people to live in their community for longer and to live independently.

The recently published HSE mid-west area service plan for non-acute services, 2013, confirms further enhancements of services at Clarecastle and serves as recognition of the range of competencies, including that of dementia-specific care, with the creation of a new development fund to support these important activities. This is most welcome news. I wish the hard-working board, manager and staff of Clarecastle day care centre well as they further develop the services. I also wish the board and management of the new Carrigoran day care centre in Newmarket-on-Fergus well as it launches its new service. It is a most impressive building that will offer a three-day service to its clients.

I acknowledge the process of change in the mid-west regional hospital network with the creation of a single hospital system incorporating six hospital sites, namely Limerick regional hospital, Ennis General Hospital, Nenagh General Hospital, St. John's Hospital, Limerick, the Mid-Western Regional Maternity Hospital and Croom orthopaedic hospital. The primary focus in 2012 was on strengthening governance in the hospital network. This was achieved through the establishment of clinical directorates and a new model of corporate and clinical governance. Key areas of patient safety concerns were focused on, in addition to achieving efficiency through the creation of a single hospital system in the mid-west region. This approach breaks down traditional barriers and makes it possible to utilise the total capacity of the hospital network in the region, which is leading to progress in the delivery of targets for scheduled and unscheduled care.

I welcome the opening of the new 50-bed ward block at Ennis General Hospital, which is a huge shot in the arm of health service provision in County Clare and the mid-west. In the coming weeks, a new site manager will be appointed at Ennis general hospital following the promotion of former manger Mr. Frank Keane to manager of the new maternity and child health directorate. Ennis has been accredited as a colorectal screening site, and this service is due to commence in the not-too-distant future.

There is ongoing commissioning of the critical care block at Limerick regional hospital with the opening of a state-of-the-art cardiology section backed up with the appointment of five cardiologists. I welcome the commencement of work on the new emergency department at Limerick regional hospital and look forward to its opening in the next 18 months. The mid-west hospital group also received an increase in the funding allocation this year of 10%. That is an increase from €216 million to €238 million. There are still funding challenges but this is certainly a boost.

I welcome this legislation as it is an important step towards achieving the goal of a single-tier health system together with universal health insurance.

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