Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

We are larger in numerical strength but equal in weight of argument.

To be consistent I have to oppose the passage of this Bill in view of the concerns that I have outlined previously. I believe it vests significant power in the office of the Minister and that is not a healthy situation. We can argue over the rights and wrongs of the establishment of the HSE, the amalgamation of the health boards and whether it was done in a way that brought about cost savings. It did not. Nobody was made redundant. I accept that it is the Minister's right and duty to set policy but my concern is that implementation of policy could be decided for political reasons. I know he argues that he wants to be accountable to the Dáil and he wants to make the health services accountable to the Dáil through the office of the Minister. That accountability could remain the case but I have concerns about decisions on the allocation of resources and the delivery of health care because it vests such huge power in him, in terms of his influence over the directorate, that it could politicise the health service. We have had this debate and I do not want to go back over it but we put down a motion of no confidence last year on that specific issue, with regard for example to primary care centres, Wexford Hospital and St. Luke's Hospital in Kilkenny and the prioritisation of funding to these hospitals.

The Minister can argue and can say, with justification, that it is his right to make representations to, or to receive representations from, other Ministers but when resources are scarce the fundamental principle of their being allocated based on need must surely apply and there is no check in this legislation that will guarantee that. That is my concern. I know that the Minister is talking about going through a transformative programme of taking the HSE and establishing hospital groups and moving to universal health insurance and all that flows from that. They are all policy decisions. It is the Minister's right and entitlement and duty to make policy decisions. I may oppose those policy decisions but he has an obligation to make them. At the same time I am very concerned that the delivery of and decisions as to where health care would be resourced and where funding would be allocated would be solely within the gift of the Minister of the day.

We have had difficulties in the past across all hues and colours of political parties in government where resources were concentrated and directed for political gain and advantage. I do not think that is acceptable. Yes, the Minister should be accountable in the Dáil in respect of policy and its delivery but surely there must be some separation so that key decisions with regard to provision of resources and the primary care centres are not made for political reasons. I hate bringing this up again and again but I feel very strongly about it. I did not lightly table a motion of no confidence in the Minister but it was based on the principle that we cannot have a situation in which resources are scarce and other areas may need them and their allocation is decided on for political reasons.

This is public funding and there should be some way of ensuring the policy decisions the Minister outlines are implemented at arm's length when it comes to resourcing, allocation and implementation. For that reason, I have to be consistent and oppose the passage of the Bill. I thank the Minister for listening to our suggestions on Committee Stage, but the principle of vesting overarching power in the hands of the Minister of the day is unacceptable. It will politicise the delivery of health care which will undermine the public’s confidence in believing scarce resources are allocated on need as opposed to political considerations. This is clearly unacceptable. We talk about the dawn of new politics, a democratic revolution and all that will flow from it. This legislation is the exact opposite as it concentrates power, decision-making and influence in the hands of the Minister of the day which will lead to difficulties. Previous Ministers were scourged in the Chamber, accused of passing responsibility for the allocation of health resources to the board of the Health Service Executive. However, during the unseemly time when the allocation of primary health care centres was an issue, we had the Minister with his logarithmic and logistical progressions and his theorems. I still have not received answers on that matter. Accordingly, I have concerns with the actual principle of the Bill which is handing the health service, policy and its implementation to the Minister for Health.

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