John Paul Phelan (Carlow-Kilkenny, Fine Gael) | Oireachtas source

I support the Health Service Executive (Financial Matters) Bill 2013. It is an awkwardly named Bill in the sense that it is really another step in the reform of the health service that will ultimately see the dismantling of the HSE. We are sometimes in the habit of naming legislation in a way that does not reflect its intent. I acknowledge there may be reasons for doing so.

Without going over the ground covered by previous speakers, the system of health service provision has been greatly transformed in the past 50 years. It moved from a system of county provision in which there were county and city health committees to a regionalised structure under the old health boards to the decision in 2004 of a previous Government to introduce the HSE and now to the decision last year by the Government and Ministers in the Department of Health to consider the provision of acute services based on the hospital network system mentioned by Deputy Fitzpatrick. It probably marks a return of acute services to a regionally based system.

The creation of the HSE by the then Minister and current Leader of the Opposition, Deputy Micheál Martin, promised much in terms of reform and the savings that could be made with regard to services that might have been duplicated under the old regional health board system. However, the system has not worked. The two parties in gvernment prior to the general election and in the programme for Government committed to a complete overhaul of the way health services were delivered. Last year's announcement on the hospital networks was part of that and this legislation which will see the Vote for the HSE being replaced by a Vote for the Department of Health is another significant step in the desperately needed reform of the health service.

One of the difficulties that emerged when the HSE was established was that it created a system that was so centralised that local decisions which had previously been and should be made on a regional basis could no longer be made at that level. I have always been a believer in empowering local democracy on different levels and believe that while the old health board system had many flaws and required reform, the fact that there was somebody in each region who was directly responsible and accountable for his or her region in terms of the service provided offered a level of accountability which the HSE never achieved. From its initiation, it was bound up in a level of bureaucracy that had gone mad. For that reason, this legislation which provides for the health service to be funded directly from the Vote for the Department of Health from January 2015 is a welcome initiative. The HSE has never properly functioned as an organisation. That is not to say there are not many incredibly excellent public servants working in it, be they on the front line or in administration. In many instances, the administrators had their hands tied under the system operated by the HSE and were unable to make the decisions they should have been empowered to make.

This legislation is another step in reforming the way the health service is delivered and, ultimately, in moving towards a universal health insurance system, an important development in which hospitals and acute services will be funded on the basis of the number of patients they treat rather than through the historical construction of budgets, as the system largely has been heretofore. For that reason, I welcome the legislation.

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