Finian McGrath (Dublin North Central, Independent) | Oireachtas source

I welcome the Bill and the opportunity to speak about it. We must move forward with the reform agenda, by which I mean meaningful reform and change, transparency, accountability and, above all, a health service that works for its patients and service users in general. We must also be conscious of staff issues and the staff's role in creating a valuable health service that works for and in the interests of people, particularly patients. This debate and reform should be about trying to get the best practice for patients and service users and encouraging and developing best practice and professionalism among the staff who work in the health service. One regularly hears complaints about the health service, but many good quality people work in it, both on the front line and in administration sections. Yes, they have many problems and there are huge demands, but we must accept that many of them are working against the odds. We should accept that in this debate and within the legislation.

The Health Service Executive (Financial Matters) Bill has been designed to disestablish the HSE Vote, with funding for the service to come from the Vote for the Department of Health, and to establish a statutory financial governance framework for the HSE. It is also part of a series of legislative measures designed to provide for the dissolution of the HSE and reform of the health system. Again, the emphasis must be on reform. Before the last general election, candidates who called to people's doors were told that they had to reform and change the system. The big issues, of course, were jobs, the economy and banking but third or fourth on the list of concerns were the health service and the education sector. People want us to do something about these issues and the Bill is part of that process. I have concerns about aspects of it, but, in good faith, I consider the broader thrust to be positive. We must stop shilly-shallying and talking about reform and get on with the job.

With providing for the disestablishment of the HSE Vote, the Bill establishes a new financial governance structure for that body, which I welcome. It gives the Minister the power to set a net budget for the HSE and approve, as part of the service plan, the executive's gross income and expenditure plan. It also reintroduces the first charge principle, whereby if the HSE exceeds its budget in a year, it must discharge the liabilities arising as a first charge in the following year.

Also, the Bill imposes certain legal obligations on the director general of the HSE to ensure the executive operates within the financial limits imposed by the Minister. One must be concerned about this provision. We must emphasise that when dealing with the health service, one is dealing with a service for sick people, people with a disability and people in need. It is not necessarily a private company. That is very important. Sometimes one hears people say a business person could run the health service in such and such a way. The focus of health and education services is on providing a health service for patients and an education service for pupils, respectively. That is a key difference from a private business. For that reason, I strongly support some of the reforms being made by the Government. It might surprise the Minister, but if I, as an Independent Deputy, see sensible proposals from any quarter, I will always support them.

Those are the core issues in the legislation. When discussing patients, we must focus on best practice. One hears much talk about accident and emergency departments, waiting lists and patients on trolleys. There are still major problems in that regard. The Minister of State, Deputy Alex White, and the Minister, Deputy James Reilly, regularly produce figures to show that this or that has been reduced, but the bottom line is that if one goes to Beaumont hospital in my constituency tomorrow morning, one will see patients on trolleys. That is also the case in Galway hospital. I was in that hospital recently to visit a relation and saw the chaos there. That is the reality, with which we must deal also. Irrespective of what the situation we face is, be it an influenza epidemic or a bad weather event, we must have a proper plan.

It always fascinates me that countries with fewer resources than this country can have a top quality health service. A couple of years ago I visited Cuba when I visited the hospitals in Havana and the centres for people with disabilities. This is a country that has been hammered by the bullies in the USA through embargoes and blockades, yet it has quality front-line services.

I met young and student doctors who, as part of their training, went up into the mountains during the summer holidays to work with families and on maternity-related issues. If a country has a good health service, we should not be afraid to consider it. We should not run away from it and be bowled over by the politically correct right-wing view in this country about all of the negative things in certain countries. The reality is that Cuba has an excellent health service, against the odds given its resources. We must be brave enough to examine its system. I would love to see the Minister of State and the Minister go there to see examples of best practice.

I was fascinated to note the policy in Cuba on children with disabilities, in particular intellectual disabilities, from the cradle to the grave. The day a child is born in Havana or any part of Cuba he or she has a service until the day he or she dies. That is the vision and leadership I would like to see. It might not be politically correct to say it, but if something works, we should not be afraid to consider it. The same is true of other countries in the European Union that have examples of good practice. We should not run away from them, rather we should look closely at them.

I mentioned services for people with disabilities which are an important part of my election platform. We have a Minister of State with responsibility for people with disabilities, but I would love to see the appointment of a senior Minister with dedicated responsibility for disabilities inclusion. I would also like to see the prioritisation of the funding for disability services in line with the pre-election commitments given by the Government. In addition, I would like to see implementation of agreed measures, targets and timelines. That is the sensible approach I wish to promote. We need something fresh and new. Let us not run away from issues; let us get on with addressing them. For those who say it is a minority issue, I remind the Minister that there are 595,335 people with disabilities in Ireland, representing 13% of the population. They deserve a senior Ministry. That is something which should be considered when changes are made next year or whenever they are made.

We must consider front-line services which have seen a massive cut in recent years. Funding has been reduced by €159.1 million, which represents a 9.4% reduction in spending at a time when the need for services is increasing. Meanwhile, people in receipt of disability allowance have endured cuts of almost 8%, resulting in the loss of more than €847 in their annual income. There have been substantial changes to essential services and supports such as adjustments to medical card eligibility; a €60 million loss under the housing adaptation grant scheme since 2010; and a 90% or €325 cut to the respite care grant in 2013. The fivefold increase in prescription charges since 2011 has had a significant impact on the everyday lives of people with disabilities.

I raise these issues because they require discussion, in particular in the context of reform. In the context of health service reform, accountability and change, I wish to ensure people with physical and intellectual disabilities are part of the reform agenda, which is most important. I again emphasise the importance of the 595,335 people with disabilities, representing 13% of the population. These figures are based on a census carried out in 2011 and they do not include many other family members and friends who are also affected by a person's disability. I refer to carers, family members and others who are involved in looking after people with disabilities. It is important to refer to such matters openly.

The Bill gives the Minister the power to set a net budget for the HSE and approve as part of the service plan the executive’s gross income and expenditure plan. Under the new Vote arrangements, the HSE will mainly be funded by means of grants made from the Vote for the office of the Minister for Health. That is the standard method of the State to fund statutory bodies. It also reintroduces the first charge principle whereby if the HSE exceeds its budget in one year, it must discharge liabilities arising as a first charge in the following year.

The Bill imposes certain legal obligations on the director general to ensure the HSE operates within the financial limits imposed by the Minister. It provides for a new procedure for the approval of capital plans which are very important. In the context of disability services, it is important that we keep up the work that was started when I raised the issues some years ago of people with cystic fibrosis. The unit is now open in St. Vincent’s University Hospital, but we must keep our eyes focused. There are other needs in Beaumont hospital, as well as in Cork and Limerick. We must ensure the families of those with cystic fibrosis are given the maximum support. They must be part of the service plans and sensible solutions. I urge that such an approach be taken.

Recent scandals emerged in various services in terms of governance and the problems caused. It is important to note that the Bill does not directly address the top-up payments scandal recently reported, for example, in the Central Remedial Clinic, CRC. I was one of those who was very critical of the carry-on at board level in the CRC. It is equally important to state parents and staff on the front line should not be included in the criticism. I received an invitation during the week from the parents of those who use the CRC to attend an event next Friday night. One of the points made in the invitation concerns how shocked and upset they were by the revelations on the governance of the CRC. They were very concerned about the effect it might have on the wonderful professional care the children had always received from the CRC. They were also very concerned about the impact it had on fund-raising. The clean-up has begun. Management levels are being reformed and new people are being appointed to boards. I urge people not to turn their backs on the CRC and other organisations that have stepped up the mark and are doing their best. Bad practice should not be tolerated in the health and disability sector. Equally, we cannot blame everyone for the problem.

To return to the broader thrust of the legislation and the reform agenda, we have all listened in recent years to the criticism of the HSE. Issues raised include the fact that personnel numbers did not reduce on the creation of the HSE, the continuation of separate financial and other structures from the health boards within the HSE, insufficient openness and transparency, a general lack of integration and coherence across the organisation and also criticism about the specifics of the relationship between the HSE and the Department of Health. That is an important issue. Deputy Bernard Durkan likes to remind me of a time when I supported a previous Government.

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