Terence Flanagan (Dublin North East, Independent) | Oireachtas source

Like previous speakers across the House I very much welcome this Bill. Any move by the Minister to reform the health system is welcome, particularly the inclusion in this Bill of the establishment of a new financial governance system for the HSE. The HSE has had some bad press since it was established but particularly over the last number of years. Politicians and the public have been crying out for more accountability and transparency to be included in its remit. I am glad this Bill will ensure that and that the Minister will ultimately be responsible and accountable for its actions.

Under the terms of this Bill spending will be determined by the Minister with, I hope, more input from elected representatives regarding areas where the money is needed. I trust that the Minister will take on board problems that constituents have highlighted with their elected representatives when finalising the health budget in future. The HSE is a separate entity and it is sometimes difficult to communicate with it and put one's points across, including so many negative experiences people have had with it. I welcome that the Minister will have more responsibility for finalising the health budget and a more hands-on approach to health service matters in general.

The Bill is an interim measure towards the dissolution of the HSE, the transfer of its functions to other bodies and the provision of universal health insurance for all citizens. It is hoped the HSE will cease to exist over time. Perhaps the Minister might comment as to whether a date is set for the HSE to cease to exist and for the functions to transfer to the Minister for Health or to the universal health insurance system. The most important point to note with this Bill is that it ultimately seeks to ensure that there is more value for money for the taxpayer from our health service. Like others I was shocked to see that the estimate for pension lump sum payments for HSE administration staff this year is €72 million. That is a lot of money. Could the Minister comment on the situation underpinning that amount of money?

The HSE was established in 2005 under the Health Act 2004. It was hoped that the new service would clearly differentiate between the responsibilities of the Department of Health and the HSE, with the Department of Health responsible for the management of services. The goal at the time was that the new HSE service would put patients first and get clear value and results for the money spent. There has been much overlap between both areas and duplication as well as issues falling between the HSE and the Department of Health not accepting full responsibility for various issues I and other Members have raised over that period. Parliamentary questions are answered when they are put to the Minister for Health but if they are put to the HSE it is a much longer process, sometimes taking up to 15 working days, over three weeks, to get answers, if one is lucky enough to get answers. No doubt that will change with this Bill.

There have been problems and it is important that the goal of putting patients first is fully realised. It is a mantra the Minister has used in the past and the idea is that, ultimately, the money will follow the patient and the patient will get the best service possible. We know that, sadly, that has not always been the case. One of the main aims of the HSE was to ensure that patients were put first in the design and management of health services. The patient is often not put first in the HSE and it is vitally important that we move towards more patient-centred care. The taxpayer pays a substantial level of tax, much of which is allocated to the HSE to fund the health service, but they often do not receive a satisfactory level of service.

I welcome the Minister to the House and thank him for his presence. Various constituents of mine have raised a number of issues regarding the health service, particularly the accident and emergency department in Beaumont Hospital and the inefficiencies in the primary care reimbursement service, PCRS, medical card application system.

We all seek to help our constituents in obtaining medical cards when they fit the criteria. Recently, a case was brought to my attention by a constituent who was dealing with the PCRS in Finglas who was told on three occasions that the application was not received. It was only when the application was sent by registered post that it acknowledged that the information had been received and the constituent was issued with a full medical card within a week. That was a turnaround in the end. This case shows there are substantial problems with the system in place to deal with medical card applications. There appears to be a lack of communication between departments to notify the system when an application is received. In this case the application had been received and signed for but, for some reason, had not been added to the computer system. Obviously, a better-quality integrated system is necessary in this case. That an inadequate infrastructure was in place undermines the whole process and the public's confidence in the health system, particularly the processing of medical card applications. Once received in the various departments, documents should be scanned and the information added to constituent's files within the system in order that it can be easy retrieved at a future date.

The accident and emergency unit at Beaumont Hospital is under extreme pressure, as Deputy Seán Kenny is aware. One in three patients has been admitted since the start of 2014, in comparison with one in five prior to that time. I am glad to hear that six additional nurses have been appointed to Beaumont Hospital to improve processing and help patients, but I want to hear what further plans the Minister has to improve the accident and emergency unit. I appreciate that the special delivery unit is doing good work. However, there appears to be some ongoing niggling issues in regard to the accident and emergency unit and the length of time people have to wait to get an adequate service. One of the criticisms is that the level of service is not the same as it used to be and, obviously, there is greater pressure on the Minister, given the reduced budget, to deal with some of these problems.

Following an operation and discharge from hospital, less support is available to patients. An element of extra help could be provided to patients to help them rehabilitate. One of the recent scandals was that of top-up payments at the Central Remedial Clinic. Why was that issue not considered in the Bill to ensure that individual agencies were not allowed pay salaries above and beyond the health sector pay policy? When the HSE is dissolved and changes have been made, we hope this type of scandal will never recur. Hospitals must become more transparent in respect of the salaries paid to their staff. I would welcome a comment from the Minister on that issue. The heartbreaking aspect of the top-up payments at the Central Remedial Clinic is that it is the patients and those at the receiving end of its services who are suffering. The CRC's image and reputation have been damaged and people are no longer donating as much as they did previously. That was obvious in the CRC Santa Bear appeal. Fund-raisers and donators feel cheated by the scandal and it is important that confidence is restored to the sector. I call on any directors who received moneys to examine their conscience and return that money so as to improve the image of the CRC and restore confidence to the organisation.

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