Áine Collins (Cork North West, Fine Gael) | Oireachtas source

When the Health Service Executive was established in January 2005 it replaced the existing ten health boards. At the time the health boards were regarded as problematic from a governance perspective. To a certain extent this view was correct. Ten different systems without any co-ordination were obviously going to be ineffective.

Also, as technology developed, systems had to develop. The exchange of information and shared services would become central to the management and running of any organisation, particularly a complex and evolving organisation such as the health service.

I believe there were political motivations at the time in putting the health service at arm's length from the then Minister. The establishment of the Health Service Executive gave the impression that there would be a division of responsibility for policy and management. Responsibility for policy remained with the Minister and the Department, while responsibility for its implementation and management transferred to the HSE. The changes meant that the then Minister was no longer directly responsible to the House for the day to day running of the health service. There is no doubt that despite the apparent affluence of the economy in 2005, the health service was in crisis. Unfortunately, the establishment of the HSE was ill-conceived and it was badly set up. That led to a deepening of the heath crisis which became more acute as the financial crisis worsened.

As part of the programme for Government, the Minister committed to a health reform programme. The goal is to have a universal, single-tier health service based on universal health insurance. As part of this process, the HSE is to be abolished and its functions will return to the Minister for Health where they rightly belong. The Minister and the Government should be accountable to the House for the functioning of the health service. This legislation is part of that reform. It provides for the funding of the HSE and its successor through the Vote for the office of the Minister for Health from the start of next year. The HSE will be abolished and a new and robust financial governance structure introduced. The main features of the Bill are to provide for the dissolution of the Vote for the HSE; the funding of the HSE through the Vote for the office of the Minister from January 2015; the establishment of a new financial governance structure for the HSE; giving the Minister powers to set a net budget for the HSE and approve gross income and expenditure plans; and imposing certain legal obligations on the director general to ensure the HSE executive operates within the financial limits imposed by the Minister.

As the Minister pointed out, this legislation will enable new funding arrangements to be put in place as part of a wider restructuring of the health service and the ultimate implementation of a universal health insurance system. In that regard, I will make a point that arose at a recent meeting of the Committee of Public Accounts. Representatives of the health service were before the committee and stated they had 15 certified chartered accountants engaged in the HSE. One example of a reform not having been introduced is that one cannot get details of any hospital budget at the touch of a button, which is unimaginable today, without the necessity of having people involved in reforming them, reanalysing them and so on. Deputy James Reilly is a reforming Minister, but the pace of reform is not as fast as he or the general public would wish. Reform and change are difficult at any time but particularly difficult in poor economic times. Despite this, however, fundamental reforms, changes and better results are being achieved every day with fewer resources. I commend the Bill to the House.

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