Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I welcome the opportunity to speak on the Health Service Executive (Financial Matters) Bill 2013. I commend the Minister and the Government for continuing on the road to reforming the health service by disestablishing the HSE Vote and bringing it back within the Department of Health. The removal of political responsibility for the health service was one of the biggest mistakes to be made in the health sector in recent years. I know from watching Oireachtas committee proceedings before I was elected to this House that Ministers used to shrug their shoulders and say "nothing to do with me, not my fault, not my responsibility". We do not want that sort of health service.

I do not want to get into the universal health insurance debate other than to say that the sort of health service I want in five or ten years' time is one that treats people on the basis of medical need. The debate on how we can get to that point is an important one. I welcome the fact that the Minister intends to publish a White Paper rather than rushing straight in. It is important to get the timing right and to consult. We are all familiar with terrible cases of people turning up for procedures like colonoscopy only to be told they have to wait for a period of time because they do not have private health insurance. We are aware that a person in the same circumstances who has private health insurance might be rushed straight through the following week. We remember what happened in tragic cases like that of Susie Long when people could not access health care on the basis of medical need but were instead denied it on the basis of their ability to pay for it.

This Bill is the latest building block in reforming the health service. I would like to remind the House of some of the recommendations and findings that were contained in a report on the health service that the Committee of Public Accounts published in March 2013 after it had examined the HSE Vote. Finding No. 3 was that "the financial management infrastructure currently available to the HSE comprises of legacy systems from the old health boards and this infrastructure is no longer fit for purpose". Finding No. 4, strikingly, was that "the HSE is not in a position to identify the number of its former staff who are now employed as agency staff and working in the public health system". Finding No. 9 stated:

Sixteen voluntary hospitals receive approximately €1.9 billion in grants from the HSE annually: Only two of the sixteen hospitals are audited by the C&AG: the remaining 14 hospitals are audited privately thus making their boards and executive unaccountable to the Committee of Public Accounts [and therefore to the taxpayer].

Finding No. 11 stated:

The HSE paid out over €2.6 million in allowances to 31 Hospital Consultants who retired in 2011 in lieu of historic rest days that had been accumulated by the consultants during their careers. A payment of over €175,000 each was made to eight of these Consultants.

We know where we have come from. Now it is about how we can get to a better place.

I want to flag two issues that need to be considered and where progress needs to be made. I appreciate that the Minister is cognisant of these issues. The first of the two issues is the provision of funding for people with disabilities. This country constantly hands block grants to service providers. I accept that many of them provide excellent services. We consistently tell people with disabilities to go off and find an available place and to be happy with whatever place they are lucky enough to find. As long as we continue to allow the health service to run like that, we will be unable to have proper oversight of every single cent of taxpayers' money and, much more importantly, people with disabilities will remain disempowered. We would not tell any other group of citizens in this country "take what you are given, there you go, be glad you have a place".

We need to empower people with disabilities. The money follows the client model must be introduced in the disability sector. If that were to happen - if people with disabilities were given control of their destinies - many of the issues that have been examined at the Committee of Public Accounts and many of the concerns of people with disabilities would be removed. I know there is a commitment in this respect in the programme for Government. I know the Minister, Deputy Reilly, and the Minister of State, Deputy Kathleen Lynch, are committed to it. If we are genuine in what we say about getting a proper grip, in terms of financial control, on the Health Vote, we must take this opportunity to do so. At the same time, we would be doing the right thing by empowering and giving an appropriate level of dignity and quality of life to people with disabilities. We should allow them to choose the services they want, rather than handing them a place and taking control out of their hands.

I want to raise the issue of section 38 organisations.

Between section 38 and section 39 organisations we are paying out more than €3 billion in taxpayers' funds each year. We all know the work the HSE is undertaking in trying to bring section 38 organisations into compliance with public sector pay policy, which I welcome. I also welcome the light that has been shone on a sector that has been in darkness for far too long. All is not well, however, in St. Vincent's Healthcare Group and I am not sure people realise the extent of the problems. The HSE is quite correctly trying to bring that organisation into compliance with public sector pay policy. I commend the job it is doing, and the dogged and determined way in which it is pursuing that. However, if the HSE believes public sector pay policy is the only issue that needs to be addressed in St. Vincent's Healthcare Group, it would be sadly mistaken.

One of the largest hospitals in the country, treating so many patients and receiving so much taxpayers' money each year, cannot even file its accounts on time year after year. The Companies Registration Office has had to take the decision to fine it. If any small business in any of our constituencies was not able to file its accounts on time we know it would be fined and would be disapproved of. We also know companies take that responsibility seriously. In this case the best-paid health administrator in the country cannot even file its accounts on time. It is not just one year; we are now into the second year of it. That usually indicates something is not right. It has been allowed to create a bizarre structure that is not in the interests of the public health service. I challenge anybody to explain to me how it could possibly be in the interests of the public health system.

On 15 January I asked the Minister a parliamentary question seeking to ascertain if the Department of Health ever gave permission for public health facilities at St. Vincent's University Hospital to be mortgaged and used as collateral to build a private commercial entity. The Minister checked his records and clarified that there was neither departmental nor ministerial consent to this. This organisation continued to get hundreds of millions of euro of taxpayers' money every year to run a public health service and yet it mortgaged the whole lot of it to banks to go and build a private hospital. It did not believe it needed to check this with the Minister's predecessor or officials at the Department of Health. It just handed over the public hospital and its lands to a bank to build a private commercial venture. I know the HSE and the Department have made efforts to put safeguards in place for the taxpayer, which I welcome. However, that is neither here nor there. There is a level of arrogance in having a health entity that believes it can take our money and do what it wants.

There is no board for the public hospital at St. Vincent's. There is an amalgamated St. Vincent's Healthcare Group board. People seem to remain on the board forever and a day. I am not clear how people are elected to the board. There is one chief executive for the public and the private hospitals, an issue of which the Department is aware. When people go to a board meeting of St. Vincent's Healthcare Group, which is getting hundreds of millions of euro to run two public hospitals, who is protecting the public health interest? Does the CEO have to step into the room and say he is there to look after the commercial venture and then step back out only to come back in again? It is ridiculous; it is like Lanigan's Ball.

It has been allowed to happen even though previous governments knew of it. The former Minister, Ms Harney, presided over it and it has not been fixed. While I accept we should bring the CEO's inordinately high salary into line with public sector pay policy, let us not stop there. The model is rotten and is not working. The model is not protecting the taxpayer and is not accountable. As far as I can make out the model was not authorised by the Department of Health and yet it has been allowed to continue.

It gets worse. There is a crossover of directors. The four directors of the St. Vincent's Foundation, the fundraising arm of the St. Vincent's Healthcare Group are also directors of the St. Vincent's Healthcare Group. Those raising the money are also making the operating and commercial decisions. I am not making a comparison to the CRC in terms of the activities, but we saw what can happen in extreme examples when those safeguards are not in place and crossover of directorships is permitted. It is bad corporate governance, as confirmed to the Committee of Public Accounts by the HSE director general and Mr. Barry O'Brien of the HSE. Yet it is still happening.

We invited representatives of St. Vincent's Healthcare Group to appear before the committee. They plámásed us and told us we were asking very valid questions; they went off and did nothing about it. They should be instructed to fix that today with none of the nonsense that they gave us, claiming it is very hard to find people to serve on boards. It is not good enough and as long as they are receiving our money to run our public health service, they ought to take our concerns with more urgency than they have shown to date.

The next issue with St. Vincent's Healthcare Group is its unique interpretation of the hard-fought for consultant's contract. It confirmed to Susan Mitchell of The Sunday Business Poston 30 January 2011 that 220 patients had been treated by public hospital consultants in St. Vincent's Private Hospital. Under the terms of their new contract, as the Minister knows well, newly-appointed public hospital consultants - referred to as category B contract consultants - are allowed to use 20% of their practice time to treat private patients in public hospitals. They are not allowed to run off to the nearest private hospital and treat their patients there. St. Vincent's Healthcare Group confirmed to the same journalist on January 2011 that it allowed this to happen and that the chief executive had asked consultants to do this in "special circumstances".

I have been contacted anonymously and by people who are willing to put their name to a letter, informing me that this is making it nearly impossible for other hospitals to compete for consultants because it is much more attractive to work in St Vincent's. Obviously, that is not in the interests of our overall health service. However, worse than that, it is depriving our public health service. This is the problem when public and private structures are allowed to merge with one person wearing two hats. The public hospital is being deprived of the income that would derive from treating the private patient in the public hospital.

I have heard of specific cases and I would be happy to provide the Minister with documentation. A patient was taken into the private hospital, told they needed to go over to go to the public hospital for the procedure. They were checked into the private hospital, saw their consultant and were then sent over to the public hospital. They were told that when they got to the public hospital they should say they had no health insurance. The public hospital carried out the operation to install a medical device, which may have cost more than €10,000, and then the patient was wheeled back to the private hospital for the tea and toast. This sort of scenario, where the public hospital is being used as a convenience to carry out the arduous medical work and then the private hospital is then generating income, is not acceptable, but we know it is happening. The HSE knows it is happening and the Minister's predecessor knew it was happening.

We need to get serious about this. The HSE does not often find itself on the right side of issues in the public mind. I commend the proactive stance it has taken on the section 38 organisations and the comprehensive audit it has carried out. In particular I commend Dr. Geraldine Smith, the HSE auditor, who has appeared before the Committee of Public Accounts on many occasions and talked us through the audit report.

I acknowledge the excellent work being done by so many front-line staff in hospitals within the St. Vincent's Healthcare Group and the excellent level of care patients receive. However, I want this House and the Government I proudly support to send a message to the group that sorting out the CEO's pay situation by the end of March is not the only issue. We need to hear from St. Vincent's Healthcare Group on the consultant's contract - it does not have a special arrangement. We need assurances regarding the mortgaging of public hospitals to pay for private facilities. We need it to introduce new corporate governance structures - not just tokenistic ones, but ones that will really protect the taxpayer and the public health service. It also needs to clearly decouple the public from the private.

Enough is enough at this stage. The St. Vincent's Healthcare Group has dragged its feet. It was the last organisation willing to reveal if it was paying top-ups and did so reluctantly just before Christmas Eve. Its representatives then appeared before the Committee of Public Accounts and, as they appeared on the same day as representative of the Central Remedial Clinic, it may have meant they did not get the same degree of media and public scrutiny that was merited.

I have heard from countless people who have serious concerns. I share their concerns and I believe this needs to be rectified.

On a broader level, the HSE and our health services have outsourced a great of deal of funding in recent years to section 38 and section 39 agencies. We need to have a debate on that also. The reason we have been outsourcing funding to disability groups and public and voluntary hospitals is that as a State we have historically failed to provide those services. While problems have arisen on occasion, one would have to worry how much worse services would have been for people with disabilities and for people reliant on health services had such organisations not stepped in and filled that breach. I commend the great work that is done by many section 38 and section 39 agencies but it is not fair that one of the largest and best-funded agency, treating the largest number of patients, would drag its heels on catching up with where the rest of sector is and is willing to go. In the context of financial reform, reforming the health and putting in place the new building blocks, I ask the Minister to take that message very seriously back to his officials and to the HSE.

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