Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

We said on Second Stage and throughout the debate on the Bill that we were very concerned about this legislation for a number of reasons. Deputy Caoimhghín Ó Caoláin has pointed to the fact that the Bill is technical in many ways in that it brings two Votes together into one under the Department of Health. However, there are also principles at stake. The difficulty we have is with a Minister and the Department setting policy with one Vote and then another agency under that Department implementing the policy. The issue we have centres on clear and distinct lines of demarcation and accountability. We want accountability in this Chamber. However, a lack of clear lines of demarcation can give rise to lines of influence. We have said previously that as the executive was structured previously, there was a certain distance between the Minister in the Department, who sets the policy and is accountable to this Chamber and the HSE which implements that policy. We can argue about whether the HSE is implementing policy in an efficient manner. Indeed, we could have that debate all day, every day. Some people argue that the direction we are now travelling, towards universal health insurance and all that will flow from that, is an effort by the Government to indicate that it wants to be different in how it funds the health service. However, it does not have any clear train of thought in terms of how that will impact on the health services. We are having discussions on an ongoing basis on universal health insurance, the establishment of the commission, the negotiations, discussions and submissions that are being received and the input of the Oireachtas Committee on Health and Children.

There are lots of reasons to be concerned about the Bill. As Deputy Caoimghín Ó Caoláin highlighted today and on previous occasions, there are also lots of things wrong with the Department of Health and the current Minister, particularly in the way they have directed policy. There is a lack of commitment to ensuring that if the entire Vote comes under the Department of Health we will have a better health service. Will this actually be more efficient and effective? Will it direct resources to where they are needed most or will it simply allow for more political interference? I do not like having to say this but the Minister has form, as do other Cabinet Ministers, in the context of deciding where resources should go. We had, for example, numerous debates in this Chamber on primary care centres, on how and why certain centres were prioritised and the lack of clarity on the criteria used for prioritisation. We had many discussions about algorithms but have yet to get a concise answer from the Minister on how particular primary care centres were prioritised. We have also dealt with issues around the funding of emergency departments, although nobody denies that funding for emergency departments in hospitals is essential. The recent HIQA report on the hospital in Dooradoyle highlights the inadequacies of the emergency department there although a new department will come on stream shortly. The point I am making relates to how decisions are made about where resources are directed.

If the Vote in question is brought within the remit of the Department of Health - of course, the Minister is the representative of the Executive in the Department - there will be potential for horse-trading to occur between Ministers in the provision of money and how and where it is to be spent. There is actually more than just potential in this regard because it has happened already. The impact of what occurred when health funding was, for horse-trading purposes, diverted to certain Ministers' constituencies has been well chronicled in recent times. That is a type of behaviour from which we are trying to move away. I am concerned that when the Vote to which I refer is transferred back to the Department of Health, there will be potential for influence to be used and interference and conflict to occur.

The Minister has not, by any stretch of the imagination, covered himself in glory in the presentation of budgets in the years since his appointment. Every year it is stated difficulties will arise. In recent times the chief executive officer of the HSE has highlighted the deficiency in this regard, namely, the fact that budgets are built on sand. We understand the need to pare back the public finances and prioritise certain areas within them. The key issue is that when a budget is set down, it must be sustainable in how services are going funded for the year ahead. Every January or February we come to the realisation that the budget the Minister presented the previous October as part of the Estimates process will not be sustainable. Representatives of the HSE have highlighted the fact in recent years, even as the Minister was negotiating the shape of the health Estimate with the Ministers for Public Expenditure and Reform and Finance. How he expects personnel in the HSE to deliver services when the budgets he is allocating are wing and a prayer efforts worthy of fantasy fiction is beyond me.

The fact that the Department of Health will have responsibility for the Vote to which I refer is a source of concern. It is with regret that I make these remarks, but at least I am being consistent. I must continue to be consistent in this matter because, as has been well documented, every September or October there has been bedlam in the negotiations on the health Estimate. Last year apparently the Minister sought an additional €1 billion in funding and ended up with €666 million less. That had an impact in the delivery of services in emergency departments, primary care centres and settings and across every other area of the health service. For all of these reasons, we are of the view that the Bill will only expand the Minister's remit even further. We have concerns about that remit in the first instance.

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