Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I move: "That the Bill be now read a Second Time."

I am pleased to contribute on behalf of the Minister for Health. As we look forward in 2019, there are opportunities we need to grasp and challenges we need to understand and control. This Bill, with the re-establishment of a board for the HSE providing independent oversight, is a key enabler of accountability, improvement and transformation in our health services. The Minister for Health and I can think of no better moment than the start of a new year to work in collaboration with colleagues across the political spectrum to deliver on the commitment across this House, and as signed up to in Sláintecare, to re-establish the board of the HSE.

The HSE is our largest State agency, with a budget in excess of €16 billion in 2019 and a substantial workforce, delivering vital services. The transformation vision for health sector reform, as set out in the Sláintecare implementation plan, is an exciting change in our health services. However, with this opportunity also comes significant risk, responsibility and work for the HSE corporately. The HSE must be supported to deliver this work on the ground and, in the Minister's opinion, it is essential that a strong board be established to drive the strategic direction of the organisation, ensuring that appropriate systems for management and performance monitoring are in place, and to ensure accountability to the people of Ireland for decision-making processes in the HSE. The board will also support the HSE in its decision-making capacity to ensure transparent, collective, evidence-based decisions in regard to the range and breadth of health and social care services it provides across the country.

It is important, therefore, to outline the main objective of the Bill. A directorate governance system in the HSE was put in place in 2013. As the Minister said when bringing this Bill through the Seanad, this system allowed for co-ordination between senior management teams in the Department of Health and the HSE but, by its very nature and design, and by intent, this was a system that was always envisaged as an interim measure. The time has now come, in line with the Sláintecare recommendations, to establish an independent board governance structure for the HSE in place of the current directorate governance system.

This board will be the governing body of the HSE and accountable to the Minister for the performance of its functions. High standards of integrity and probity will be expected of the board. There are also central principles which must be at the heart of how the new governance model is implemented and which should guide the board. As the governing body, the board will support transparency and accountability of actions, benefitting decision-making and management performance in the HSE. Part of this will be for the board to challenge itself, as well as the HSE, to show how the HSE is getting value for the public funds it has been given. Part of this will be to foster a culture of continuous improvement in the HSE. The board will act collectively in order that all perspectives of patients, staff and the taxpayer will be taken into account, and will take decisions based on the public good. However, in acting on these principles of independence and inclusivity, the board must ensure that fundamental values of care, compassion, trust and learning are well rooted throughout all services for which the HSE is responsible.

Board members will be appointed by the Minister for Health following a Public Appointments Service, PAS, process for identifying suitable appointees. This process is a robust, competencies-based process and will result in candidates being appointed to the board based on the skills and experience they bring to the board and their ability to engage in collective, complex decision-making. The board will have strong competencies in key areas, giving leadership to guide, challenge and support the CEO and HSE executive team, ensuring accountability and delivering organisational transformation within our health service. The PAS process ensures that members of the board will have experience and expertise in one or more of a range of areas, including corporate governance; clinical governance; quality assurance and patient safety; patient advocacy; strategic planning and change management, business management skills, financial planning and management; strategic human resource management; and public communications.

From the outset, patient advocacy was identified as one of the core competencies needed in board members. The Minister for Health was also clear on the Government's commitment to implementing in full the recommendations of the Scally scoping inquiry into the CervicalCheck screening programme, including the recommendation in regard to advocacy and the new HSE board. This issue was also raised by Senators as the Bill passed though the Seanad. The Minister listened carefully to their concerns and reflected on the best way of delivering on the letter and spirit of Dr. Scally's recommendation. He, therefore, tabled an amendment to the Bill on Report Stage in the Seanad to provide that at least two members of the HSE board have patient advocacy experience or expertise.

The Minister would like to take this opportunity to update the House on progress with identifying board members. In September 2018, after a demanding public appointments process, Mr. Ciarán Devane was selected as the chair designate of the HSE board. He brings to that role a range of skills, experience and leadership from his extensive experience of the British Council, NHS England and as CEO of Macmillan Cancer Support.

The Public Appointments Service process to identify the other nine members of the board took place recently. The Minister hopes to be in a position to make an announcement on the selection of members shortly.

I turn now to the main provisions of the Bill. Part 1 contains a number of standard provisions including the Short Title and collective citation of the Bill. It also provides for the repeal of Part 3A of the Health Act 2004, which instituted the directorate governance structure.

Part 2 allows for the required changes to be made to the Health Act 2004 to reflect the structural changes proposed in the Bill. In essence, these changes include the establishment of an independent board, the appointment of a CEO to the HSE and the formulation of the values, principles and conditions to underpin this new structure.

Section 7 proposes to insert a new Part 3B, sections 16N to 16U, into the 2004 Act to make provision for the membership and role of the new HSE board. Section 16N(1) provides for a board of the HSE composed of ten members, namely a chairperson, deputy chairperson and eight ordinary members, all of whom will be appointed by the Minister for Health. As I mentioned earlier, at least two members must be persons who have experience of, or expertise in, advocacy in respect of matters affecting patients. The appointment and functions of the CEO of the HSE are covered by the insertion of a new Part 4A, sections 21A to 21G, into the 2004 Act. As Deputies will be aware, we are currently in the process of recruiting a new director general for the HSE. The successful applicant will become the new CEO of this important national State body under the legislation before the House. This will be a pivotal appointment in improving the management, performance and quality of our health and social care services.

The Bill also sets out the accountability structure between the CEO and Oireachtas committees. Under the new section 21E, as provided for in section 8 of the Bill, the CEO of the HSE will be required to attend before Oireachtas committees to give an account of the general administration of the HSE. The requirement for the CEO to appear before the Committee of Public Accounts is covered in the amendment to the Health Act 2004 proposed in section 17 of the Bill. Sections 9 to 29 provide for other amendments to the Health Act 2004, mainly consequential to the new board and CEO structure and take account of the move to a board and CEO structure from the directorate governance structure. Part 3 of the Bill consists of sections 30 to 34 and amends references to the director general in primary and secondary legislation.

The primary purpose of the Bill is to establish a board governance structure in the HSE to establish independent oversight. The Minister is also considering amendments to further strengthen oversight and accountability and to support a more structured and strategic performance dialogue between his Department and the HSE. I stress, however, that the Bill, including any amendments to it, is a first step. The Minister is committed to continuing this journey of reform outside of the Bill by means of ongoing work to review, refine and refresh the performance and oversight framework for the HSE. Sláintecare has placed the reform and transformation of our health services into a space that transcends party politics because the importance of what we are doing goes beyond our political affiliations or ideological standpoints. It is about providing the people with the best health service. The health service they deserve is one based on equity, professionalism and compassion which places the patient at the core of all that it does. The Minister believes re-establishing the board of the HSE is a key enabler of this and a fundamental building block to strengthen governance and oversight in our biggest State agency. I commend the Bill to the House.

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