Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I welcome the opportunity to say a few words on this important legislation, some of which is technical in nature. It seeks to reintroduce a board to oversee the operations of the HSE. I hope this overarching premise means it will have beneficial ramifications for our health service.

It is interesting to look at how we got here. Before I was elected to this House, I had the privilege of representing workers. It was very interesting to hear Deputy Donnelly say that workers should be listened to. I represented workers when Fianna Fáil was in government. They were roundly ignored. I was sitting in Government Buildings when the Taoiseach of the day, in the face of industrial action by tens of thousands of healthcare workers, called a general election, suspended the talks and literally walked away from the table. Deputy Donnelly has told an interesting story, but the history of his party is one of ignoring front-line healthcare professionals. I hope it will change. I hope a lesson has been learned.

Just six years have passed since Fine Gael abolished the board of the HSE in favour of creating the office of HSE director general and conferring more powers on the Minister.

What the Minister exactly did with those additional powers is anyone’s guess because I do not know.

The dismantlement of the HSE was announced by the then Minister for Health, Senator James Reilly, who pushed strongly for what he called reform of the health system. It was not based on available evidence or on information from having talked to experts or front-line healthcare professionals but simply on the belief that he was right. The changes and the decision to scrap the executive were agreed in the 2011 programme for Government between Fine Gael and the Labour Party.

In the Seanad, the Minister had the temerity to say that the directorate governance system of the HSE introduced through the Health Service Executive (Governance) Act 2013 was by its nature and design, and by intent, always envisaged as an interim measure. The Taoiseach when he was Minister for Health went on to say that the executive would be fully dismantled by 2020. Unsurprisingly, that did not materialise and we find ourselves discussing this Bill and the board must return.

The new board will be a slimmed down, nine-person version of the former HSE board. Sinn Féin opposed the original legislation that sought to dissolve the board, not because we thought the board was perfect or was working well but because the legislation that delivered its removal was unclear, weakened the health service through the removal of the board for purposes of oversight, bestowed too much additional power on the Minister and did not give the Dáil additional powers of scrutiny or make the Minister further answerable to the Dáil. I do not believe there is another multi-billion euro healthcare body operating in the world without an appropriate board to provide oversight. It is welcome, therefore, that the Government has seen fit to reverse the decision of six years ago, but let us not fool ourselves, that was not the Government's decision. That was a recommendation of the committee that produced the Sláintecare report. I and others sat on that committee and that is from where it came. If pats on the back are being handed out, Deputy Róisín Shortall should probably get one ahead of anyone who sits at the Cabinet table.

It was important that amendments were made in the Seanad, which guaranteed that two of the people appointed under the section to support the board would have experience or expertise in advocacy relating to matters affecting patients. This followed the suggestions made by Professor Gabriel Scally in the scoping inquiry. It was unfortunate that the same accommodation could not be made to include worker representatives on the HSE board. We believe that workers should have some form of representation on the board, and that healthcare and medical professionals would be of major benefit to the board in its workings. The participation of healthcare workers would be an asset. It would help to ensure a deeper understanding of clinical issues, best practice, quality indicators and other issues related to the safety and quality of care and overall delivery of healthcare by the HSE. Sinn Féin had submitted amendments to this end, but they were ruled out of order. We will submit reworded amendments to this effect on Committee Stage and we hope they will be supported. There is nothing wrong with having healthcare workers represented on the board that oversees the operation of their workplace. More important, they have much to offer in terms of their membership of the board and the expertise they can bring to it.

The Government claims that the new board will restore public confidence in the HSE through a series of actions to strengthen the management, governance and accountability of the organisation. Those are grand claims but they are almost a photocopy of the claims that were made when the board was dissolved. The board had to be removed to have all this accountability and now the board has to be brought back to have accountability; perhaps it could stop reforming the structures and just focus on accountability. Only greater oversight and proper accountability of the board by the Minister of the day will ensure better governance, accountability and delivery of health services. It is a pity that was not the view six years ago. If the then Minister had the bit between his teeth and was interested in reform, then he probably could have done a better job six years ago.

There is no other multi-billion euro healthcare body operating in the world without an appropriate board and, therefore, I welcome the reintroduction of the HSE board because it is standard practice for public bodies to have an independent board, which operates at arm's length from Government and provides independent oversight, particularly in the context of the spending of public money and accountability to the taxpayer.

It was a sad state of affairs for the former Minister to do away with the necessary and important checks and balances. However, without radically altering how the board will operate in comparison with the previous regime and the previous board, then the Government is doomed to make the same mistakes again. It is important that the board has the right mix of talents and does not just comprise ministerial appointees who are appointed for political reasons. I do not believe the Minister would do that but he will not be the Minister forever. When we look at the Cabinet table I see people who have made appointments to boards which made as much sense as Caligula appointing his horse to be a Roman consul. These people will be tasked with an important job. We need to make sure that they are the right people who can deliver. It is a multi-billion euro organisation, a great deal of taxpayers' money goes into it and a great deal of accountability is needed.

We need to ensure against manipulation in appointing members to boards on one hand and ensuring the best and most appropriate people are appointed on the other. It is important that any member appointed to the HSE board is familiar with, and committed to, the implementation of Sláintecare. We have a unique chance to fix some of the problems in our health service, and that cannot be achieved if those on the board of the HSE are not committed to working towards that through Sláintecare. By that, I mean a commitment to public health service, to the delivery of healthcare on the basis of need and not ability to pay, and fully funded by the public purse, not through privatisation but through the public health system.

Progressive corporate governance reform at the highest level of the corporate body of the HSE is also needed. When the HSE board was dissolved in 2012, there was an opportunity to progressively reform the organisation to achieve the highest level of corporate governance. This was not done and amendments to strengthen the legislation at the time were not facilitated. That was one of the reasons we did not support its dissolution. We have the same concerns again regarding this legislation. We would like the provisions strengthened to make the Minister for Health and the new board more accountable to the Dáil. The board must also robustly hold the Minister to account, and the Oireachtas must be able to hold the chairman of the board to account. The re-establishment of the board cannot give the Minister the opportunity to hide behind or push aside the HSE when it suits. The HSE has been described as a growing monster by many but, in the main, that is because it has not been given adequate political direction by successive Ministers for Health. We need only note its initial foundation by the then Minister, Deputy Micheál Martin. He just amalgamated the old health boards. In saying that, I am being kind to him because he just shoved them together. It made no sense. Deputy Donnelly has treated us to a few of the greatest hits of Fianna Fáil in government but the ones I remember were the recruitment moratorium, privatisation and the first recorded overnight trolley wait.

Since the board was dissolved, there has been a sequence of bad moves and a lack of sensible direction. Sinn Féin welcomes the key fundamental principles, as outlined by the Minister, of independence, inclusiveness and compassion. At times, those principles are sorely missing, not on the part of nurses, doctors, healthcare professionals who, as we know, have them in abundance, but in the boardroom.

The board, as the governing body, must be independent, transparent and ensure accountability in its actions in order that people can have confidence in the decision-making and management processes within the HSE. Furthermore, it must be committed to a truly public health system. We cannot have members of the board who have conflicts of interest such as stakes in private hospitals, or video medicine systems, which for the avoidance of doubt are the antitheses of what it means to deliver public healthcare. While we need experience on the board, we do not need conflicts of interest. We need to see commitment to improvement, to the proper and prudent use of public funds, to combating waste and to ensuring direct health benefits and better outcomes for those who use the health service. If my memory serves me correctly, the HSE is the largest employer in the State.

In that context, an understanding of workers' rights and not simply human resource management is really important.

I welcome the appointment of Mr. Ciarán Devane as the chair-designate of the new board. I understand the Public Appointments Service process to appointment a chair was exhaustive. I know Mr. Devane has experience in health service provision from his time in Britain where he was chief executive of the charity Macmillan Cancer Support and served as a non-executive director of the National Health Service, NHS. Perhaps, in time, when we have Mr. Devane in front of the Joint Committee on Health, I will get an opportunity to ask him about his time with the NHS in England and see what his analysis is of the performance of the NHS during that period and of attempts by the Tories to privatise elements of the NHS. A huge job lies ahead for the new board, the HSE, the Department of Health and the Sláintecare implementation office, and I wish them well in their endeavours. I look forward to further debating this Bill on Committee Stage. I have outlined the type of amendments that Sinn Féin will bring forward and look forward to engaging with Mr. Devane.

In the few minutes I have remaining, it would be remiss of me not to mention the impending strike by nurses and midwives in our health service. One of the frustrating factors as a person who represented healthcare workers which is still true today is that one is often engaging with people who cannot make decisions. In the absence of the Department of Public Expenditure and Reform, one is talking to HSE and health service officials, but those people are not empowered to make that decision. That is extremely frustrating for healthcare professionals and obviously frustrating for nurses and midwives because they have found that they have no option but to take industrial action. We know that industrial action is the last port of call for any worker, especially nurses and midwives. I would like to see a situation where the HSE is empowered to make those decisions in the interest of the health service, to have the power to actively negotiate and engage with those healthcare professionals.

I heard Deputy Donnelly's view and that of Fianna Fáil about how well paid nurses are. I heard that view about how well paid nurses are in the Joint Committee in Health in July. I do not share that view because we are competing with English-speaking countries where nurses are paid more and their conditions are better. That is why our nurses are leaving. We need to have a health service that is empowered to deal with the front-line healthcare professionals we need, put in place strategies and know that it has the power to make good on any commitments that it makes at the negotiating table. I do not think that every person in this Chamber shares the Fianna Fáil view about how well-paid our nurses are and I do not think that we should be making comparisons between our nurses and healthcare workers in other jurisdictions except those that the nurses are going to, because we are competing with those.

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