Alan Kelly (Tipperary, Labour) | Oireachtas source

I am glad to be in a position to speak on this Bill this evening. The Ceann Comhairle will be delighted to know that I will stick to the Bill. We will have other opportunities to deal with many of the serious issues raised by previous speakers in the next 24 hours. This legislation is important. It is concise. The Government was bounced into producing it because of the Sláintecare report, the committee which Deputy O'Reilly and I sat on for 11 months with Deputy Shortall as the Chair, which recommended this. As somebody who is into the detail of the cervical cancer debacle, it was quite obvious as a result of what many of us saw transpire at that time in the Committee of Public Accounts and the Joint Committee on Health, both which I am a member of, when speaking to HSE and Department of Health officials, that governance had collapsed and that an independent board was necessary. What was recommended in Sláintecare and the greatest example of why it was needed was before us in the cervical cancer situation.

I believe the decision to abolish the board in 2012 was foolish. The structures that were supposedly to be put in place never materialised. I looked back at the cervical cancer debacle and some of the committee hearings. I cannot remember whether it was at the Committee of Public Accounts or Joint Committee on Health - it was probably at both - and I remember questioning accountability and how this could happen. The national screening programme, which had been quite successful, had fallen down the organisational structure of the HSE. The history of how it fell down from the top tier of the management and directorate of the HSE, a number of years ago, is that a number of directors, working together, made a decision in a vacuum away from accountability to a board or anyone and it slipped down two tiers. As a result, the director in charge of it did not have a clue what was going on. At a management level, the directors speaking together at directorate meetings were obviously raising the issue and screening programmes were discussed. The audit which we all know about now never really reached the top table. No one was asking questions. Screening was merged into being part of the directorate in relation to wellness, so it was mixed up with that. It is very positive for that to be in the media and publicly known.

This is a very specific area and there was a lack of oversight and management structures that were decided by the HSE directorate, which I accept there is an element of need for, and there was no board to ask if and how something is working and other things that are necessary where boards are in place, including challenging a CEO or a management team, which is the directors in this case. As a result of that, the issues that we are going through did not get to the top and we would not have known if not for Vicky Phelan and everyone in this House knows that. To be fair and balanced, the CEO was left in this situation so I will not criticise them for that. There was a structure with a tier of directors and a CEO without an accountable board. It is an organisation with a budget of €17 billion or more, the largest number of employees of any State company in Ireland.

This Bill is small but it is incredibly important to ensure good governance, accountability and transparency. It is in tandem with other legislation which will go through the Houses, especially in the area of open disclosure. I wish the chair-designate the best. I also wish the new CEO the best, whoever that is, if we can find one. It is proving difficult to find one. Things that will have to happen in tandem are the psychological changeover in the HSE regarding open disclosure, honesty, transparency and how to deal with the public.

The establishment of the independent board and the putting in place of governance measures will not happen overnight. The board will be put in place, but the actual process by which it will do its work will have to be quite closely overseen by the Minister and his Department. We need to be very careful about the type of people who are appointed to the board. It is not that easy to get people onto boards any more - it is incredibly difficult - so we need to ensure that we get the right people across all the disciplines listed in the Bill, a matter to which the Minister referred previously. I welcome the fact that the Minister has changed the composition of the board in order to add two patient advocates. This is very positive. Dr. Scally referred to this matter. I want to be clear about one thing - and this must happen, particularly in healthcare but also, potentially, in the context of other boards - namely, that the members will have to be reimbursed. I do not mean travelling expenses, I mean full reimbursement in respect of loss of pay. Otherwise, it will not be possible to get a proper cross-section of society. I have raised this matter on half a dozen occasions. Let us consider the type of people we need to get on these boards. There is nothing wrong with one, but we do not want two retirees who can afford membership financially. We also need people with real-life experiences who have been through a lot. The majority of the families affected by CervicalCheck and related issues include young women. The best patient advocate when it comes to such a topic and cancer in general could come from that sector, but one of those people will not be able to go on the board because they will not be able to afford to give up the time from their job. I know this from the groups that have already been set up with the HSE in respect of CervicalCheck. Some of the people giving up their time on these boards will not be able to continue doing so long-term because they have jobs to go to and children to feed and cannot afford the loss of income. In that context, I plead with the Minister of State: if he takes away one small point I make, he should bear this in mind. It is something we need to ensure across Government and across politics.

The new board and chair designate need to set a new tone as to how they make the management structure and the management team accountable. Dare I say it, from an accountability point of view, Oireachtas committees have had to fill a void because of the fact that there has not been accountability at board level. What is happening at present is, because there is no such accountability, I and others, particularly members of the two committees to which I referred, are going into a level of detail which we probably should not need to go into because there is no board to do it. We are getting into levels of detail on medical and health issues, and also spend issues on other committees, because of the fact that there is no board. There is a vacuum and we are possibly not being consistent in targeting some of the main issues to the degree we should as a result of the level of detail we are having to get into. The new board, the new chair designate, can set a new tone in ensuring that the issues that need to be dealt with at that level are dealt with and that issues that need to be dealt with in here, at the highest macro level, will be dealt with in here as well.

As stated, the board must be inclusive and comprise a cross section of society with different skills. The patient advocates must represent a cross-section of society as well. It is also important that the new board fit in with the Sláintecare strategy. Some work has been done in this regard with the establishment of the programme office, the advisory group, etc. It is important that in setting this up we do not just think it will act in some way like other boards. There is a strategy in place here that is the only show in town and across politics. Any Minister for Health should glide into the slipstream of this because it is a strategy that has been adopted by an overall majority of the House. It is important that the new board understands that while the chair designate is accountable to the Minister, there is also the requirement to be part of this larger trans-politics, trans-time strategy because Governments and Ministers come and go. This is critically important as well and needs to be fitted in.

I wish to say a few words about the issue of regional alignment. This is a real bugbear of mine, and I know it is for some other Deputies. As part of the new structures, the whole alignment of the community healthcare organisations, CHOs, and the hospital groups must happen but in an organised fashion because otherwise the accountability chain up and down gets broken because people do not know who is aligned to whom geographically. All of us in this House deal with, as I call it, the acute side and the non-acute primary, community and continuing care, PCCC, side. I am lucky enough in the mid-west, where they are aligned. I would say it is the only place in the country where they are aligned. Well, most of it is aligned. Part of it in south Tipperary is not, but that is a different story. This causes real issues, so this alignment needs to happen relatively quickly and in tandem with the setting up of the new regional boards. Those boards are massively important and have the potential to be extremely effective because they will get into a level of detail that the national board will not be able to get into. There are specific issues that can then be dealt with at regional level. There are specific issues which are higher-priority in the south-east than they are in the north-west and vice versa- one can pick any regions in the country - so those regional boards are critically important but they must happen following on from the alignment of the non-acute and the acute.

One issue that arises relates to the role of politicians at local level. I am not necessarily saying we should go back to the old health boards, but certainly when it came to accountability, common sense and a focus on the minds of regional health managers, they did not necessarily do that bad a job. Therefore, while not going back to that whole structure, we do need a format which is not just about the platitudes that happen in many regions at present whereby a couple of times a year there is a meeting and we are given presentations, etc. I obtain a great deal of information from our regional managers, but the point is that, in general, there is a role for politicians at the local level as well because there are cross-over issues that happen at local authority level - transport, environment and other issues - that need to be taken on board.

I welcome the Bill. I hope the Minister of State will take on board two or three of my comments, which I think are progressive. We will support the Bill. We will look at one or two amendments, potentially - not many. The HSE is too bureaucratic and too large. Dr. Scally stated in his report, "It [was] difficult to see who, under this configuration, was representing the patient and public interest". It is to be hoped that with the change in structures and the new chairperson designate, the new board, a new CEO, the new transparency, the new open disclosure, the new regional structures aligned and regional boards, that statement will become redundant. I fear, however, that it will take some time and much concentration to reach that point.

See this speech in context