Dara Calleary (Mayo, Fianna Fail) | Oireachtas source

I was due to share time with Deputy Eugene Murphy but I do not see him in the House.

I welcome the Bill, which is basically a legislative "mea culpa" on the part of a former Minister, Senator Reilly, whose bull-in-a-china-shop approach to health reform is now being reversed by this Bill. I listened to Deputy Durkan's homage to the past.

There was a lot of sense in what he said about the old health boards. When I was first elected to this House in 2007, the HSE held regular quarterly consultative meetings on a county by county basis, at which hospital and local HSE managers engaged with public representatives. They were very effective meetings but during the tenure of the former Minister for Health, now Senator Reilly, they too disappeared. The hospital groups were established and they considered themselves to be unaccountable to local elected representatives. The final vestige of involvement on the part of local representatives was fully cleared away and the aforementioned regular local meetings do not happen now. There is no longer any opportunity for engagement with local management.

The abolition of the board of the HSE was based on the then Minister's pursuit of the so-called Dutch model of healthcare, which was going to be the panacea for all of our wants, like some sort of classy beer. It was supposed to improve accountability and delivery by the HSE but it was never going to happen. Unfortunately, we have had so many incidents since which have proved that. The lack of accountability at the very top has spread right across the organisation. When one deals with local managers and local front-line staff, one sees their passion for the patient, which is fantastic and immense. However, as one goes up through the layers of the organisation, that passion gets lost.

One of the issues with this Bill is that it only provides for a minimum of two patient representatives on the board. That is too few. Everyone on the board should have the interests of the patient at heart. Everyone on the board should be able to live the patient's experience and the patient's journey. There should also be representatives of patient's relatives and parents who depend on the HSE for day-to-day services so that somebody around the board table can tell the story of cancelled appointments, of not being able to access physiotherapy, occupational therapy or home care packages. Someone needs to tell the story of being told on Tuesday that surgery scheduled for Wednesday has been cancelled. Those experiences need to be heard at board level. If HSE and Department of Health managers are unwilling to hear them from directly elected representatives, then we must ensure that in the design of this new board, the patient experience is central. We must also ensure that other issues and experiences take second place.

Ós rud é go mbeidh an bord seo i gceannas ar chúrsaí sláinte in Éirinn, ba cheart go mbeadh Gaeilge ag na daoine a bheidh ar an mbord. Níl aon rud leagtha amach sa reachtaíocht nua faoi chúrsaí Gaeilge. Tá a fhios agam go mbíonn cruinnithe ag coiste na Gaeilge - tá an Teachta Connolly i gceannas ar an gcoiste sin - faoin gá atá ann go mbeadh seirbhísí éagsúla ar fáil trí Ghaeilge. Tá sé an-tábhachtach go mbeadh Gaeilge ag gach duine a oibríonn sa chóras sláinte agus go háirithe ag gach ball den bhord.

We must look at the experience of the HSE since 2011 and the abolition of its board. We have had budget overruns which Deputy Durkan dismissed as an annual event that always happens but it should not always happen. It happens because there is no proper financial planning in place and no accountability when things go wrong. We have had so many controversies, both locally and nationally, that have impacted negatively on patient care and on confidence in the health service. Nobody is accountable for that. Nobody has paid for involvement in these controversies with his or her job. There is no sense of transformational change taking place which is what any new board must grasp and run with. We must ask whether by changing the board we are actually changing the culture of the organisation because that is the most important change. We are all committed to going down the Sláintecare path but that path must have at its heart a change in the culture of service delivery. We must put the patient first. We must make the required investment and put in place the proper legislative and regulatory framework required for primary care. Any investment in primary care must make it an attractive place to work. At the moment we are alienating our primary care professionals to such an extent that they are fleeing the country for Canada, Australia and other countries whose health systems are set up in such a way as to allow them to be general practitioners or physiotherapist rather than all that they are expected to be here. Instead of just paying lipservice to primary care, the new HSE board should place primary care at its heart because so many problems can be dealt with in that setting rather than the hospital setting. When patients attend hospitals, they must receive a timely service. They should not, depending on the time of year, have to wait on trolleys for hours. Primary care services must be available on a consistent basis across the country which is the not the case at the moment. Primary care services vary from area to area, from CHO to CHO, depending on the availability of therapists or appointments. Patients living in some parts of the country can access health services far quicker than patients living in other areas. A central board of governance of a national health organisation must be committed to consistency and continuity of care, regardless of geography. There is some care that cannot be provided locally, including specialist care. Tough decisions were taken in this House, in the context of the old HSE structure, on the reform of cardiac and cancer care services which were opposed by Members opposite at the time. Those reforms have delivered much improved outcomes but there must be a consistency in the delivery of services across the country. There must be a genuine understanding of the patient's journey in terms of the way that care is delivered and accessed and the board of the HSE must take on the responsibility in that regard.

The board must have teeth and HSE management must be answerable to it. Senior management in the HSE has not been held to account to any great extent. The Oireachtas health committee does a superb job but is limited in what it can do in terms of holding senior managers to account. Calling senior HSE managers before the Committee of Public Accounts on a crisis by crisis basis is not necessarily the best way to get consistent answers or reform. The new board must be entrusted with the responsibility for doing that.

The board itself must also be answerable to the people. Producing an annual glossy report full of staged pictures of people looking happy does not amount to responsibility or accountability. Members of the board must be accountable to this House in a different and new way. No longer will the standard procedures suffice whereby board members appear before committees of this House and spend hours at a time trying not to answer questions posed, having spent tens of thousands of euro of taxpayer's money on communications consultants who told them how to do that. That is not responsibility or accountability to the Oireachtas.

The Minister for Health has now decided to reverse the car that was driven through the health service by the former Minister for Health, James Reilly, without any concern for the damage caused. However, he needs to make sure that he is driving a new car and that the board of the HSE has the strength, capacity and skill set to represent the interests of patients, first and foremost and of communities. The board must ensure consistency and continuity of care across the country insofar as possible. Where services cannot be spread evenly across the country, the board must ensure that patients have access to care that is timely and that is delivered in a manner suited to their condition and respecting of their dignity as patients and citizens of this republic.

The people who are asked to take on the duties of this board will have a very big responsibility. We will have to take that responsibility into account when considering the remuneration of board members. If we want the right people for this job, the standard way of rewarding them may not suffice. Thought will have to be given to the kind of person and the kind of experience we want around that table. Every single person who signs up to become a member of the board of the HSE must know from the beginning that his or her job is to represent patients. The people who are treated in our health service deserve representation and must know that if their treatment goes wrong or if they have a negative experience, there is someone at the board table who will stand up for them, for their community and for their health service.

See this speech in context