Eugene Murphy (Roscommon-Galway, Fianna Fail) | Oireachtas source

This House has spent a considerable period of time discussing health issues today. Many nurses were present for this afternoon's debate on pay and conditions in the nursing profession. The number of staff nurses has decreased by more than 1,700 in the last ten years. This is symptomatic of the difficulties that have arisen under the HSE. Every day, we hear justified criticisms of aspects of work and things that are not being done. I want to state clearly that there are many good staff in the HSE. A great deal of good work is being done by the HSE. It would be wrong to paint everybody with a negative brush just because the system under which the HSE has operated has not been very successful. It is the system that is the problem, more or less. The board of the HSE was abolished in 2012. To be honest, we have had many difficulties and problems in the six years that have elapsed since then. We have spent a long time trying to fix this problem. According to the Sláintecare report:

Good leadership and governance are critical functions of any health system. The Committee strongly believes there is a requirement for clearer clinical and managerial accountability and governance throughout the system. This includes clarity at all levels, from the Minister for Health, the Department of Health, the HSE and healthcare providers.

It must be in everybody's interest to ensure all the work that was done on Sláintecare is implemented as quickly as possible.

We have problem after problem within the system. It is bizarre that waiting lists seem to get worse and worse. When I looked at some figures as part of my research on this issue in advance of tonight's debate, I learned that over 5,000 people are on outpatient waiting lists in the CHO 2 area, which covers counties Roscommon, Mayo and Galway. It is bizarre that waiting lists in virtually every area of healthcare are growing and growing. It emerged recently that inpatient and outpatient waiting lists have grown by approximately 50,000. That is a shocking indictment of any system. This problem is not confined to the CHO 2 area; it is found all over the country. We need to have change. We have to bring that change around as quickly as possible because people out there are frustrated and annoyed. Sláintecare proposes "that the HSE be reformed into a more strategic national centre, with an independent board and fewer directorates". The Sláintecare report continues:

Recognising international evidence on the negative impact of system re-organisation or merger, the Committee believes structural change should be as simple as possible, and only what is needed to meet the requirements of integrated care. The HSE strategic national centre will be supported by regional care delivery through regional bodies, recognising the value of geographical alignment for population-based resource allocation and governance to enable integrated care.

It is vital that these changes are made and brought forward as quickly as possible.

I would like to refer to another indictment of the system. It was mentioned earlier today that many people, particularly nurses, are leaving this country. They are finding themselves unable to work within our system, mainly for reasons of pressure and conditions. We must acknowledge the outstanding commitment of front-line staff who deal with unbearable situations every day. We have to remember that people in queues who have been waiting a long time for assistance sometimes complain. When people are in pain, they get into bad form. Nurses and front-line staff are required to deal with all of that. It can be seen right through the system that this particular problem has been getting worse year after year.

Sláintecare explicitly recommends that the Minister for Health should appoint "an independent board and Chair" to the HSE "at the earliest opportunity...following a selection process through the Public Appointments Service" and that the membership of the board should reflect "the skills required to provide oversight and governance to the largest public services in the State". We should remember that over €15 billion, which is a lot of money, is spent on the health service each year. The director general of the health service will be accountable to the board. This Bill provides for the establishment of a nine-person board for the HSE. The board will be the governing body for the HSE and will have the authority to perform the HSE's functions. The board will be accountable to the Minister for Health for the performance of its functions. If there is one word I have heard time and again in recent years, both during my time as a local councillor and since I was elected to Dáil Éireann in 2016, it is "accountability". We all know that people regularly talk about the lack of accountability in the system.

I welcome this Bill, behind which Fianna Fáil will throw its support. As I have said, the abolition of the board by the former Minister, Senator Reilly, was a mistake. It was abolished and it was left there. We have moved on six years. Things have worsened over those six years. It is beyond time for the Members of this House and the Government to pursue this particular change. In my view, we should make the change happen as quickly as possible. We have enormous mountains to climb as we try to improve the health service. I stress that in no way am I making any derogatory reference to the many good people who work in our health service day and night, 24-7. As I said, they do a lot of good work within the health service. We owe it to the staff and the public to make the changes that are necessary. That is why Fianna Fáil is supporting this Bill.

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