Catherine Connolly (Galway West, Independent) | Oireachtas source

While some of what the previous speaker said echoes with me with regard to my personal experience, I totally disagree with him in certain respects. I agree about lack of accountability and reviews not being carried out properly. It merges with my own experience. I have raised some of those matters in the Dáil. When he extends that to say that politicians or the Government have no responsibility, I have to fundamentally disagree with him. We are here to re-establish an independent board as a monitoring mechanism over the Health Service Executive and I support that. One has to ask why there was no board and for how long has there been no board. The previous speaker, who has left the Chamber, was part of the Government that made the decision in 2012 to dissolve the independent board and to replace it with civil servants. I will address some of the consequences. Why are we re-establishing that board tonight, almost seven years from the time it was dissolved? There are three reasons, two of which are interconnected. One is the Scally report, which clearly outlined the consequences of bad governance, especially the lack of board representation.

The second is the Sláintecare report which includes the input of members across parties, reflects a new Dáil and a new type of politics. I am still innocent enough to believe in new politics, even though my cynical side tells me that we are going nowhere. I will stay with my innocent side tonight and the Sláintecare report which clearly states we need an independent board. That is one of the reasons we are here. I would like to think we are here because the Government has learned something and will state it made a terrible mistake at the time and that the then Minister, Senator James Reilly, thought he was doing the right thing but that it was not good. However, I do not hear that being said.

The third reason is the Scally report, from which I will quote because it is important. I contributed to the debate on it. It concerned cervical cancer screening, what had happened, the patronising attitude and the failure to give information. That is what it was about: the failure to give information to women to empower them and let them make decisions. The report which I have read closely is scathing, albeit in very moderate language, about the absence of governance. In fairness to the CervicalCheck programme, another point is noted, that within a few days of the launch of the cervical screening programme, there was the bank guarantee:

Staff recounted how the Irish bank guarantee occurred three days after CervicalCheck was launched nationally in September 2008. As the financial crisis contributed to an economic recession, public sector programmes and organisations saw a reduction in the level of resources afforded to them, with CervicalCheck no different. As its budget was reduced, CervicalCheck struggled to adequately replace departing staff.

That was the background. The reason I mention this in the context of this debate is that even with these difficulties, it struggled on gallantly until it was put back within the remit of the Health Service Executive in 2010. Dr. Scally states clearly, "Since 2010 ... CervicalCheck has not had a single, accountable senior person responsible for the delivery of the programme on a full-time basis." At that point there was an independent board, but we were in trouble with CervicalCheck because there was no accountable person. On top of this, the then Minister, Senator James Reilly - I do not wish to personalise the matter but he happened to be the Minister at the time - walked in and dissolved the board in 2012. Therefore, the level of accountability that was supposedly there in theory was also taken away and civil servants were put in charge.

In 2013 a Fine Gael and Labour Party Government introduced legislation that copper-fastened the absence of monetary accountability and of a means of holding the system to account. What did they put in place? There was a director general going into a room to be answerable to other directors of services and when he came out of it, he was answerable to himself and, ultimately, the Minister. All of this was done in the context of debates in which it was said this was to bring more openness and greater accountability. The Minister of State is as aware as I am of the many mistakes made from 2013 to date. My own family has suffered. I will not go into it here, but I have alluded to it on a number of occasions and will come back to it when I speak about the failure to carry out an independent review when something happens. On this point alone I have asked a simple question of the hospital in Galway: how many reviews have been carried out independently within a certain period? By whom were they carried out and what was the cost involved? An answer has been given to the effect that it has no system in place for recording this information. That is the official reply to a Dáil question. Again, this will be relevant when I come back to the board we are going to re-establish. The first hurdle is the board; the second is ensuring it functions adequately, that it has adequate data, help and research facilities and so on.

I will quote Dr. Scally because balance is important and I want to balance some of the things I said at the time:

Changes to the overall governance of the HSE itself had a significant impact. In March 2012 the Board of the HSE, which had consisted of an external, non-executive Chair and Board members, was removed and replaced by a Board consisting of civil servants and HSE officials. This change from the accepted good practice of having independent Board members in an oversight role, and involved in a committee structure beneath the Board, was a major move away from the established norms of good governance of public bodies. It is difficult to see who, under this configuration, was representing the patient and public interest.

Again, this is something to which I will return, if time permits. Talking about putting patient representatives on the board is not sufficient to represent the patient. Much more is necessary to have an independent board. I will continue with Dr. Scally what he said for the moment:

In the case of civil servants appointed as Board members, it raises the question of whether they are acting in their civil service capacity, supporting Ministers to carry out Government policy, or are there to administer a major public body in the interests of the public it serves. This was further compounded by senior civil servants at times fulfilling two roles, one in a senior executive position in the Department of Health and the other within the top-level governance structure of the HSE.

Again, Dr. Scally is clearly illustrating the difficulty at the time. It is something to which I will return when I speak about appointments and conflicts of interest on any new board. The report continues: "In 2013, legislation changed the nature of the governance of the HSE entirely, replacing the Board [as I said] with ... a Director General and [other] Directors". This was supposed to be part of the beginning of the abolition of the Health Service Executive, which never happened. However, no politician or member of Government came back and said, "The Health Service Executive has not been abolished, so we need to put back in place an independent board to monitor it." It has taken Sláintecare, Dr. Scally's report and the loss of lives, including of someone close to me, to realise we need an independent review board, not for the purposes about which Deputy O'Dowd was talking because they are for independent reviews. That is an entirely separate matter and he confounded and conflated issues in his emotional address to the Dáil, which I fully understand. However, the independent board has a different function.

The net effect of removing the board by legislation, supported by a majority of the House and led by Fine Gael and the Labour Party, was to remove an external independent input into the running of the Health Service Executive at its highest level. There was absolutely no independent input or monitoring. That is the way we have progressed and I make my contribution in the context of a health service that is very much struggling. So far this year there have been 73 children on trolleys and we are barely two and a half weeks into 2019. I hope the time will never come when I accept this as collateral damage in a thriving economy. I certainly do not accept it now and do not think one can have 73 children on trolleys and at the same time talk about a thriving economy. We have thrown out all of the other figures. Last year, in Galway alone, there were 8,750 patients on trolleys, chairs and other contraptions in wards. The hospital in Galway distinguishes itself, despite the best efforts of staff, by having the most appalling record for the number of patients on trolleys. It should be borne in mind, as I said, that Dr. Hickey, the brave consultant that he is, has repeatedly pointed out that every year there are between 300 and 350 premature deaths as a direct consequence of the time spent on trolleys by patieints. We are having this debate in the context of the Government's appeal to nurses not to strike because of patient care issues, but we are missing the point - the very reason they are promising to go on strike is that they are concerned about patient safety and that patients are dying as a result of inadequate care because there are not enough staff and many mistakes are being made.

For the second time tonight, I thank the Oireachtas Library and Research Service for its very detailed report. It is important to compliment staff when they do an excellent job. The service has given the history, with Dr. Scally. Thanks to its report, I now have the language to address something that has always jumped out at me. The report refers to the characteristics or qualities essential for a good board. It examined international literature, simplified it for us and provided the key characteristics of a good board, namely, transparency, accountability, participation, integrity and capacity or TAPIC. Many boards are caught considering financial issues and key performance indicators given by government. The literature tells us that one of the better characteristics of a board is to have consideration of patient safety placed on the agenda of every board meeting.

The initial hurdle is to set it up an independent board. The second is to make sure the board is representative, has gender equality and has members who have the capacity to absorb knowledge, ask questions and hold the system to account. That is the role of an independent directorate. I re-read with fascination the comments of the former director general of the HSE which were given great prominence in The Sunday Business Post and found myself agreeing with some of the things he said. I found others extraordinary, however, including his comment that shit only went one way, namely, uphill to him. He spoke about the abolition of the independent board but did not consider its consequences for himself. He also commented that on one day in 2012, the very year the former Minister for Health, now Senator Reilly, got rid of the board, the HSE lost 5% of its staff. It lost all that experience and wisdom because of cutbacks.

Those cutbacks were made before the Minister of State took office. I was on a health forum in Galway at the time. In 2007 and 2008, only the language used was different. When we asked why beds were empty or wards closed, the reasons given were cost-containment measures and bed refurbishment measures. During all that time the privatisation of the service was intensifying. Now Fine Gael repeatedly talks about how wonderful the National Treatment Purchase Fund is. The NTPF was to be a temporary measure, not a permanent one. The opposite happened and we ran down the public system.

I welcome the Bill and hope it is implemented as quickly as possible. The selection of board members will be extremely important, as will be the services provided to the board. Gan aon amhras, tá gá le daoine le Gaeilge. Tá dualgais reachtúla ar an Rialtas agus ar aon bhord an Ghaeilge a úsáid agus a chur chun cinn. Glacaim go mbeidh Gaeilge ann, ar aon nós. In addition, there has to be expertise and research available. There has to be clear evidence that the people appointed, men or women, have the ability to ask questions, are not afraid and that patients are first on the agenda.

In respect of conflicts of interest, the former director general of the HSE saw no problem in taking a position in a certain pharmaceutical company. This is public knowledge. In addition, apparently the Government did not see any difficulty in the fact that the chair of the pharmaceutical company in question was also chair of one of the hospital groups. I view that as a conflict of interest, although perhaps others disagree. That is the type of thing that in a small country we have to be particularly aware of.

The final point that emerged from the research done by the Library and Research Service was about oversight of the independent board. We know this on the Committee of Public Accounts, PAC, membership of which is both a prison sentence and a privilege. What comes out every week are the difficulties arising from lack of governance, and even when governance procedures are in place the failure to monitor those. We get tied up with all of these governance words but the consequence is that patients suffer and die. In respect of other groups that come before us, the whistleblowers and employees suffer, and the public purse suffers because of inquiry after inquiry. In my two years as a member of the committee, I have lost count of the number of independent inquiries there have been - separate from health - on the vocational educational colleges, universities and technological colleges. They are costing us a fortune because we have not managed to implement good governance. Even when we do so in theory, we do not ensure it is implemented on the ground and that costs us more. I welcome the Bill and look forward to further discussion on Committee Stage.

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