Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

There are serious problems in the healthcare system, such as waiting lists, issues with which patients and their families have to deal, recruitment and retention issues, along with numerous human resources issues for nurses and midwives, non-consultant hospital doctors, general practitioners, consultants and allied health professionals. We all want them solved. We all have different views on how to solve them, however.

One of the root causes of many of these problems is down to the lack of a voice for patients - something that has been greatly under-represented to date - the lack of a voice for clinicians and the lack of financial oversight. Budgets have been running over by several hundreds of millions. Clinicians do not feel represented. There is now a chief clinical lead but it is a relatively new appointment; for a long time there was none. Many of our hospitals do not have a senior clinical leads or administrators to run them. The model whereby hospitals are run by such individuals tends to work well.

The exercise in appointing an interim board was very useful. We can now engage in a debate on the final details of the legislation, almost all of which Fianna Fáil will support, and have a conversation about the board that was appointed. The discussion does not have to be about hypotheticals relating to future potential boards. I will not mention any individuals or cast any aspersions. I hope that all of the eight of those who have been appointed to date are geniuses. I have no doubt that they are all excellent people. I do not refer to any individuals but let us take the board and ask if there financial expertise on it. The Minister has stated that there is not but he is looking to appoint some. There are two people with some background in patient advocacy. That is fantastic and very much in the spirit of Senator Ruane's amendment. However, something that really jumped out at me was that there was not a single person on the board with a clinical background, whether as a doctor, nurse, midwife, public health professional, physiotherapist or anything. The board is completely devoid of that. Furthermore, the chief executive has just been announced. I am sure he is a very fine person, I hope he is a genius and I wish him the very best of luck. However, it is interesting that, to the best of my knowledge, he also does not have a clinical or healthcare background or training.

Neither the chief executive nor the members of the board, which, on behalf of the people of Ireland, must hold that chief executive to account and support him in every conceivable way, have clinical backgrounds. This indicates that the very damaging culture in healthcare whereby clinicians have been silenced - and it has been wired into the system that their voices are not heard - is alive and well. I am not blaming the Minister for this. He did not pick the board, he was sent recommendations by the appointment committee, but is it not extraordinary that the machine has managed to appoint a chief executive and a board and not one of those involves has a clinical background? We have the opportunity to fix that culture, albeit not even close to fully, but to make a very important step and say that, at a minimum, two members of the board must have clinical backgrounds. That is not just a sensible thing to do but it is essential. As legislators, we will have to force the clinicians voice up the chain so that they are heard.

I take everything the Minister said in good faith but his amendment does not provide for two people with clinical or healthcare backgrounds. Based on knowing what the system appoints now that we have the interim board, I do not believe that it will do it on its own. It is essential that there are two people with clinical expertise.

On the number of patient advocates, it was noted during the Seanad debate that research shows two are needed. One person, whether he or she has a clinical or patient background, can feel alienated and ganged up on. The Bill, as amended, provides for two clinical advocates. The Bill says that "shall include a patient advocate" - it does not say that it is limited to only one - and later in that section, on the same page, it specifies that "at least 2 of the persons" will have experience of, or expertise in, patient advocacy. The two may not sing perfectly legally but they are clearly not in conflict.

The financial oversight is essential. While the Minister says he hopes to appoint someone with financial expertise the system may not want that. It did not want to appoint anyone with clinical expertise. The Bill, as amended at Committee Stage, makes the HSE stronger. It strengthens the clinical voice, financial expertise and oversight and still allows the two patient-advocacy positions. Therefore I will oppose the Minister's amendment. I would prefer not to go to a vote on that and if miscellaneous Bills come forward during the year when the legalese might be adjusted I will be very happy to work through that with the Minister. However, I would be reluctant to remove the necessity to have financial expertise and the two clinical experts given that the two patient advocates, which are also critical, feature on the same page.

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