Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I move: "That the Bill be now read a Second Time."

I am pleased to introduce the Health (Amendment) Bill 2025, by means of which it is intended to enhance the oversight and accountability of the Health Service Executive to both the Minister for Health and the Minister for Children, Disability and Equality. The Bill addresses a number of goals arising from the Sláintecare implementation plan, which highlighted the need to shift away from the previous directorate structure of the HSE towards an independent board overseeing a chief executive officer. The HSE board was established through the Health Service Executive (Governance) Act 2019 and has been in operation since then.

Given the implementation of the HSE health regions and the accompanying changes to the governance and structure of the executive, this is an opportune time to introduce these amending provisions and strengthen the oversight relationship between the Department of Health and the HSE. The provisions in the Bill will ultimately enhance the governance of the HSE, the relationship between the executive and the Government and subsequently improve the standard of care offered to those who make use of its services.

Since the foundation of the HSE board, the Department of Health has extensively consulted with the HSE and, more recently, with the Department of Children, Disability and Equality to develop robust and effective governance, oversight and accountability structures and processes. The structures and processes are guided by the founding legislation of the HSE, the executive's code of governance, the separate but complementary oversight agreements between the two Departments and the HSE, and the code of practice for the governance of State bodies of the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation. The Bill's provisions will build upon these structures and processes to further enhance the HSE's accountability while retaining the independence and autonomy of the HSE board.

The purpose of the Bill is to ensure a more formal alignment of HSE and Government planning processes and to introduce more robust financial oversight measures, particularly in regard to any expenditure that exceeds the maximum amount allocated in the annual letters of determination issued by both the Department of Health and the Department of Children, Disability and Equality. This is achieved through the introduction of a number of new measures.

The Bill introduces an obligation on the Minister for Health to prepare a strategic direction statement in respect of health service priorities to guide the HSE in the preparation of its three-year corporate plan. The statement will specify the Department's priorities for the three-year period in question and may also specify particular goals or outcomes related to those priorities. The statement will be prepared in consultation with the Minister for Children, Disability and Equality. Similarly, the latter will have an obligation to prepare a strategic direction statement in respect of specialist community-based disability service priorities. These statements will issue to the HSE simultaneously no later than three months before the expiry of the corporate plan in operation at the time. The statements can be amended at any time throughout the three-year period if and as necessary.

The Bill provides for the replacement of the national service plan with a performance delivery plan. It places an obligation on the Minister for Health to issue an annual statement of health service priorities to the HSE. The statement will guide the executive in the preparation of the performance delivery plan and will contain priorities that are consistent with the contents of the strategic direction statements in operation at the time. The annual statement of health service priorities will be prepared in consultation with the Minister for Children, Disability and Equality. The latter will prepare a similar statement of priorities for specialist community-based disability services, to issue simultaneously and at a date no later than the issuing of the annual letter of determination from each Minister. The statements can be amended by either Minister in consultation with the other.

The Bill places an obligation on the chief executive officer of the HSE to notify in writing the executive's board, the Minister for Health and the Minister for Children, Disability and Equality if the CEO forms the opinion that the HSE is likely to exceed its allocated expenditure for any given year. When doing so, the CEO will be required to submit corrective action proposals for the approval of the HSE board. These proposals must outline the reasons for the projected overspend and the actions taken to attempt to avoid it. The proposals must be in line with the strategic direction statement and statement of priorities at the time. Either Minister may request that the HSE amend the proposals if they are deemed to be inconsistent with the strategic priorities or corporate plan in operation at the time or do not have sufficient regard to Government circulars or priorities.

The Bill makes a number of miscellaneous amendments that are required by outlying changes or to address practicalities arising from other provisions. These include, for example, the extension to 28 days of the 21-day deadline for the submission of the HSE performance delivery plan and the HSE capital plan to the Departments of Health and Children, Disability and Equality. A number of provisions correct references to sections of the Health Act 2004 that are being amended, removed or substituted by the Bill. The Bill also makes an unrelated amendment to the National Cancer Registry Ireland, NCRI, establishment order, which seeks to increase the membership of the board and amend the quorum arrangements accordingly. This addresses a recommendation in the Scally report to review the composition of the board of the NCRI.

I will now outline the provisions of the Bill section by section to clarify its content. The Bill comprises 28 sections. Section 1 is a standard provision giving the Title of the Bill and when it will come into effect.

Section 2 defines the Health Act 2004 as the principal Act referred to in the Bill.

Section 3 repeals sections 10A and 10D of the principal Act, which relate to the setting of priorities for the HSE by the Ministers for Health and children. The proposed new process for the setting of priorities is outlined in sections 17 and 18 of the Bill.

Section 4 inserts a definition for an approved performance delivery plan, which is to take the place of the definition for an approved service plan contained in the principal Act.

Section 5 amends the object and functions of the HSE to include a specific and explicit obligation to have regard to Government circulars related to expenditure as well as other relevant documents in the performance of its functions.

Section 6 updates a reference to the service plan to refer instead to the performance delivery plan being introduced in the Bill.

Section 7 amends the principal Act to account for the repeal of section 10A. Specification of priorities and performance targets to the HSE by the Minister for Health, which is currently facilitated under section 10A, will instead be provided for in section 17 of the Bill.

Section 8 updates a reference to the service plan to instead refer to the performance delivery plan being introduced in the Bill.

Section 9 amends the principal Act to account for the repeal of section 10D. Specification of priorities and performance targets to the HSE by the Minister for Children, Disability and Equality, which is currently facilitated under section 10D, will now be provided for in section 18 of the Bill.

Section 10 amends the functions of the HSE board to include an explicit obligation to ensure systems are in place to provide assurance the HSE is achieving the highest standards of budgetary management and value for money and is operating within authorised resources. It also requires the board to ensure compliance with Government circulars related to expenditure as well as Government policies, codes, guidelines and other relevant documents. Section 11 similarly amends the functions of the chief executive officer to include the same provisions as those in section 10.

Section 12 inserts definitions for each of the new strategic direction statements and removes the definition of an approved service plan.

Section 13 inserts a number of provisions outlining the obligations of the Minister for Health regarding the strategic direction statement in respect of health service priorities. These provisions include instructions on the content of the statement, the time of issue and the amendment process. The statement must be issued in consultation with the Minister for Children, Disability and Equality. Section 14 similarly outlines the obligations on the latter in regard to the strategic direction statement in respect of specialist community-based disability services.

Section 15 outlines the new obligations of both the HSE and the Government regarding the preparation, content, submission and approval of the HSE corporate plan. The section requires the plan to be prepared within three months of receipt of the strategic direction statements and in a manner consistent with the priorities of the Departments of Health and Children, Disability and Equality.

Section 16 corrects a reference to a provision that is repealed by the Bill. The section updates the reference to account for the new structure of section 29 of the principal Act.

Section 17 outlines the obligations of the Ministers for Health and Children, Disability and Equality and the HSE in regard to the annual statement of health service priorities that will guide the executive in the preparation of the performance delivery plan.

It also details the contents of the statement deadlines for issue, the amendment process and other relevant considerations. Section 18 similarly outlines the obligations of both Ministers and the HSE in relation to the annual statement of priorities for specialist community-based disability services.

See this speech in context