Cormac Devlin (Dún Laoghaire, Fianna Fail)

I welcome the opportunity to speak in support of the Health (Amendment) Bill 2025, which is a timely and necessary step to strengthen governance, transparency and accountability in our health service. This Bill delivers on a core commitment in the programme for Government to embed productivity and ensure full transparency in how healthcare services are delivered. It recognises that strong, accountable structures are essential if we are to meet the needs of a growing and ageing population and deliver better health outcomes for our citizens.

This legislation addresses a long-standing gap in the Health Act 2004 by clearly setting out how the CEO of the HSE and the board must engage with the Minister for Health and, in the case of disability services, the Minister for Children, Disability and Equality. It introduces a more structured, accountable framework for how the HSE plans and delivers services, including strategic direction statements that Ministers will issue to guide the HSE’s three-year corporate plans; a new system of performance delivery plans, replacing the old service plans and informed by annual statements of priorities from each Minister; and, most importantly, a new statutory requirement for the CEO to bring forward corrective action proposals where expenditure is expected to exceed allocation. This is about real accountability, not just in how money is spent, but in how performance is measured and managed.

The scale and complexity of our health service has grown rapidly over the past two decades. The HSE now operates with a budget of €26.9 billion, a €1.6 billion increase on last year alone. That includes nearly €300 million in new service developments within mental health, older persons and disability services. With that level of investment comes a responsibility to ensure that we are delivering the best possible return for patients, staff and the public.

We know the challenges. Demand in our hospitals is rising by 5% to 10% annually. The number of people over the age of 75 has increased by 26% since 2019. We are dealing with the long-term costs of high inflation and post-Covid activity spikes.

Despite these pressures, progress has been made. Waiting times are falling, and are now down from 13 months to just longer than seven months for outpatients. Trolley numbers are also down 11% year on year. Free GP care has been extended and hospital charges abolished. This progress is possible because of the record levels of investment. Now, thanks to this Bill, we are building in the governance structures to sustain that progress into the future.

The return to a board-led governance model for the HSE, first legislated for in 2019, was a vital reform. The 2013 directorate structure was rightly found by the Sláintecare report to be unfit for purpose. This Bill builds on that by ensuring that the CEO is directly accountable to the board and that the board, in turn, is accountable to the Minister. It also reflects the significant transformation under way with the establishment of the six new health regions. These regional structures aim to deliver more integrated care closer to home and tailored to local needs, a key ambition of Sláintecare.

The Bill reflects the values of the Government more widely and of Fianna Fáil, namely, responsibility, reform and better outcomes for patients. It ensures that the HSE is not only better funded, but better managed. It also complements the work of the productivity and savings task force, which is delivering efficiencies across the system. Last year alone, and as the Minister alluded to, €251 million in savings were delivered. A further €382 million is targeted this year. These are not abstract numbers; they translate directly into shorter waiting times, more staff and better care.

While this Bill focuses on management and accountability, we also need to see continued capital investment in buildings, infrastructure and equipment. I think of the need for the expansion, of which the Minister will be well aware, of the National Rehabilitation Hospital in our own constituency, an objective to which we are both very committed. Hopefully, we will see the capital funding arise for that in the upcoming budget.

St. Michael’s Hospital, Loughlinstown hospital and St. Vincent’s University Hospital also all have ambitious plans.

Of course, while the big ticket plans grab attention, it is equally important that we support smaller capital projects in communities, for example, delivering on housing and respite facilities for people living with disabilities. I know the Minister will continue that focus in budget 2026.

I commend the Minister on introducing this legislation forward. It will help to ensure that health spending is tied to clear plans, clear targets and clear accountability. That is what the public expect and that is what the Bill will deliver. I am pleased to support it. Go raibh maith agaibh.

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