Peter Roche (Galway East, Fine Gael)

I support the Second Reading of the Health (Amendment) Bill 2025. The Bill is timely and necessary and fundamentally about one thing: accountability in how we plan, manage and deliver healthcare in Ireland. The central purpose of the legislation is to ensure the Health Service Executive operates under the highest standards of prudent and effective financial management. It replaces the old service plan model with a more accountable performance delivery plan, strengthening the role of Ministers and the HSE CEO in financial oversight and correction.

Since 2015, health spending has exceeded its initial allocation almost every year. These overruns not only challenge our public finances; they ultimately threaten service delivery. The people of Galway East, like communities across our country, deserve assurances that resources are being used efficiently to deliver timely and effective care. This Bill gives the Minister the capacity to question these finances and work for the communities that need care and intervention.

This Bill introduces several key reforms and brings in: strategic direction statements from the Minister will help guide the HSE’s corporate plan, ensuring alignment with national priorities; mandates early warning and corrective action mechanisms if the HSE is projected to overspend; and, crucially, places legal obligations on the CEO and board to stay within approved financial parameters.

I welcome the clarity and discipline this Bill imposes. However, will the performance delivery plan give local health services, like Portiuncula Hospital in Galway and community care hubs in east Galway, the flexibility they need? Will funding allocations truly reflect the demographic demands of rural regions like east Galway, which has an ageing population and growing waiting lists for inpatient and outpatient care? Accountability must not become bureaucracy rather it must lead to outcomes.

This Bill rightly brings sharper tools to financial governance but it must be paired with real insight into what drives health spending. We know, for example, that east Galway continues to suffer from GP shortages, delayed disability assessments and pressure on mental health services. Budget discipline must be matched with strategic investment, especially in primary and community care, in line with Sláintecare.

In east Galway, the community is ready to embrace integrated, regionally led care models but we must see more visibility around the HSE's performance locally and not just nationally. How will this Bill ensure that people in Ballinasloe and Loughrea can see tangible improvements on foot of national reforms?

I fully support the power of Ministers to direct the HSE when it comes to corrective actions, but we must go further in the context of clarifying accountability between the Department and the HSE. Oversight without consequences is not accountability.

This Bill is a strong step forward. It reflects the findings of the Sláintecare report and builds on the governance improvements of the 2019 Act but we must ensure that it results in better care, not just better paperwork. For Galway East, for our nurses, GPs, and carers, this Bill must ultimately support those on the front line and not just the balance sheet.

In the context of the contributions already made to this debate, it would be remiss of me not to mention the outstanding work our front-line workers do every day and sometimes under severe pressure. No one can predict when there will be an emergency or an outbreak. From experience and from my knowledge of how the HSE, particularly in the context of University Hospital Galway, Merlin Park and other hospitals in Galway, deals with these scenarios, I have to compliment and thank those workers. It is important to say that.

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