Dáil debates

Thursday, 30 April 2009

Health (Miscellaneous Provisions) Bill 2009: Second Stage (Resumed)

 

Question again proposed: "That the Bill be now read a Second Time."

2:00 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Cuirim fáilte roimh an Aire Stáit. This is not the Health Bill we should have before us in the Dáil today. On 1 April the Minister for Health and Children, Deputy Mary Harney announced the establishment of an expert group on resource allocation and financing the health sector. It is not due to report until April 2010. I have no doubt the deliberations of the new group will be used to further delay the publication of the Eligibility for Health and Personal Social Services Bill, which has been promised for years. Why the delay? The answer is obvious. The last thing the and the Government want to discuss is the question of rights and entitlements to health services. They have presided over and reinforced a system where wealth can buy better health care and the private for-profit health business is allowed to act as a parasite on the public health system.

As the public health system reels under the cuts imposed since 2007 and braces itself for even worse to come, the Minister, Deputy Harney ploughs on with the building of private for-profit hospitals on public hospitals sites, subsidised by the hard-pressed taxpayer. The Minister, Deputy Harney and the Government imposed a so-called public service pension levy on nurses and have sanctioned the non-renewal of contracts for up to 14,000 workers in the public health service. At the same time the Minister, Deputy Harney gave a gold-plated guarantee to the hospital consultants that their €250,000 per annum contract will not be touched. This is for a 33-hour week in the public system, and they can still work up to 25% of the time in private practice. Even at that, the hours are not properly monitored, providing another lucrative let-off for whatever number - it is not everyone - is happy to abuse their privileged position.

This is what the Minister, Deputy Harney and the Department of Health and Children preside over in crumbling Hawkins House which, a view not unique to me, is the ugliest building in this city. At times it has struck me as a very appropriate symbol of this Government's health policy.

What is the role of the Legislature in all of this? We are excluded from any role, except for the rubber-stamp type of legislation we have before us today, the Health (Miscellaneous Provisions) Bill 2009. The Minister, Deputy Harney has made herself unaccountable through the establishment of the HSE, while major policy decisions with major implications for the health service are not put before the Oireachtas. For example, the Government never put one sentence of substantive legislation before us regarding its co-location proposals.

This Bill gives more functions to the HSE and the Department, something I would be reluctant to do. Earlier this month in my constituency, two prominent general practitioners resigned from the HSE GP unit, citing in an open letter to Professor Brendan Drumm the arrogance of HSE management and its complete disregard for the views of general practitioners. In February this year, 41 GPs in Cavan and Monaghan signed another open letter opposing, on patient safety grounds, the removal of acute medical services from Monaghan General Hospital.

We have no choice but to address this Bill within its limited scope and to accept in good faith the assurances we have been given that the functions of the various bodies now to be subsumed into the Department and the HSE will be properly fulfilled. However, we must also be assured, and this is the assurance I am seeking today, that the work will be properly monitored and that the Minister, Deputy Harney, and the HSE will be fully accountable for these functions.

The Bill dissolves the National Council on Ageing and Older People and transfers its employees, assets and liabilities to the Department of Health and Children. It establishes the office for older people to support the Minister of State at the Department of Health and Children with special responsibility for older people, Deputy Barry Andrews The programme for Government has a commitment to frame and publish a national positive ageing strategy and the Department has informed me that this will now be its function.

A cross-departmental group has been set up to prepare the strategy and the former Minister of State, Deputy Hoctor, has said it is intended to facilitate the participation of older people in the process of preparing the it. These include an invitation to make written submissions and the conduct of consultation meetings around the country. I urge that this work proceed without delay. I also urge that the Government reverse its recent decision and proceed with the publication of the national carers' strategy, a matter of vital concern to older people. The production and implementation of these strategies will be the real test as to whether the office of older people will work.

With regard to the dissolution of the National Council on Ageing and Older People, the Women's Health Council, the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency, concern has been expressed about whether their functions will be safeguarded within the Department and the HSE. I wish to refer here to the relevant questions posed by the National Women's Council of Ireland and I ask the Minister of State, Deputy Andrews to respond in detail. As the Bill does not provide for any review mechanism to monitor or measure this change of policy direction against outcomes how will Government and the Oireachtas know if the functions of the agencies are being carried out by the Department of Health and Children? I ask the Minister of State, Deputy Andrews, to note the specific question, as well as a number of others I wish to pose, and to ensure they will be responded to fully in his closing contribution to this Second Stage debate. What is the estimated cost of dissolving these bodies and what are the projected savings, which we are told there will be? What is being done to safeguard the knowledge or institutional memory built up by these agencies since their inception? The staff in question have much knowledge and experience which should not be lost to the public service. What commitments have been made to ensure that the Department and the HSE will continue to work in partnership with civil society and other relevant sectors?

These questions are especially relevant to the Crisis Pregnancy Agency. Its establishment in 2001 was a recognition of the need to address crisis pregnancy in a comprehensive and effective way. It has made progress and helped to improve support for women facing crisis pregnancy. Since the inception of the agency, counselling services for women in this area have expanded significantly. The agency has also played a role in helping to prevent vulnerable women from ending up in the hands of rogue pregnancy agencies. However, the need for the work of the agency is as great as ever. Crisis pregnancy is still, and will always be, a major problem. What has changed to warrant dissolving the agency? This question goes to the kernel of the Bill. Is it really about enhancing efficiency and co-ordination or is it simply a money-saving exercise? We need clarity; we need the bare facts laid before us. Whatever answers we are given, time will tell, but we also need to know what mechanisms are in place to monitor the effectiveness of the work formerly carried out by these agencies and now to be carried out by the Department and the HSE. I have made this point already and I re-emphasise it.

I welcome the amendment of the Hepatitis C compensation scheme to remove age limits for travel insurance. The National Cancer Screening Service Board is also to be dissolved and its functions subsumed within the HSE, becoming part of the HSE's cancer control programme. The Bill provides for the National Cancer Registry Board to be appointed by the Minister, yet it is also to be subsumed into the cancer control programme in 2010. Will this be an interim board pending the change in 2010? If so, what will its functions be over that period? I hope the Minister of State will address the questions I have raised during the course of this contribution.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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The Minister of State has not less than 15 minutes to reply.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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Not less?

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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Actually, I am advised the Minister of State can speak for as long as he wishes.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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I assume I am also permitted to speak as little as I wish.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I will protect the Minister of State as much as possible.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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I thank Deputy Ó Caoláin for his contribution and for the attention he has brought to the Bill. He was the only person to make a contribution, which is to his credit.

This Bill contains some of the efficiencies recommended in the public sector. The OECD, as the Deputy knows, made it clear that certain efficiencies could be secured through amalgamation and by subsuming certain agencies into parent Departments. In my own area, the Centre for Early Childhood Development and Education is to be subsumed into the Office of the Minister of State for Children and Youth Affairs.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I am sorry to interrupt. On a point of information, what did the Minister of State say about Deputy Ó Caoláin's contribution?

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It was a fine compliment and I do not ask him to take it back.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Not at all, but did the Minister of State say it was the only contribution?

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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Yes.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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This is the end of Second Stage. We have all made our contributions prior to this.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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I am sorry; I did not understand that.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I wanted to put that on the record of the House.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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I apologise and withdraw the slur on the Deputy's character.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank the Minister of State-----

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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Deputy Reilly has never been lost for words.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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-----magnanimously.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The spirit of what the Minister said is accepted graciously.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I do not want to detract from Deputy Ó Caoláin's contribution.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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Neither Deputy has been lost for words in my experience.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I presume it will read well in the Cavan and Monaghan papers.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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If not The Echo in Tallaght.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There you have it.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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They will recover from the shock.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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The Minister of State may proceed.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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As I was saying, the Centre for Early Childhood Development and Education is to be subsumed into my office, but this will not require any statutory change. The OECD mentioned in particular the Office of the Minister for Children and Youth Affairs for the way in which it interacts with the main Government Departments and other agencies. This step is in keeping with the announcement in the budget that we will be rolling out an free early-years preschool system for all three and four year olds. The centre will bring to the Department a level of expertise that has hitherto been farmed out to other agencies, which is welcome. It has been suggested the Government is afraid to make tough decisions, but we have been making extremely tough decisions, and this has been recognised internationally. The Deputies do not have to take our word for it. Many commentators have noted that the tough measures in the emergency budget and last October's budget attracted much praise for the mettle shown by the Minister for Finance.

The health reform programme acknowledged that there was a need to streamline the number of health sector agencies with a view to achieving a more co-ordinated system. This objective was echoed in the Government's plans, announced last year, for the rationalisation of State agencies. The primary aim in rationalising these bodies is to streamline service delivery in the health service and promote service integration. The proposals are consistent with and build upon progress to date with agency rationalisation in the sector under the overall health reform programme. However, the Minister expects financial efficiencies to be gained over time due to economies of scale and the elimination of duplication in areas such as recruitment, procurement, payroll and ICT systems.

Deputies have raised concerns that the impact of the Women's Health Council and the National Council on Ageing and Older People will be diminished when they are integrated into the Department. The primary function of these two agencies is to give advice to the Minister. The repositioning of this advisory function with regard to women's health and older people in the Department will facilitate the Minister in formulating policy in these areas. It has often been a criticism that Departments do not have the expertise to formulate policy, and these steps will serve to address that perceived shortfall. Employees will be transferred under the Bill and their expertise, therefore, will be retained as they become civil servants in the Department.

Employees of the Crisis Pregnancy Agency, the Drug Treatment Centre Board and the National Cancer Screening Service Board will be transferred to the HSE and thus their skills will remain within the public health service. In the case of the Crisis Pregnancy Agency, the Bill expressly provides for the transfer of functions to the HSE in line with legal advice. The work of these bodies will be continued within the HSE and the integration of their functions and staff will be carefully managed to ensure the seamless continuation of services.

The National Cancer Registry will be integrated within the HSE in due course and the amendment to the board's structures is, as was outlined by the Minister, intended to forge closer links between the registry and the HSE's national cancer control programme. The board is currently composed of up to ten persons appointed by the Minister, seven of whom are appointed on the nomination of particular bodies such as the Irish Cancer Society and the Royal College of Surgeons in Ireland. The Bill provides for the appointment of a seven-person board with knowledge or experience of the collection, recording and analysis of information, the use of such information in research projects, or the management and planning of services.

Deputies have asked how they might ensure services are not impaired on the integration of the five agencies within the Department of Health and Children and the HSE. There are well-established accountability arrangements in place. The Minister is accountable to the Oireachtas and the chief executive of the HSE is required to appear before Oireachtas committees. Both the Department and the Health Service Executive publish annual reports which set out activities and service developments and which are, appropriately, subjected to the not inconsiderable glare of the media.

I thank Deputies for their contributions. The Minister looks forward to further constructive examination of the Bill on Committee Stage.

Question put and agreed to.