Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 5: To ask the Minister for Health if the number of senior managers in the Health Service Executive receiving salaries of more than €100,000 per annum will be reduced as part of the changes in management and administration of the HSE he announced recently after Cabinet approval; and if he will make a statement on the matter. [1361/12]

James Reilly (Dublin North, Fine Gael)
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As a step toward achieving this goal, I will bring legislation forward involving significant changes in the governance of the HSE. The legislation will abolish the board of the HSE and will replace the board structure with a directorate structure. The purpose of the new directorate structure is to drive greater transparency, accountability and efficiency, and to reshape the system to better support the Government's health reform programme.

The following seven areas will be the subject of a directorship: - hospital care, primary care, mental health, children and family services, social care, public health and corporate/shared services. One of the directors will be appointed as the Director General. The directorate team will run the health services as they exist and prepare for the transformation required in the move to UHI.

The new structure is intended to provide clarity as to the responsibility for the delivery of the services under each director, as well as greater financial transparency and accountability in those services.

Given the very challenging situation the health service faces in 2012 and future years, strong management capacity is needed to improve performance, to deliver on service targets in an effective and efficient way within available resources and to lead change in a complex environment. The changes I have announced are intended to improve the management of the service. In view of the nature and scale of the changes proposed, it is not possible at this stage to say whether there will be a reduction in the number of senior managers being paid salaries of more than €100,000.

It is envisaged that the directorate posts will be filled on an accelerated basis in accordance with the Public Service Management (Recruitment and Appointments) Act 2004. The remuneration for these positions will be in accordance with Government policy and will be subject to the approval of the Minister for Public Expenditure and Reform. The following seven areas will be the subject of a directorship: hospital care; primary care; mental health; children and family services; social care; public health; and corporate-shared services. One of the directors will be appointed as the director general. The directorate team will run the health services as they exist and prepare for the transformation required in the move to universal health insurance.

The new structure is intended to provide clarity as to the responsibility for the delivery of the services under each director, as well as greater financial transparency and accountability in those services. Given the very challenging situation that the health service faces in 2012 and future years, strong management capacity is needed to improve performance, to deliver on service targets in an effective and efficient way within available resources, and to lead change in a complex environment. The changes I have announced are intended to improve the management of the service. In view of the nature and scale of the changes proposed, it is not possible at this stage to say whether there will be a reduction in the number of senior managers being paid salaries of more than €100,000.

It is envisaged that the directorate posts will be filled on an accelerated basis in accordance with the Public Service Management (Recruitment and Appointments) Act 2004. The remuneration for these positions will be in accordance with Government policy and will be subject to the approval of the Minister for Public Expenditure and Reform.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am sure the 110 senior managers will heave a sigh of relief that at least the Minister is not signalling that their salaries will be cut any time soon. Why did the Minister wait until the Dáil went into recess to announce this so-called package of reforms? Why was it not done it in the previous weeks when we had the opportunity to discuss it here in the Dáil Chamber? He has not given us a timeline for legislation. He heralded wholesale change in the HSE appointing an interim board and now seven directors are signalled to take over responsibility. However, accountability must rest with him. When will we see the legislation and what exactly is involved? What reduction in bureaucracy does the Minister expect from changes and how does he expect that to impact? If the salaries of those 110 managers earning in excess of €100,000 are not to be touched, what reductions will take place in the administration and bureaucracy of the HSE as against the cuts in front-line services we have seen all too regularly in recent years, which are continuing apace in the current year?

Michael Kitt (Galway East, Fianna Fail)
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I call the Minister.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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When does the Minister expect to introduce legislation? When will we see the reality of the changes he intends?

James Reilly (Dublin North, Fine Gael)
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I assure the Deputy that he will have plenty of opportunity to discuss this in coming weeks. I intend to introduce the legislation at the earliest possible time - probably towards the end of next month. As I said in my original response, we are doing this because I want much clearer sight of money. We know what happened during the fair deal issue when moneys were put aside to accommodate people in long-term institutions. Once it went below the level of the regional director of operations it became very difficult to follow it. Moneys were going under different headings, which was unacceptable. I want to be able to know where the money went from the very top down to the very bottom. Hard pressed taxpayers have the right to expect that we, as Ministers acting on their behalf, have full sight of where money goes and how it is spent, and who makes decisions and why.

In addition we will move care, particularly of chronic illnesses, from the hospital sector back to primary care. I am working very hard with the Minister of State, Deputy Shortall, in this regard. We want a clear line of vision of the funding for those pillars, whether it is mental health under the Minister of State, Deputy Kathleen Lynch, primary care under the Minister of State, Deputy Shortall, or hospital care. When we can see those lines we can move money from one to the other in a very clear transparent fashion. When we have that done, we can look back towards universal health insurance through an integrated care agency.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Nothing in what the Minister said indicates we will see changes that will impact on the important front-line service delivery systems within the health services. Nothing he has signalled in terms of so-called reform will in any way reduce the impact of the cuts announced in budget 2012 in terms of the delivery of front-line services this year.

I welcome that the Minister is putting a timeframe on the introduction of legislation, which means we will at least have an opportunity to scrutinise what is intended. The Minister, in response to a question from me on the White Paper on the financing of universal health insurance which he proposes to introduce, indicated in this House that it will be three or even four years before that White Paper presents. Is that still the case? As such, these so-called reforms are very much long-fingered proposals and what the Minister is doing is tweaking at the higher echelons of oversight and management. Nothing the Minister is doing will impact on the front line in terms of the needs of people and patients.

James Reilly (Dublin North, Fine Gael)
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I can assure the Deputy that the needs of patients and patient experience are to the fore of everything we are doing. That is the key issue for us. The Deputy is correct that many people who work within the service believe we are only moving the old pieces at the top again and that this will make no difference to them. It may not be easy to see when one is down on the floor working hard dealing with emergencies day in, day out but things are going to change, including how budgets are organised, where money is going and who is making the decisions on where it is spent.

On the White Paper, it will be finished by the end of this year. The directorates around the universal health implementation group have been formed but the names have not yet been signed off on.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Is the Minister bringing forward the White Paper in 12 months' time?

James Reilly (Dublin North, Fine Gael)
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Yes.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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When did the Minister make that decision, given just over a month ago he told me it would not be ready for three to four years?

Michael Kitt (Galway East, Fianna Fail)
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Deputy Ó Caoláin should allow the Minister to continue without interruption.

James Reilly (Dublin North, Fine Gael)
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It is in the service plan. I would prefer to under-promise and over-deliver than to do it the other way round.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We will see. I regret the Minister has not yet ticked that box.

Billy Kelleher (Cork North Central, Fianna Fail)
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Lessons have been learned.

James Reilly (Dublin North, Fine Gael)
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I would like to make the following final point, much to the mirth of our friend from Cork. The reality is that we must reform the service at the top so that structures can be put in place to allow people on the front line to deliver the service they are well capable of delivering. We must support those at ground level at the same time. This is being done through the service delivery unit, SDU, which has made a real impact. The clinical programmes commenced their genesis under the previous Administration. Without the support of the SDU in terms of implementation, the impact made to date would not have been made, which is acknowledged by the people concerned. What we have is a powerful combination of clinical programmes and a service delivery unit to ensure they are implemented, not alone where they start, namely, Cork, but across the system.