Brian Lenihan Jnr (Dublin West, Fianna Fail)

The Health (Amendment) Bill 2004 represents a further step in the implementation of the Government's health service reform programme, which it announced last June. It is very much interim in nature and is being enacted pending the introduction by the Minister for Health and Children of legislation later in the year to give legislative effect to the other proposals in the reform programme.

As Senators will be aware, the reform programme is one of the most ambitious change management programmes undertaken in the health service. It has its origins in the national health strategy, Quality and Fairness — A Health System for You. The strategy forms a blueprint for the further development of our health system to meet the needs of patients and deliver high quality care in the years ahead. While the current structures have served us well over the past 30 years, the strategy recognised the need to review them to ensure they were appropriate and responsive to the needs and challenges of delivering health services in the changing environment of the 21st century.

The four principles of equity and fairness, the need for a people-centred service, quality of care and clear accountability underpinned the development of the strategy. On the basis of these principles, four goals were identified to guide and shape the strategic direction of the development of health services. These were better health for all, fair access, responsive and appropriate care delivery and high performance. The strategy recognises that the health service of the future must be co-ordinated and integrated with a consistent, national approach to delivery based on clear and agreed national objectives.

Arising from the strategy commitment, three reviews of the health system were undertaken. These included the Prospectus review, an audit of structures and functions in the health system, and a review commissioned by the Minister for Finance and carried out by the commission on financial management and control systems in the health system. The reform of the acute hospital sector was being advanced at the same time by the national task force on medical staffing which issued the Hanly report. This report set out recommendations on how to plan the reduction of average working hours of non-consultant hospital doctors by 1 August 2004 to meet the requirements of the European working time directive. Its recommendations also covered planning for the implementation of a consultant-driven service and the medical education and training needs associated with the working time directive.

A main finding of the review of the health system was that the number of agencies involved in the provision of health services caused the delivery to be very fragmented. This fragmentation resulted in an overlap in the delivery of certain services and, in some instances, a lack of clarity as to who was responsible for the delivery of the service. The Government announced the health service reform programme based on the recommendations of the Brennan and Prospectus reports in June 2003. The programme's priorities are improved patient care, better value for taxpayers' money and improved health care management. The reform programme centres on an organisation of approximately 100,000 staff and a budget in excess of €10 billion. I am sure Senators can recall me pointing these figures out before.

Key elements of the programme include a major rationalisation of existing health service agencies, including the abolition of the existing health board and authority structures and the establishment of a health service executive, which will be the first ever body charged with managing the health service as a single national entity. Furthermore, a health information and quality authority will be established to ensure that safety and quality of care are promoted throughout the system while the reorganisation of the Department of Health and Children will take place to ensure improved policy development and oversight. It is also necessary to modernise the health system's supporting processes of service planning, management reporting, etc, to bring them into line with recognised international best practice and to strengthen governance and accountability across the system. The establishment of a health service executive as the first ever body charged with managing the health service as a single national entity is the cornerstone of the reform programme. On its establishment and following the abolition of the health boards and the Eastern Regional Health Authority, the executive will be responsible for the delivery of health services on a national basis.

The responsibilities of the proposed health information and quality authority will include assisting the health service executive in the development of high-quality health information systems to enable it to plan and arrange the delivery of health services based on evidence-supported best practice.

The HIQA will also provide an independent review of quality and performance and it will be involved in promoting and implementing quality assurance programmes nationally. Its analysis will support and inform the Department in its policy development role.

The HIQA will be established as an independent statutory agency, directly accountable to the Minister for Health and Children. The reorganisation of the Department of Health and Children to allow it to support the Minister in focusing more on strategic and policy matters is also proposed in the reform programme. Following its restructuring, one of the Department's fundamental roles will be responsibility for holding the service delivery system to account for its performance. The reform programme also involves a programme of consolidation and rationalisation of 27 existing agencies, which will be subsumed by the HSE, HIQA or the restructured Department. This consolidation of service providers will help reduce the fragmentation of services in the health system and make services more integrated and easier to access for the public.

The implementation of the reform programme is now well under way. Phase 1 included a communication and consultation process; the establishment of the national project office within the Department of Health and Children; the establishment, work and output of 13 action projects; the establishment of the interim health service executive and appointment of the chairman and board of the interim executive; and the development of a high-level programme plan identifying key milestones for 2004.

A national steering committee, whose role is to oversee, monitor and steer the reform programme, has been appointed. It reports to the Minister and to the Cabinet committee on health and children on progress achieved on implementation. Its task is to drive the overall reform programme in a co-ordinated manner, involving the interim health service executive, the Department and the Hanly group, and to ensure that direction and progress are in line with the Government's decisions.

The interim health service executive, which has been established as a corporate body, has begun its work of drawing up a plan, for the approval of the Minister, for the establishment of a unified management structure for the proposed new health service executive. It will also need to plan for the smooth transition from the current structures to the new HSE structure. The interim executive is also required to put procedures in place for the development of a national service plan for the delivery of health services on a national basis and for the establishment of appropriate structures and procedures to ensure proper governance and accountability arrangements for the proposed health service executive.

As I mentioned earlier, the Minister will be bringing forward legislation later in the year which will provide for the establishment of the health service executive to replace the Eastern Regional Health Authority and the health boards. That legislation will also provide for the establishment of the health information and quality authority. It will make provision for improved governance and accountability as well as planning, monitoring and evaluation. It will provide for the establishment of a statutory complaints framework for handling of complaints in the health services, as recommended in the health strategy. The framework will provide for greater clarity and uniformity of approach in dealing with complaints and will also provide for structured local resolution processes with an opportunity for independent review.

The Minister is conscious of the concerns expressed regarding the lack of public participation in the restructured health system. This Government takes the issue of democratic accountability seriously. The Minister has, therefore, given much consideration to the appropriate mechanisms to be put in place to facilitate opportunities for input at both regional and local level between locally elected representatives and the health service executive.

The provisions in the legislation are likely to include the establishment of a series of regional forums to facilitate local representatives in raising issues of concern to do with health services within their regions with the executive. Membership of the forums would be based on the participation of a number of nominees from each local authority. Putting such arrangements in place would ensure that the voice of local public representatives would continue to be heard in the matter of the development of health services. These arrangements will be designed to complement and reinforce the role of the Oireachtas Joint Committee on Health and Children in reflecting the views of public representatives in the ongoing oversight of the health system.

The health strategy identified the need for a more structured approach to community participation in decisions about the delivery of health services. In furthering this objective, the health boards executive, in association with the Department, issued guidelines to the health boards on community participation. These guidelines set out the principles and framework for structures for such participation. Most health boards have established consumer panels that deal with a wide range of issues such as the development and delivery of services. Two boards have also established regional advisory panels for older consumers and their carers. The Minister intends to establish these structures on a legislative basis in the next Bill. It is the Minister's intention that these structures will be in place from January 2005.

As I said at the outset, this is interim legislation pending the introduction of legislation establishing the new structures which the Minister will be bringing forward later in the year.

The Bill provides for the abolition of the membership of the Eastern Regional Health Authority, area health boards and health boards, while retaining the authority and boards as legal entities; the termination of office of all members of the health boards and the authority from the date on which an order is made bringing the Act into operation; the assignment of the authority or boards' reserved functions to the chief executive officers or the Minister for Health and Children, as appropriate; and the amendment of existing legislative provisions regarding the acquisition and disposal of property by the health boards and the Eastern Regional Health Authority by re-introducing the need for ministerial consent prior to the acquisition and disposal of property.

The Bill amends the Health Act 1970, which established the health boards, the Health (Amendment) (No. 3) Act 1996, which deals with accountability issues and defines "reserved" and "executive" functions, and the Health (Eastern Regional Health Authority) Act 1999, which established the Eastern Regional Health Authority and the area health boards. It also amends the provision of the Local Government Act 2001 which provides for the nomination by local authorities of members to the health boards and the Eastern Regional Health Authority. I will now deal with the main provisions of the Bill.

Section 1 deals with the Title of the Bill, its collective citation and its construction. It is a normal type of section. It provides for the commencement of the provisions of the Bill by order of the Minister and it provides that different provisions may come into force on different dates. Section 2 deals with the definitions used in the Bill. Section 3 provides for the repeal of sections of previous Acts detailed in the Schedule.

Section 4 of the Bill amends section 4(1) of the 1970 Act by deleting the reference in that Act which enabled the Minister to specify the membership of health boards. The provisions specifying the membership of the boards, the application of certain rules in the nomination of members by county or city councils and the obligation to consult such councils before making regulations defining functional boundaries of the boards are being repealed.

Section 5 of the 1970 Act deals with the rules that apply in regard to membership and meetings of health boards and authentication of the board's seal. These provisions, subsections 1(d) and (e), 2 and 3 and the Second Schedule, are being repealed. Currently, the signature of the chairman or that of another member of the board is required to authenticate the seal. As a result of the removal of the membership of the board, section 5 of the Bill provides that the board's seal shall be authenticated by the signature of the chief executive officer and another officer authorised to do so.

Sections 6 to 8, inclusive, delete the requirements of the chief executive officer to consult or agree with the chairman or vice-chairman of a health board on any matter. These are necessary to take account of the fact that there will no longer be a chairman or vice-chairman of health boards in this interim period.

Sections 9 to 14, inclusive, make amendments to the Health (Amendment) (No. 3) Act 1996. Currently, under the 1996 Act, reserved functions of a health board are functions exercised directly by the board and the authority, while executive functions are those exercised by the chief executive officer. Section 9 of this Bill assigns all functions of health boards to the chief executive officer. Section 10 provides that the CEO must provide the Minister with any information in regard to the performance of his or her functions which he or she may request from him or her.

Sections 11, 12 and 14 make amendments to the provisions relating to the adoption of service plans by health boards and the authority and to the provisions relating to the submission of accounts to the Comptroller and Auditor General and the publication of the annual report. Section 13 assigns the board's function in regard to the appointment and removal of the CEO to the Minister.

Section 15 amends the Health Act 1947. It provides that the board and the authority must obtain the consent of the Minister prior to the acquisition or disposal of property. This reverts the legal position to the state of affairs which obtained before the enactment of the 1996 Act, which introduced an amendment permitting the boards and the authority to acquire and dispose of land subject only to general directions by the Minister. In the absence of appointed boards, there is a need for control in this area in the interim period.

Sections 16 to 24, inclusive, make the necessary amendments to the Health (Eastern Regional Health Authority) Act 1999 to abolish the membership of the ERHA and the area health boards. Sections 18 and 21 deal with the authentication of the seals of the authority and the area health boards. Section 20 assigns the functions relating to the appointment of the regional chief executive to the Minister. The functions relating to the appointment and removal of an area chief executive are assigned to the Minister in section 23. Section 25(a) assigns the functions of the authority to the regional chief executive and section 25(b) assigns the functions of an area health board to an area chief executive.

Under section 220 of the Local Government Act 2001, local authority members are empowered to nominate members to specified linked bodies. Section 220 is amended by section 26 of this Bill by deleting the inclusion of a health board, the Eastern Regional Health Authority or an area health board from the definition of "linked body". The effect of this amendment is that local authority members will no longer have nominating rights to health boards, the authority or to area health boards.

Section 27 of the Bill terminates the membership of all members of the boards, the authority and the area health boards from the date on which an order bringing the section into operation is made. As the terms of office of the members vary for the different categories, the purpose of this section is to ensure that the terms of office of all members is terminated at the same time.

Section 28 makes provision for work commenced by the members of the boards, the authority or an area health board to be carried on by the CEO without having to begin the process again.

Section 29 of the Bill was inserted at Report Stage in Dáil Éireann. A similar amendment was tabled on Committee Stage by Fine Gael and the Minister provided his own amendment which is now in the form of this section. This was voted on last night by the Dáil. It provides that the Oireachtas Committee on Health and Children may require the chief executive officer of a health board, the regional chief executive of the authority, or an area chief executive of an area health board to appear before it to give account for the general administration of the board or the authority. Similar provisions are included in other legislation establishing State bodies, such as the Courts Service.

As I said at the outset, this interim Bill marks a further step in the process of the implementation of the health service reform programme. Its enactment is a further indication of the Government's commitment to the delivery of a reformed health service which has as its objective the maximisation of the level and quality of care provided to patients and clients in the years ahead. It is obvious the Minister has undertaken an ambitious programme of fundamental reform on health structures in the State.

This Bill is necessitated by the fact the local elections are now due. In the absence of this legislation, the new authorities would begin the process of appointing new members to health boards. It would be pointless to do so when the Government is committed to introduce legislation to abolish these boards within the year. That is why the Bill is before the House. I commend the Bill to the House and I look forward to hearing the views of Senators.