Kathleen O'Meara (Labour)

I welcome the Minister of State to the House. It is important to have such a debate, although I am disappointed, not in the time allocated for Second Stage, but that we are up against the Christmas deadline in terms of passing this legislation. It is probably not the Minister of State's fault. The Bill also came late to the Dáil. This legislation has been talked about for approximately 18 months, since the interim Health Service Executive was established. We now have a massive piece of legislation and not all amendments were debated in the Dáil. Many of them are significant and important. We are implementing a major administrative change in probably the most important area for which the Government has responsibility. We are doing so against a backdrop of a deadline. Regrettably we do not have enough time to fully debate the issue.

I have perused the recent Dáil and Committee Stage debates. The more one reads the legislation, the more concerned one becomes. Much is not included and much is not clear. If the Government is not clear about the issues, one wonders if we are going headlong into a major mistake. The legislation seems driven by an ideological imperative regarding centralisation. It seems the health boards must be abolished because they were somehow doing a disastrous job and costing a pile of money, that politicians should never have had a role in their function and that we would never have a modern health service while the structure existed. Opinion on the structure of the health boards was that it was unmanageable, unwieldy and at fault for the health service which exists. That is not true.

From the Prospectus and Brennan reports we know reforms are needed. Nobody in either House could dispute this fact. One must update a structure as important as the health service to ensure it delivers. It clearly has not been delivering. One only needs visit an accident and emergency department in any of the major Dublin hospitals, in particular the Mater, to realise something is seriously amiss. One only needs to look at waiting lists and listen to the complaints of communities across the country about the use of hospitals and the health service to know something is extremely wrong.

In spite of more and more money being poured into the health service in the past number of years by the former Minister, Deputy Martin, it is still not meeting the mark. This legislation is about administrative reform, as if that alone is the solution. If only it was. Let us assume it is the solution and that if the health service was better managed it would work more efficiently for everybody. What would be the best administrative structure? The Government has devised the most centralised and removed structure. There will be a board, but we do not know who will be on it or what their interests might be. A powerful chief executive officer will head the board, but he or she has yet to be appointed. The board will report to an Oireachtas committee under-resourced to do the job. Consultative forums will have no teeth. The workforce are, at this stage, unclear on certain issues and concerned about the future. Many communities around the country are also concerned.

In terms of administrative reform of the health board around the country, I noted on the map that north County Tipperary is now included in an area that stretches from north Tipperary to the top of County Donegal. Its central administrative function, or regional office, will be in Galway. The same outline is used by BreastCheck for administrative purposes. Its reason for using such a structure is that it needs a critical mass of population in order to operate correctly. I was astonished to see the same administrative boundaries applied to the health boards. The area is huge. North Tipperary, which is currently grouped with counties Limerick and Clare is disconnected from Limerick and creates a different dynamic for the staff in the north Tipperary area. Nobody has been able to tell me clearly what the future looks like. Here we are on 10 December being told that establishment day is 1 January. I note a report in The Irish Times today, which suggests that while establishment day is 1 January 2005, many of the old structures will remain in place for the moment. Perhaps the Minister of State will clarify that point. The Tánaiste made no reference to that issue in her speech earlier. We are looking at a centralised administration, a board whose complexion is unknown, a CEO whose name is not known and a future we cannot predict. That is an unsatisfactory situation. Despite the fact that it is very long, the legislation does not spell out how the health service will work in practice. There are a number of issues I want to raise.

The Minister says, quite rightly, that the main ethos of the new administrative structure is the care and welfare of the patient. It is interesting, given the Bill is so substantial, that the patient is mentioned only once. This is an administrative structure, but it seems that while administration and accountability for public money are obviously important, this does not appear to be a structure designed to serve the patient. It looks like a structure designed to serve itself and the Minister. I note in particular the relationship between the board and the Minister and I begin to wonder if we are getting to the heart of the question as to why Professor Halligan did not take up the job. The Minister retains a large amount of power.

A budget is being given to the board with which to produce a world-class health service for the patient, allegedly. However, the Minister will issue directions to the board, which can be fired if it does not follow them. Therefore, the board is not independent and the power of the Minister is substantial. To a certain degree, that is probably necessary because the money is coming from the taxpayer and under our democratic system the Minister has accountability in that regard. By the same token the Minister is giving enormous power to the board, so there appears to be a recipe in place for serious conflict in the future between it and the Minister. I wonder how this can work out in practice.

In terms of the board itself I am concerned over its membership. There are currently very powerful players within the health service who have ways of making their voices heard. One thinks, for example, of the consultants and the royal colleges in particular. The power of the royal colleges to grant or withdraw their approval is critical as regards how a teaching hospital, for example, might or might not be run. Will the royal colleges be represented on the new board? Will pharmacists, nurses or workers be represented on the board? We do not know.

I am also concerned about the role of the voluntary and community sector. One of the major features of this legislation, apart from the removal of elected representatives, is the absence of the voluntary and community sector from the health board structure. I hope the Minister of State appreciates by now that there is major concern in this sector over its representatives being excluded from the superstructure being passed in this legislation. I know the Tánaiste referred to the voluntary and community sector in her speech. Aspiration is one thing, but reality is different.

I am sure Members of the House will have received, as I have, representations or an analysis from the disability federation arising out of what has not happened with this legislation in the Dáil and what remains to be done. I will be tabling amendments next week, for which I hope enough time will be given, to reinstate the voice of the voluntary and community sector within this framework. It is completely excluded and there is much concern, particularly among groups such as the Disability Federation of Ireland, which is so dependent as a representative group on its good relations with health boards. However, now it does not know with whom it has a relationship and nobody is able to tell it because the situation is so unclear. That is not satisfactory.

The Minister paid lip-service in her speech to the role of the community and voluntary sector. However, it is notable that the community and voluntary sector is a pillar of the National Economic and Social Forum as well as being an important partner in all of the national agreements that have underpinned the success of the economy. On the one hand the Government recognises the important role played by the community and voluntary sector, while on the other, it has excluded it from this vitally important legislation. There are so many groups who have had long relationships with health boards as service providers, lobbyists or representative groups who do not know what the future has in store for them. This has to be clearly spelled out. It is important in this respect that the role of the voluntary and community sector be formally recognised within the body of the legislation. I will be tabling amendments as regards this next week and I hope the Minister will look favourably on them. I do not understand how a Government which has given the voluntary and community sector a seat at a vitally important table, can exclude it from this legislation. That, at least, is my information which is set out clearly in documentation that I imagine the Minister of State will have received in the past day or two.

The regional health forums, in Part 8 of the Bill, for instance, only refer at present to members of local authorities. The proposed forums are no more than talking shops anyway and are a sop to members of local authorities who no longer have a role, given the abolition of health boards. This provision is designed to create an impression of a role. I am sure they will meet with great pomp and will be fully reported in the media, but at the end of the day they will have no comeback or input into the administrative structures being set up under the legislation. Those of us who have been around long enough recognise, on reading legislation, how it needs to look and what it needs to reflect in order to give bodies a statutory role and a seat at the table. The Minister of State is shaking his head at my assertion that the voluntary and community sector has no role. If he could show me that it has a satisfactory role, I would be obliged because I have not seen this so far. That certainly is not the information given to me by the groups themselves who obviously have major concerns in this regard.

I would also like to comment on the admission early in the Minister's speech that the health information and quality authority is not now being provided for in the legislation but is being brought forward early in 2005. This would appear to be going forward in the manner of a cart without the horse. The process of having quality information has been a cornerstone, as identified by the reports referred to by the Minister. The fact is we do not have the information we need. We do not have the databases we need for a CEO or board to make the decisions expected from them by this legislation. An administrative structure is being set up, the Minister will appoint a board and eventually, we hope, a CEO, give them money and instruct them to provide a world class health service, but without the information they need. It is a sign of the chaos which is indicative not alone of the way the health service is being managed, but also its reform. This legislation is a mistake and has not been fully worked out. The fact the board will not have the information it needs to get started is something of a joke. It leaves us with a structure devoid of democracy, with limited accountability and if it goes wrong the chances of turning back the clock are minimal.