Seán Power (Kildare South, Fianna Fail)

I thank the Senators for their contributions on this important piece of legislation and for their good wishes. As the Tánaiste said in her contribution, this legislation provides for the complete reform of the organisation and management structures of the health services, the first in over 30 years. The Health Act 1970 provided for the introduction of the regional health board system. Prior to the establishment of the boards, the health services in Ireland were administered by the local county councils except in Dublin, Cork, Limerick and Waterford, where the service was managed by the joint health authorities.

The health strategy contained a commitment that an audit of functions and structures in the health system would be undertaken which would help clarify roles and co-ordinate the work of different organisations in the system. The aim of the Government's reform programme, based on the findings of the Brennan and Prospectus reports, is to provide a co-ordinated and integrated health service with a consistent, national approach to the delivery of health services, based on clear and agreed national objectives, within a strong accountability framework. It provides for organisational and structural reform based on the principle of placing the patient at the centre of the health service.

The reform programme was announced by the Government 18 months ago and the need for this legislation has been well signalled in the intervening period. This Bill is the second of two pieces of legislation to be brought before the Oireachtas in the current year in respect of the Government's health reform plans. The first legislation was the Health (Amendment) Act 2004. This Bill will replace that Act, the part of the Health Act 1970 establishing the health boards, most of the Health (Amendment) (No. 3) Act 1996 and the Health (Eastern Regional Health Authority) Act 1999.

It is recognised that the implementation of this reform programme is a major challenge. The Bill will mean the establishment of a unified management structure for the health services. Much work has already been carried out to establish and ensure a smooth transition to the new system on establishment day which will be 1 January 2005. However I reiterate that the transition is being undertaken on a phased basis. The provisions of this Bill are also designed to assist in the transition to these new structures.

As well as providing for the establishment of the Health Service Executive and the abolition of the health boards and the ERHA, the legislation makes provision for improved governance and greater accountability in the health system as well as planning, monitoring and evaluation.

A key objective of reform in the health system, as identified in both the Prospectus and Brennan reports, involves the separation of policy and operational responsibilities. The result will be greater clarity, transparency and accountability about lines of responsibility in the health system and this Bill clarifies the lines of responsibility and accountability. The legislation sets up the health service executive which will have responsibility for the delivery of health and personal social services. The statutory functions and responsibilities being taken on by the executive are set out in section 7 and Schedule 3 of the Bill. A review of this Schedule will give Senators an idea of the breadth of the functions currently being carried on by the health boards and other agencies being dissolved by this legislation.

The establishment of the Health Service Executive as a single entity with statutory responsibility for the management and delivery of health and personal social services, represents the central plank in reforming what are, as the Tánaiste described in her speech, the patchwork of amendments made to health legislation over the years which has led to the growth of 58 separate health agencies.

In carrying out its objectives and functions the executive is obliged to ensure that the services are delivered in an integrated and co-ordinated manner to ensure a proper continuum of care from hospital services through to primary and community care services. In delivering or arranging for the delivery of health and personal social services, the executive is required to have regard to the services being provided by voluntary and other bodies and the need for co-operation with other public authorities as necessary where their functions have an impact on the health or welfare of the public. Examples of this include co-operation with the Food Safety Authority of Ireland on food safety matters, the Department of Education and Science in providing services for children with disabilities or local authorities on public health matters. The executive is also being required to have regard to the need to co-operate and co-ordinate its activities with those of other public authorities if the performance of their functions could affect the health of the public. This is important for the executive in its role of protecting and promoting the health of the public.

I will now address some of the points made by Senators during the debate. I do not accept the argument that the legislation is being rushed through the Houses without consultation. The reform programme was announced by the Government 18 months ago and the need for the legislation has been well signalled in the intervening period. Communication and consultation have been at the core of the health reform process dating back to the national health strategy, Quality and Fairness, in November 2001. Immediately after the Government decision on health service reform in June 2003, the Secretary General of the Department briefed political parties on the proposals.

From the beginning, the process has involved an open discussion. The Prospectus and Brennan reports were published in June 2003 and laid before the Houses. At the time, 100,000 copies of an explanatory booklet outlining the reforms, The Health Service Reform Programme, were issued, particularly to those working in the health system. The previous Minister for Health and Children, Deputy Martin, and the Secretary General of the Department visited each health board area to meet and discuss the reforms with staff. Simultaneously, an extensive consultation and communication process was under way.

Following this initial process, the Department commissioned the Office for Health Management to conduct and information and consultation exercise reaching as many people and agencies in the system as possible. More than 20,000 staff were directly engaged over the summer months and into September 2003. They included staff and representatives of the Eastern Regional Health Authority, the health boards, the voluntary, hospital and disability sectors, the community and voluntary pillar, the trade unions and the Department of Health and Children. The Office for Health Management produced a detailed report of this process, which was published earlier this year.

This legislation is the second of two Bills brought before the House this year on the Government's plans for structural and organisational reform of the public health services. As I stated, these plans were widely notified and relayed on a fully inclusive basis. As recently as April and May last, the House discussed the Health (Amendment) Bill 2004, as part of the legislative arrangements necessary to underpin the reforms. In that context, my colleague, the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, discussed in detail the reform process and the arrangements to be put in place to implement it. He specifically informed the House of plans for further legislation, such as that before us today, which would establish the Health Service Executive, make provision for improved governance, accountability, planning, monitoring and evaluation, introduce a statutory framework for the handling of complaints and provide for democratic input at regional and local levels under the new structures. No surprises are being sprung on the House under the Health Bill 2004, as the changes involved have been well explained and communicated publicly and specifically previewed in the House.

The Government is strongly of the view that the executive should be as widely and directly accountable as possible for its decisions, plans and actions related to the discharge of its statutory functions. Such an approach is central to ensuring that the highest standards of service are achieved and maintained. It is, therefore, the Government's intention that this should be reflected in the quality of service the executive will provide to Members of the Oireachtas in responding to queries and providing information about the management and delivery of health and personal social services, whether at national, regional or local level.

The interim Health Service Executive is aware of and making plans for the proper and effective discharge of its serious responsibilities in this area. Earlier this month, it announced that the overall structure of the executive would include an office of the chief executive officer and a corporate affairs directorate. In addition, responsibility for the important function of managing parliamentary affairs would be assigned by the chief executive officer to one of the central governance areas. As we move forward, the operation of any new arrangements will be monitored closely and reviewed as necessary.

The provisions of section 10, which provides that the Minister may give directions to the executive and that the executive shall provide any information and statistics required by the Minister, and the provisions relating to the production of service plans by the executive are strong accountability provisions. The Minister is politically responsible for the health service to the Oireachtas. In line with the recommendations of the Brennan and Prospectus reports, the executive will be responsible to the Minister for the management and operation of the health service. The Department will be responsible for supporting the Minister and the Government in all policy matters. The lines of accountability are clear and transparent and do not leave room for non-accountability at any level.

I thank Senators for their contributions. The Bill represents the first major reform of the delivery of the health service in 30 years. It is historic legislation which will lead to a more efficient, effective and patient centred service. I commend it to the House.