Kathleen O'Meara (Labour)

I move amendment No. 1:

In page 12, between lines 19 and 20, to insert the following:

7.—Subject to the provisions of this Act and the resources available to the Executive, the primary function of the Executive is to take such steps as are open to it to ensure that each person in the State is facilitated in availing of an individual entitlement to such health services and personal social services as are appropriate to meet the needs of that person.".

I welcome the Minister of State, Deputy Brian Lenihan, back to the House for the continuing saga. What we are at here is effectively a talking exercise because nothing we say can effect any change in the legislation. While it is worthwhile to have the debate in the context of the amendments put forward and to articulate our views for the record, we can have no impact in terms of amending the legislation. This is a pity. The legislation is rushed and the Minister is determined to have it on the Statute Book by 1 January, even though she has admitted that it will not be possible to implement the new structure on that date and that existing senior personnel will remain in place for a time. This is not the way to run a health service.

During debate on Committee Stage last Tuesday I quoted from an article by Fintan O'Toole in The Irish Times which rightly stated this was no way to start a health revolution and that the Bill represents the most radical overhaul of the governance of our health service since the foundation of the State. In that regard the legislation requires much more time for consideration than we have allowed. It also requires the Tánaiste and her Department to be far more open to the views expressed by the Opposition. We speak on behalf of many groups of service users and providers who have had a seat at the table in the past but who now do not have the same access to the system. These groups play a vital partnership role in the monolith that is the Irish health service. In that regard we are not doing this legislation much service and we are not giving it the consideration it needs. As Senator Henry and others have said, I believe we will need to amend the legislation in the future, which should not be our purpose.

Amendment No. 1 is the same as an amendment I moved on Committee Stage. I resubmitted it as it addresses a fundamental cornerstone of the legislation and encapsulates one of the most serious shortcomings of the Bill, which is the failure to set out a mission statement outlining the direction the new health service executive should take. We probably all have a view on how the executive should run the health service, which is fine. However, there is no mechanism whereby we can make such an input. This means, for example, that we will be unable to do anything if we as legislators consider the executive is taking a point of view we believe not to be in the public interest. While the legislation makes provision for the executive to appear before the Oireachtas Joint Committee on Health and Children, no framework is specified to require it to operate in a particular way, which is the sole prerogative of the Minister. The Minister will direct the executive and it is clear that if it does not do as it is told, it will be gone. The legislation gives the Minister that power for a particular reason.

The health service executive is based on a centralised structure which runs contrary to the ethic of partnership that has underpinned the vision of successive governments in recent years and has allowed the voluntary and community sector, service users and providers, not just in the health area but in a very wide context, to play a role. We have seen how well this works for the country in the context of the National Economic and Social Forum, the partnership agreements, etc. Excluding the notion of partnership from this structure marks a departure from a policy that works and it is a pity for it to be absent. Partnership enhances the work of those framework organisations and has helped ensure things get done well. Its absence is more than a pity and will mean the health service executive will lack something that would enhance its work.

The remarks of the Minister of State on Tuesday on other Committee Stage amendments have made it clear that the kind of board we can expect to see will be very much along the lines of the interim board. It will have a very strong management and, as others have said, banking element. It is not clear whether representative organisations will have a presence; it is totally at the whim of the Minister. It will be interesting to see how it turns out, although as the Minister of State has said, we have a fair idea already.

I hope the Minister of State will not come back to me with the same sterile argument about entitlement and eligibility. My amendment is clear and would set out in the legislation the kind of vision the health service executive should have. We have framed the amendment in a broad and flexible way because we are not in the business of tying the hands of the executive. We want to ensure the individual entitlement to such health services and personal social services as are appropriate to meet individual needs would be enshrined in the legislation, which we consider very important. While we do not suggest the executive will not achieve this, we have no guarantee it will happen in the absence of it being specified in the legislation. In the same way, we have no guarantee that other considerations, such as value for money, will not take priority. While value for money is very important we believe the individual entitlement to health services and personal social services to meet individual needs are of paramount importance.

For more than ten years we have had a debate about rights-based legislation for the disability sector. The debate on how legislation should enshrine a rights-based approach started when Mervyn Taylor was Minister for Equality and Law Reform. Without such legislation, it will not happen. We know that unless we enshrine a rights-based approach in legislation all the pious waffle in the world and the aspirations of Ministers will get us nowhere. The system as established is not rights-based. Although in some contexts it has developed a partnership approach with service users and providers it could easily slip back into the old way of doing things, which is one of my biggest concerns.

Without this kind of mission statement and having this entitlement stated in the legislation, whole sectors, which have struggled for years and have finally begun to be treated as partners, would find that their entitlement to be treated as partners simply does not exist. Without it being specified in the legislation, they cannot ensure it will happen. As I said on Committee Stage, the health service executive will regard them in a semi-commercial sense as being service providers and not being partners in a broader sense in terms of their input and ideas for initiatives, etc. We know the resistance that exists in the system to having a rights-based approach. However, without it we are banging our heads against a brick wall. It would be a move backwards.