Camillus Glynn (Fianna Fail)

Ba mhaith liom fáilte a chur roimh an Aire Stáit. I welcome the Bill and the opportunity to speak on it, as it is an example of how the Minister is forging ahead with necessary change.

As we all know, this Bill is a fundamental part of the health reform programme begun by the former Minister for Health and Children, Deputy Martin, in 2003 and continued by the current Minister, Deputy Harney, since taking over the Department of Health and Children. The programme is the most extensive reform of the health system in more than 30 years and its priority focus is improved patient care, better value for taxpayers' money and improved health care management.

The development of a world class public health service is a core objective for everyone in the House because we want to expand quality and access. We will achieve this through greater investment and system reform. No one can claim there has not been investment in our health services during the past ten years. As a share of national income, non-capital public expenditure on health has increased from 5.8% of GNP in 1997 to 7.6% today. The Government is matching this increase with reform. For example, the HSE has been established under the reform programme. While I acknowledge it is facing many challenges, I am confident it will succeed.

The Bill has many important components, one of which relates to the protection of whistleblowers. We are all familiar with cases which came to light when whistleblowers draw attention to them. Those who came forward to expose the details of the Neary case can take credit for bringing to light the outrageous practices in that instance.

The Minister for Health and Children, the Ministers of State at the Department of Health and Children and the Members of the Dáil and Seanad are responsible for introducing legislation. They are not responsible for operational matters. It seems Opposition Senators like to infer that the Minister is to blame if there is malpractice in a hospital, or if a hospital is not living up to the standards of care and cleanliness one would expect. As somebody who worked in a hospital for many years, I remind the House that those who are paid as managers have to manage. If management means taking harsh decisions against subordinate staff who are not doing their jobs properly, clear decisions have to be taken on whether the people concerned should continue to work in their current roles.

The Bill will establish the Health Information and Quality Authority which will guarantee information and assure a certain quality of service and put in place an inspectorate and all that pertains thereto. Patients will benefit from the top class service that will be secured by the authority. The inspectorate will ensure the standards of care which will obtain in care locations will adhere to best practice. One of the key policy aims of the health reform programme is to deliver high quality services, based on best practice supported by evidence.

My colleague on the other side of the House, Senator Coghlan, spoke about the use of trolleys in hospitals. We have to be fair and admit that the number of patients on trolleys has reduced significantly. Similarly, there has been a substantial decrease in the number on waiting lists. The phrase "A Lot Done — More To Do" is as true today as it was the day it was first coined. The nature of the health service means there will always be more to do.

The establishment in this legislation of the Health Information and Quality Authority is a central part of the Government's health strategy. The authority's mandate is to ensure standards of world class apply to health and personal social services throughout the public, private and voluntary sectors. The authority will engage in monitoring and inspection to ensure those standards are upheld. It will provide information on health and personal social services and undertake health technology assessments.

All the information available should be given to those caring for others. This is important to ensure carers can offer the best possible health care service. The Health Information and Quality Authority will play a crucial role in providing the highest quality and most efficient health services for patients. The authority will bring a common thread of efficiency, quality and effectiveness to the health sector. It will inform and assist decision-making at national, local and individual level. It will ensure best practice is advanced nationwide rapidly, effectively and consistently. It will act as a resource for planners, health care professionals, patients and their carers by helping them to make decisions about treatment and health care.

The Health Information and Quality Authority will provide a stamp of assurance by acting as an underwriter for taxpayers. It will ensure the highest possible standards of safety and systems are adopted by and embedded within the sector. It will guarantee value for money in the delivery of health and personal social services. A great deal has been said about the waste of money. The establishment of the authority and the inspectorate in this legislation proves that the Government is keen to obtain value for money in the health sector.

A great deal of the Bill's focus comes from the fact that the Health Information and Quality Authority will incorporate a new and independent inspectorate and registration authority for residential services. The independence of the inspectorate will be one of the central reasons for its success. It will not have to look over its shoulder at Members of the Oireachtas; it will be able to do whatever needs to be done to discharge its functions without apologising to anybody. The establishment of the inspectorate will allow us to get tough in setting and enforcing standards. One should not doubt that an independent organisation with real power is being created.

The Bill will place the existing Social Services Inspectorate, SSI, on a statutory basis. It will provide for the expansion of the SSI to allow it to inspect and register residential services for people with disabilities and older persons. This will ensure there will be no recurrence of the problems at Leas Cross and other nursing homes, which have been exposed in recent years. We cannot undo what has been done. We can never change history, but we can learn its lessons.

The Social Services Inspectorate was established in 1999, on an administrative basis, to inspect social services. While it initially prioritised the inspection of children's residential services run by the Department, it has recently extended that remit to cover foster care services. Such inspections are particularly important in the light of the revelations of recent years about the abuse of children in some care centres. The SSI bases its inspections on the national standards for children's residential centres, the 2002 standards for special care units and the 2003 standards for foster care. These standards which were produced by the Department of Health and Children were the first nationally agreed standards in this area.

It would be remiss of me to mention foster care without commenting on the important service foster parents provide for children and parents who experience various difficulties. I wish to state publicly that I appreciate the fantastic role played in society by foster parents.

The inspection reports of the Social Services Inspectorate include findings and recommendations based on the standards of best practice. The first full round of inspections of statutory children's residential centres was completed in 2005. The SSI uses the unique insights it gains through inspections to support developments which improve quality in the sectors in which it operates. Its annual reports give an overview of its findings in the sector, prioritise areas for improvement and offer a national summary of service provision.

The Social Services Inspectorate will be established as an office within the Health Information and Quality Authority, thereby allowing it to continue its work on child welfare and protection services. The current inspection and registration arrangements are being replaced and strengthened. There will be a fully independent inspectorate for public and private nursing homes, as well as for the first time centres for children and people with disabilities. I welcome this provision, one of the most innovative aspects of the Bill.

This legislation provides for clearer procedures which will allow a centre to be closed if its continued operation poses a risk to the health or welfare of its residents. It outlines an explicit procedure to be followed if a centre needs to be closed immediately or urgently. The Government is responsible for ensuring the standards set are applied consistently and on a national basis. We need to outline the circumstances in which action can be taken quickly and effectively, when necessary, to protect service users.

The Health Information and Quality Authority will have strong powers to monitor standards, including the power to enter and inspect premises, access documents and interview staff. Senators will be aware of a notorious case in the last couple of years in which documents disappeared. The Bill will give the inspectorate more power to deal with such cases. The authority will engage in reviews and inspections to ensure standards are being met. It will investigate serious concerns relating to health or social services. It will evaluate and provide information for staff and the public on how well services are performing. Such information will inform the planning of future services. The authority will also assess new and existing drugs and equipment to ensure that they impact positively on the quality of life for patients and, importantly, represent value for money.

Inspections by the chief inspector of social services will be carried out against standards set by HIQA and ministerial regulations. They will cover areas such as accommodation, qualifications, numbers of employees, food and records. In regard to the number of employees, in some cases, especially in private nursing homes, the euro features largely on the horizon, particularly in geriatric care, where a certain staffing level is required to meet the needs of patients. It will be a core role of the inspectorate to ensure that all care locations, public or private, will have the required number of people to provide the appropriate service. That is important.

If the chief inspector is not satisfied that a residential centre meets the relevant standards, the centre will not be registered and will not be able to operate. If he or she considers that a registered centre fails at some stage to comply with standards, the registration will be cancelled. In other words, if such a centre does not deliver, it will be shut down and rightly so.

The Minister of State outlined the penalties and I will not repeat them. The HIQA is already established on an interim basis and it will be established on a statutory basis under this Bill. It has undertaken a considerable amount of work to ensure that it will be able to recruit staff and undertake its responsibilities following the passage of this legislation.

We all have a right to expect that when we or our loved ones come into contact with our health and social services we will be treated safely with high quality care, dignity and respect. The responsibility for delivering a quality service lies with the providers of health and personal social services. I am sure that HIQA will be a strong and fair watchdog to protect those in residential care settings. I welcome the Bill and wish it a speedy passage through this House.