Brian Lenihan Jnr (Dublin West, Fianna Fail)

——most Senators recognised the need for legislation of this character.

Senator Coghlan referred to the scourge of MRSA. Of course, the authority will set standards on safety and quality in health care and, as part of that function, has been asked to address the issue of MRSA.

Senator Coghlan also raised the question of whether mental health services could be included in the legislation, but the view the Minister took was that it would be inappropriate to include mental health services in view of the establishment of the mental health commission and to give HIQA a role in these services would give rise to confusion as to what organisation was responsible for the mental health services.

Health technology assessment was also raised by Senator Coghlan. Clearly, health technology assessment is important and a critical part of HIQA's functions is to promote quality care. The role of HIQA here will be to support evidence-based decision-making and the availability of expert evaluation of health technologies will be a valuable resource for the HSE and for service providers. HIQA adds further value to the health chain by having an advisory function in that regard. That role in health technology assessment will be important in the future and I appreciate why Fine Gael has raised this issue because health technology assessment is widely regarded as able to deliver succinct, high-quality and trusted evidence to decision-makers at all levels of the health care system.

It is envisaged that the HIQA health technology assessment function will support those evidence-based decisions and that the availability of impartial evaluations of the clinical value and cost-effectiveness of complex health technologies, including drugs, would be very valuable for service providers, health care practitioners and policy-makers. The role of HIQA in this context will be to advise the Minister and the HSE in this regard.

Senator Glynn warmly welcomed the Bill and made the point that the Government is responsible for legislation and for the overall funding allocated to the HSE, but of course operational decisions on matters are the responsibility of those who carry them out. As we approach the next few weeks when there will be a great deal of debate about the quality and fairness of the health service, it is a point worth making in the public debate that the Minister for Health and Children presides at the top of a pyramid, which employs in excess of 100,000 persons and which is involved in the expenditure of over €15 billion. Clearly, critical responsibilities exist at every level of this system.

Senator Henry was anxious to inquire as to how quickly and effectively the Bill would be implemented. The interim HIQA was established in 2005. That body already recruited a chief executive officer and recruitment of the other staff is being undertaken, and the existing staff in the Irish Health Service Accreditation Board and the Social Services Inspectorate will join HIQA on the establishment day. Clearly, a considerable amount of work has already been done. The health technology assessment was also raised by Senator Henry and I restate the point that of course the function here is advisory in character to the HSE and to the Government.

In carrying out its functions HIQA must co-operate with other public authorities and this would include the Health Research Board. That is quite clear from section 8(2)(b). The Bill, therefore, gives wide scope to HIQA to carry out work with other bodies.

Senator Henry also raised the question of the patient safety commission. Legislation will be required to implement the licensing of hospitals and health facilities, either by way of new legislation or by way of an amendment to this legislation, depending on the recommendation of the patient safety commission.

Senator White raised the important question of enforcement. Clearly, this new independent inspection system established under the legislation will ensure that regulations and standards in designated centres will be enforced.

Senator Leyden turned to the important question of the inspection system, that it now covers both public and private nursing homes. I agree with him that a critical feature of this legislation is that it applies equally to both. He also referred to the licensing of homes and, as I stated earlier, the question of licensing is being addressed by the patient safety commission. Depending on what the commission recommends, we must make a decision as to whether to amend this legislation or introduce separate legislation to deal with it.

Senator Leyden also raised the question of the membership of members of local authorities of boards such as the one established in this legislation. He stated that it is an issue about which he has had considerable concerns for a period of time and despite receiving some favourable assurances from a member of the Government, the matter does not seem to have been followed up at the drafting level where the standard clauses are being introduced. I will draw the attention of the Minister to this matter. Senator Leyden indicated he may well table an amendment to the Bill in this connection.

Senator Tuffy raised the question of redress for substandard care. A new complaints system was established by the 2004 Health Act and it was brought into operation at the beginning of this year. It provides a statutory system for making complaints and seeking reviews on a wide range of issues other than clinical decisions and actions. Complaints about clinical decisions and actions are dealt with by the professional regulatory bodies such as the Medical Council in the case of doctors and the analogous bodies in nursing and pharmacy. The position on attitudes is that a complaints framework can provide for dealing with complaints issues such as staff attitudes and hygiene.

The Bill is an important part of the health reform programme introduced by the Government. There are those who will argue the Bill does not go far enough, but we must be practical and look at what has been worked up within the system. Looking to the future, the authority established by this system will provide a valuable external audit on an area which, as I stated at the beginning, involves the expenditure of a significant amount of public money and the deployment of a considerable number of personnel. It is important in considering legislation of this type that we appreciate that fact and, given the amounts involved, that we put in a system of external evaluation such as is envisaged by this legislation. I thank the Senators for their help in the debate.