Frances Fitzgerald (Fine Gael)

I move amendment No. 2:

In page 10, column (2), to delete lines 6 and 7.

One of the issues which has emerged as a key concern to all sides of the House is the relationship between the Health Service Executive and the Department of Health and Children. That relationship has undergone a fundamental change following legislation a couple of years ago. This was illustrated clearly when the information emerged at the Joint Oireachtas Committee on Health and Children that women were being called back for rechecks. The Minister and her officials were in the dark about it, as were some senior members of the HSE. We had representatives of the HSE on the one hand and representatives of the Minister and her Department on the other, but there had been no exchange of information between them at that critical time on a matter which was of particular concern to the women concerned. Those women had not been told, the Minister did not know they were being recalled, her senior officials did not know and the senior officials in the HSE did not know. If that situation does not raise questions about accountability and responsibility, I do not know what does.

What happens in the Bill is that the HSE is substituted for the role of the Minister. I am sure the Minister of State will address the reason this is seen as necessary in the context of the legislation. I understand that, but it raises the issues of the role of the Minister, accountability, the question of who is in charge of health policy and who is accountable for its delivery. What impact has the change in legislation had on decision making in recent years? What is the impact when a budget is removed from within the Department? What do senior Department officials think of this and do they think it is effective? In their view, what impact has the fact the budget has been taken away from the Department had on the delivery of health care services? I look forward to the book being written on the shifts in authority, responsibility and decision making that have emerged in recent years and their impact on the front line of health services and on responsibility for how the service is failing patients.

This group of amendments has been put forward because of the deep unease in both the Dáil and Seanad about the structure of those relationships, the changes in them and the need to examine the impact they have had. That, allied with the lack of reorganisation in the HSE and the fact the Taoiseach intervened on the day before the legislation was due to take effect and guaranteed there would not be any redundancies or that no effort would be made to deal with the duplication of staff or to look at the management structures, led to the retention of many ineffective management structures within the HSE, as acknowledged by Professor Drumm and others.

These amendments address that issue. It may be a peripheral issue in this legislation, but there is a substitution of the Minister's role with the HSE, with all that implies. I look forward to hearing what the Minister of State has to say on the issue. I understand it is deemed necessary in the context of the changes being made.