Ciarán Cannon (Progressive Democrats)

I second the Government amendment to the motion and welcome the opportunity to contribute to this important debate on the management and operation of our public health service. This is a matter of concern not only to all public representatives but to all members of our society. I agree with the Minister that the Labour Party's motion was tabled in that spirit of concern.

The fundamental objective of the health policy of this Government is to achieve the best clinical outcomes for all patients across the country. This is a central tenet of the health service reform programme.

The reforms are aimed at helping to deliver a health system that is more responsive and adaptable and that more effectively meets the needs of the population at an affordable cost. The principles underlying the Government decision in June 2003 to establish the Health Service Executive as a national health authority are as valid today as they were four years ago, namely, to improve patient care, to provide a new national focus, to reduce the fragmentation of the health service and to improve budgetary and service planning. Nobody, I believe, is suggesting that we should go back to a time when we had a plethora of health boards operating almost independently of one another. In a small country of 4 million people it made perfect sense to move towards a centralised and more efficient model of health care and this continues to be the case.

It is important to clarify the current governance and accountability frameworks, both within the HSE and between the HSE and the Minister, as there appears to be a small amount of confusion about the precise position. The board of the HSE is accountable to the Minister. The CEO is accountable to the board and has responsibility for the implementation of the board's operational policies. The CEO is also answerable to the Oireachtas in his capacity as Accounting Officer for the appropriation accounts of the HSE.

The annual service plan, which sets out the quantum of services to be provided in any financial year by the HSE from the resources allocated to it, is the primary vehicle through which the Minister and her Department monitor and evaluate the performance of the executive against the targets set out in the plan.

Ultimately, the Minister and the Government are politically accountable for all aspects of the health services. The Minister, Deputy Harney, has confirmed this many times. The specific political accountability of the Minister under to the Health Acts is quite clear, and I do not subscribe to the theory that the establishment of the HSE has in some way diluted her political accountability or that of the Government collectively. Senator Alex White mentioned the issue of political accountability and previous suggestions of a democratic deficit in the way the HSE is operated. My experience at local level in Galway is that we have accountability and a democratic input into the operation of the health service. I and other Members of the Oireachtas have regular meetings with our local health manager and we are her eyes and ears on the ground in that we funnel to her the concerns and needs of the people we represent. I do not know whether there is a similar process in other areas but there should be.

The budget for the HSE for 2008 is €14.2 billion, or almost €10,000 for every taxpayer in the country. This amount is more than a quarter of Government current expenditure and is nearly the equivalent of total estimated income tax receipts. Given the sheer scale of this budget, it makes perfect sense that those who have responsibility for managing and delivering services out of the budget should be also accountable for it. Senator Prendergast mentioned in her speech the wisdom of granting real powers to local management and suggested that these bodies should be given real autonomy in running their local health services. A welcome development this year is the assignment by the HSE of budgets, approved employment ceilings and service delivery commitments to named individual budget holders at both hospital and community service levels. These managers are being held accountable throughout 2008 by means of the HSE monthly performance monitoring reporting system. This represents real and tangible accountability and it is being delivered by the Minister.

The HSE was formally established on 1 January 2005 and, some three years later, the current review of its internal organisational structure is timely. The objective of this review is to improve the effectiveness and efficiency of the organisation. The Minister for Health and Children agrees that a properly planned and managed voluntary redundancy scheme could have an important role to play in helping to streamline management within the HSE. This should result in an improvement in the delivery of health services to patients. Such an initiative would mean the numbers involved in senior management should become integrated and streamlined. There will need to be much greater clarity in terms of roles and accountability. Absolute clarity will be also necessary on the staffing requirements of any revised internal organisational structure based on the review I mentioned earlier.

The issue of safety in the delivery of health services lies at the heart of any care system which has the confidence of the people using those services. Although the health sector is one of the most complex areas of activity in any country, it must by its very nature command the confidence of those who use it. Patient safety and quality of service are at the heart of the Minister's agenda. The Health Information and Quality Authority, which was established in May 2007, is responsible for setting and monitoring standards across health institutions and services in the public sector. Its functions also include the undertaking of investigations, the evaluation of the clinical and cost effectiveness of health technologies and the evaluation and setting of standards for information on health services and the health and welfare of the population. There are still some services that are not operating to the highest standards, and errors have been made. However, the new system of checks and balances is working, as demonstrated by HIQA investigations and other service reviews being carried out by the HSE. We must now ensure that we learn from these events by improving the service and maintaining a higher standard.

Earlier this month the Minister for Health and Children launched the national strategy for service user involvement in the Irish health services, which is one of the most exciting and interesting developments in the reform programme. The strategy was developed by her Department in partnership with the HSE and will drive service user involvement in our health services. As a result of this strategy, new primary care teams will work with their patients and local communities to develop models of service provision that will meet their needs. Older people and their families will have the opportunity to speak about the quality of their community care provision. Mental health service users will be able to work with service providers to tailor their health care appropriately to their specific needs. Through this strategy, service user involvement will enable the health services to anticipate problems and avoid complaints and it will guarantee that service users will be at the centre of efforts to drive up the quality and safety of service provision.

The Minister for Health and Children has only had one interest at heart since her appointment to that role, and that is the interest of every patient who accesses our health system. She has taken total responsibility for providing a world class health service. In my short time in this Chamber I have seen no other Minister appear before us so often. I have seen no other Minister with such a command of his or her brief and such a commitment for far-reaching and meaningful reform. She is accountable and committed, and with all our support she will succeed in making that reform happen.