Áine Brady (Kildare North, Fianna Fail)

I will begin by briefly outlining the six distinct purposes of the Health (Miscellaneous Provisions) Bill 2009 in the order in which the relevant provisions appear in the Bill. I will then speak in more detail about the policy objectives underpinning the Bill.

The Bill advances Government policy on health service agency integration as put forward in the health service reform programme and more recently in regard to the rationalisation of State agencies generally, by providing for the integration of the National Council on Ageing and Older People and the Women's Health Council within the Department of Health and Children and the integration of the National Cancer Screening Service Board, the Drug Treatment Centre and the Crisis Pregnancy Agency within the Health Service Executive. As part of this overall process, the Bill progresses Government policy on the establishment of the office with responsibility for older people within the Department of Health and Children.

Second, the Bill provides for the transfer of ministerial responsibility for the local government superannuation scheme, health sector, from the Minister for the Environment, Heritage and Local Government to the Minister for Health and Children. The Bill also gives legal effect to amendments made to this scheme by the Minister.

The third purpose of the Bill is the amendment of the Hepatitis C Compensation Tribunal Act 1997, as amended, to remove age limits for travel insurance benefit provided in accordance with that Act. The Bill also provides for an amendment to the Mental Health Act 2001 to address difficulties in the operation of the Act which have arisen following a recent High Court judgment. In addition, the Bill makes technical amendments to the Health Act 2007. The Bill amends the National Cancer Registry Board (Establishment) Order 1991 in regard to the composition of the board. This amendment to the establishment order is intended to facilitate the integration of the registry within the Health Service Executive in due course.

Turning to the policy objectives of the Bill, I referred to the health service reform programme and, in this context, Senators will know that the rationalisation of health services agencies was one of the recommendations of the Prospectus report on the audit of structure and functions in the health system. A number of such agencies had been established over several decades by successive Governments. Each one of these played its part in the development of our health services. However, by 2003, with over 55 different agencies, it was acknowledged that we were working with a system that was, in overall terms, unnecessarily complicated and fragmented. A core principle underpinning this policy of streamlining was the achievement of better co-ordination and reduction in duplication and overlap of functions between agencies, through the amalgamation of bodies carrying out similar functions and operational work. In the case of advisory bodies, the thinking underpinning the health reform programme was that the role of assisting a Minister in policy development should not, where possible, be devolved to outside agencies.

As part of this planned rationalisation programme, several agencies were integrated within the Health Service Executive under the Health Act 2004 while provision was made in other legislation for the integration of a number of agencies within other bodies.

Since that time, following on from the efficiency review announced in 2007 and the publication of the OECD Review of the Irish Public Service, the Government agreed a process of rationalisation of State agencies. In the case of the health sector, the number of agencies is being reduced from 34 to 18.

In this Bill, the programme of rationalisation is moved forward through the integration of the National Council on Ageing and Older People and the Women's Health Council within the Department of Health and Children and the integration of the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency within the Health Service Executive.

The principle of integration in regard to these agencies had the general support of the Dáil. We must now build on what has been accomplished in the past by these agencies and work towards achieving all the advantages to be gained from coordination and integration. During the debate on the Bill in the Dáil, my colleagues made the point that efficiencies must be gained from the rationalisation process but that the primary aim of agency integration under the Bill is to streamline service delivery and policy making. Efficiencies will be achieved over time from economies of scale and the elimination of duplication in areas such as recruitment, procurement, payroll and ICT systems.

I stress that it was also made clear that the integration of the staff and work of these agencies will be carefully managed to ensure a seamless continuation of important services they provide. Staff transferred under the Bill will bring their expertise and experience to the Department and the Health Service Executive.

Before moving on to the other aspects of the Bill, I would like to pay tribute to the boards of these agencies and their employees for the work they have carried out over the years. The National Council on Ageing and Older People has made a key contribution to policy development in respect of services for older people. The Women's Health Council has had a significant part to play in facilitating policy formulation on women's health. The work of the National Cancer Screening Service Board in early detection of cancer is well known and valued. The Drug Treatment Centre Board has made an important contribution to the delivery of services for drug misusers. The Crisis Pregnancy Agency has played a critical part in the delivery of strategies to reduce the number of crisis pregnancies. I have no doubt that Senators share my views in this matter.

I will deal with the transfer of ministerial responsibility for the local government superannuation scheme (health sector) from the Minister for the Environment, Heritage and Local Government to the Minister for Health and Children. Part 7 of the Bill confers the same powers on the Minister for Health and Children as were conferred on the Minister for the Environment, Heritage and Local Government under sections 2 and 4 of the Local Government (Superannuation) Act 1980 in respect of a range of health sector organisations. All powers exercised by the Minister for Health and Children under sections 2 and 4 of the Local Government (Superannuation) Act 1980 since 1 February 2001 are confirmed and apply to all of the organisations mentioned in section 60.

On the amendment of the hepatitis C legislation dealt with in the Bill, the position is that the Hepatitis C Compensation Tribunal (Amendment) Act 2006 provides for the setting up of an insurance scheme for persons infected with hepatitis C and HIV through the administration within the State of infected blood or blood products. This provision is intended to assist persons with hepatitis C or HIV to obtain insurance where they would otherwise have difficulty in doing so on the open market.

This amendment will provide for the removal of the 65 year age limit when applying for travel insurance under the scheme. The scheme encompasses mortgage and life assurance and travel insurance. The current legislation limits entry age to the scheme to 65 years. The Minister has agreed that the age limit for travel insurance only should be removed, as this age restriction under the Act may make the availability of travel insurance cover to the relevant claimants under the scheme more limited than for persons who are not infected.

The Minister is satisfied that any additional cost, which would be spread over many years, will be modest and can be met from within the costs originally provided for the scheme.

On the amendment to the Mental Health Act 2001, the 2001 Act provides for the involuntary admission to approved centres of persons suffering from mental disorders. The legislation also provides that where a person is acutely mentally ill and requires admission to hospital but is unwilling to travel to hospital voluntarily, the person may be brought to the hospital. Section 13(2) of the 2001 Act places a statutory obligation on the clinical director of an approved centre to provide such assisted admissions where necessary, using "staff of the approved centre".

In recent High Court proceedings, a patient sought and was granted a declaration that her removal to a psychiatric hospital in April 2007 was not in accordance with section 13(2) of the Mental Health Act 2001. The patient had been removed to the psychiatric hospital by an external agency contracted by the HSE to provide assisted admissions, where these could not be provided by the local service. In his ruling the judge found that the meaning of the term "member of staff" is confined to an individual, and a corporate entity such as the external agency could not be a member of staff.

This narrow interpretation of the term "staff of the approved centre" presents difficulties in the ongoing provision of an assisted admissions service. In 2008 there were 2,004 involuntary admissions of which 604 were assisted; 42% or 250 of those assisted admissions were provided by the external agency and it is worth noting that all the assisted admissions in the Dublin-mid-Leinster region were provided by the external agency.

I am satisfied that the external agency has provided a very professional, high quality and safe assisted admission service for both the HSE and two private psychiatric hospitals since 2006. To date, over 600 people have been safely brought to hospital by this agency and no complaints have been made about the service during that period, which is noteworthy when one considers the sensitive and potentially difficult nature of the service.

The provision of the assisted admissions by a central agency enables the development of specialised expertise in the de-escalation of difficult situations, which is of immense value and ultimately makes the situation easier for the patient and the patient's family. The company employs only fully qualified psychiatric nurses, all of whom have received intensive, specialised training, including appropriate interaction with service users and training on de-escalation and "talk-down" techniques. The company complies with all Mental Health Commission guidelines and standards in its work. It provides special transport with trained drivers and co-operates effectively with the Garda Síochána when its assistance is required.

The amendment proposed is necessary to ensure that acutely mentally ill persons who require hospitalisation and who refuse to come to hospital voluntarily can be brought to the hospital by specially authorised persons, where the local service is not in a position to provide the necessary assisted admission. It is proposed to amend sections 13 and 27 of the 2001 Act to provide that a clinical director can arrange for a person to be removed or returned to the approved centre by members of staff of the approved centre or by authorised persons. The amendment provides that the registered proprietor of an approved centre may enter into a contract for the purposes of arranging externally assisted admissions; persons who are employed by the external agency will then be authorised in writing by the clinical director to provide assisted admissions to his or her particular approved centre for a period not exceeding 12 months.

It is also proposed to amend section 9(2) of the Mental Health Act 2001 to disqualify authorised persons from making an application to detain a person under the Act and thus ensure that no conflict of interest can arise.

A question has arisen as to whether assisted admissions by the external agency to date are valid. Counsel has advised that the Legislature has the power to ratify previous breaches of sections 13 and 27 and in these circumstances, and for the avoidance of doubt, a validation provision is included in the amendment to confirm all external agency assisted admissions to date.

It is without question that we need an assisted admission service so that vulnerable people in need of care and treatment are not left in the community when they should be admitted to hospital. It is also fundamentally important that such a service is available uniformly throughout the country. However, to ensure the continuation of externally provided assisted admissions in circumstances where the local service is not in a position to provide the necessary assisted admission, we must amend our current legislation on the lines proposed.

I have mentioned that the Bill makes technical amendments to the Health Act 2007. That Act provided for the establishment of the Health Information and Quality Authority, the Office of the Chief Inspector of Social Services and a new inspection and registration system for residential centres for older people, children and people with disabilities. Amendments to the Act in the Bill are technical drafting amendments.

I also indicated that the Government's rationalisation programme for agencies included the integration of the national cancer registry within the Health Service Executive. To prepare for this, the establishment order for the National Cancer Registry Board is being amended to change its provisions relating to board composition which currently provide for the Minister to appoint a board of up to ten persons nominated by various bodies. The smooth integration of the registry with the Health Service Executive in due course will be facilitated through the forging of closer links at this point between the registry and the Health Service Executive's national cancer control programme. The Bill, therefore, amends the provisions of the establishment order for the registry to allow the appointment of a seven person board with knowledge or experience of the functions of the board, including those related to Government policy on cancer control.

Turning to the details of the Bill, Part 1, sections 1 to 3, contains standard provisions dealing with the Short Title, commencement date, definitions and expenses.

Part 2 consists of sections 4 to 14. Section 4 provides for the dissolution of the National Council on Ageing and Older People. Section 5 dissolves the council. Section 6 transfers rights and liabilities of the council to the Minister for Health and Children. Section 7 transfers land, other property and any moneys, stocks and shares and securities of the council to the Minister. Section 8 requires the Minister to cause final accounts of the council to be prepared and submit them to the Comptroller and Auditor General for audit. Copies of the audited accounts and the Comptroller and Auditor General's report on the accounts must be laid before each House of the Oireachtas. Section 9 requires the Minister to cause a final report on the council's activities to be prepared and lay copies of the report before each House of the Oireachtas.

Section 10 substitutes the name of the Minister for Health and Children for the name of the council in any pending legal proceedings to which the council is a party immediately before the commencement of Part 2. The proceedings shall not abate by reason of such substitution. Section 11 provides that every contract or agreement made between the council or any trustee or agent thereof acting on its behalf, and any other person, which is in force immediately before the commencement of Part 2 shall continue in force and shall be construed and have effect as if the Minister were substituted therein for the council and shall be enforceable against the Minister.

Section 12 provides that every person who, immediately before the commencement of Part 2, is an employee of the council shall, on the commencement of Part 2, hold an unestablished position in the Civil Service. Save in accordance with a collective agreement negotiated with a recognised trade union or staff association concerned, a person transferred shall not, on the commencement of Part 2, be brought to less beneficial conditions of remuneration than the conditions of remuneration to which he or she was subject immediately before the commencement of Part 2. The previous service of a person transferred shall be reckonable for the purposes of the employment legislation set out in section 12(3), subject to any exceptions or exclusions in that legislation. Any superannuation benefits awarded to or in respect of a person transferred and the terms relating to these benefits shall be no less favourable than those applicable to or in respect of that person immediately before the commencement of Part 2. The pension payments and other superannuation liabilities of the council in respect of its former employees become, on the commencement of Part 2, the liabilities of the Minister for Finance. A person transferred under section 12 shall undertake such duties as the Minister may from time to time direct and shall be subject to and employed in accordance with the Civil Service Regulation Acts 1956 to 2005.

Section 13 transfers each record held by the council immediately before the commencement of Part 2 to the Minister. Section 14 revokes the establishment order for the National Council on Ageing and Older People.

Part 3, sections 15 to 25, provides for the dissolution of the Women's Health Council. The provisions of Part 3 are similar to those in Part 2 in regard to the National Council on Ageing and Older People.

Part 4 consists of sections 26 to 36 and provides for the dissolution of the National Cancer Screening Service Board. Section 28 transfers rights and liabilities of the board to the Health Service Executive. Section 29 transfers land, other property and any moneys, stocks and shares and securities of the board to the Health Service Executive. Section 30 requires the Health Service Executive to cause final accounts of the board to be prepared and submit them to the Comptroller and Auditor General for audit. A copy of the audited accounts and the Comptroller and Auditor General's report on the accounts shall be submitted to the Minister who shall lay copies of the audited accounts and the Comptroller and Auditor General's report on the accounts before each House of the Oireachtas. Section 31 requires the Health Service Executive to cause a final report to the Minister on the board's activities to be prepared. The Minister shall lay copies of the final report before each House of the Oireachtas.

Section 32 substitutes the name of the Health Service Executive for the name of the board in any pending legal proceedings to which the board is a party immediately before the commencement of Part 4. The proceedings shall not abate by reason of such substitution. Section 33 provides that every contract or agreement made between the board or any trustee or agent thereof acting on its behalf, and any other person, which is in force immediately before the commencement of Part 4 shall continue in force and shall be construed and have effect as if the Health Service Executive were substituted therein for the board and shall be enforceable against the Minister.

Section 34 provides that every person who, immediately before the commencement of Part 4, is an employee of the board shall, on the commencement of Part 4, be transferred to and become an employee of the Health Service Executive. Save in accordance with a collective agreement negotiated with a recognised trade union or staff association concerned, a person transferred shall not, on the commencement of Part 4, be brought to less beneficial conditions of service, including conditions in relation to tenure, or remuneration to which he or she was subject immediately before the commencement of Part 4. The previous service of a person transferred shall be reckonable for the purposes of the employment legislation set out in section 34(3), subject to any exceptions or exclusions in that legislation. Any superannuation benefits awarded to or in respect of a person transferred and the terms relating to these benefits shall be no less favourable than those applicable to or in respect of that person immediately before the commencement of Part 4. The pension payments and other superannuation liabilities of the board in respect of its former employees become, on the commencement of Part 4, the liabilities of the Health Service Executive. A person transferred under section 34 shall be subject to and employed in accordance with the Health Acts 1947 to 2008.

Section 35 transfers each record held by the board immediately before the commencement of Part 4 to the Health Service Executive. Section 36 revokes the National Cancer Screening Service Board (Establishment) Order 2006.

Part 5, sections 37 to 47, provides for the dissolution of the Drug Treatment Centre Board and the provisions are similar to those in Part 4 for the dissolution of the Cancer Screening Service Board.

Part 6, sections 48 to 59, provides for the dissolution of the Crisis Pregnancy Agency. Again, the provisions are similar to those in Parts 4 and 5. In addition, however, there is provision under section 50 for the transfer of functions from the Crisis Pregnancy Agency to the HSE in view of legal advice that the HSE may not currently have the statutory authority to carry out these functions. Functions transferred under the Bill are: the preparation of a strategy to address the issue of crisis pregnancy in consultation with Departments of State and other appropriate persons; to work with appropriate agencies to promote and co-ordinate the attainment of the objectives contained in the strategy; to produce periodic reports on progress and to propose remedial action where required; to further the attainment of the objectives of the strategy by promoting public awareness, developing, promoting and disseminating information and information material and by fostering the provision of education and training; to draw up codes of best practice for consideration by agencies and individuals involved in providing services to women with crisis pregnancies; to promote and commission research into aspects of crisis pregnancy, as considered necessary; to furnish advice to the Minister and other Ministers on issues relating to crisis pregnancy; and to perform any other function in relation to crisis pregnancy that the Minister may assign.

Part 7, section 60, confers the same powers on the Minister for Health and Children, from 1 February 2001, as were conferred on the Minister for the Environment, Heritage and Local Government under sections 2 and 4 of the Local Government (Superannuation) Act 1980 in respect of the organisations set out in that section. Part 8, sections 61 to 64, provides for miscellaneous amendments to other legislation. Section 61 provides for the amendment of the Hepatitis C Compensation Tribunal Act 1997 to remove the age limits in respect of the travel element of the insurance scheme established for persons infected with hepatitis C or HIV through the administration within the State of infected blood or blood products. Section 62 amends the Mental Health Act 2001. Section 63 makes technical drafting amendments to the Health Act 2007. Section 64 amends article 5 of the National Cancer Registry Board (Establishment) Order 1991 to provide for the appointment by the Minister of a seven person board with knowledge or experience or relating to particular functions and other relevant competencies to assist the board in the performance of its functions.

I conclude by again acknowledging, on behalf of the Minister and myself, the work of the agencies to be dissolved under this Bill and the commitment of their boards, past and present. I commend the Bill to the house.