James Reilly (Dublin North, Fine Gael) | Oireachtas source

I welcome the opportunity to bring this Bill into the Seanad. It is an important Bill which, as the title, the Health Service Executive (Governance) Bill 2012, suggests, provides for a new governance structure for the HSE.

Senators will know that, in line with the programme for Government commitments, a series of legislative changes are planned to bring about radical reform of the health services which will see the introduction of universal health insurance. The programme for Government also envisages the HSE will eventually no longer exist as its functions move elsewhere under the health reform programme. This will take careful planning and sequencing, and further legislation. The Bill is intended, therefore, as a transitional measure, building on earlier changes to the composition of the board last year, and is designed to help prepare the health system for the changes ahead.

Under the Health Act 2004 which established the HSE, the HSE board is the governing body of the HSE. In 2011, I made changes to the composition of the board designed to facilitate greater co-ordination and integration between the senior management teams in my Department and the HSE. Since that time, the interim board has provided a basis on which to make early progress on the health reform agenda, facilitating a greater unity of purpose. However, when making changes to the board, I signalled that I would be bringing forward legislation to abolish the board structure and establish new governance arrangements for the HSE, pending its eventual dissolution. These changes are in the Bill now before the House.

The Bill abolishes the board structure of the HSE under the Health Act 2004 and provides for a directorate, headed by a director general, to be the new governing body in place of the board. This new structure is designed to help prepare the service delivery for the next phase of the health reform programme. The Bill's other purpose is to provide for further accountability arrangements for the HSE. In line with health reform policy, the Bill is intended to make the HSE more directly accountable to the Minister for Health, who in turn is accountable to the people through the Oireachtas. A number of technical amendments are also being made to the Health Act 2004 to take account of the replacement of the board structure by the directorate structure.

The HSE has legislative responsibility for the organisation and delivery of health services. Under the Bill, as the governing body, the directorate has authority to perform the HSE's functions. The directorate will consist of a director general and other directors. To offer flexibility and allow the size of the governing structure to adapt to changing circumstances, the Bill does not specify a fixed number of members for the directorate but instead provides for a maximum of seven and a minimum of three members, including the director general, who is automatically a member and chairperson of the directorate. The Bill provides that other members of the directorate must be HSE employees in the senior grade of national director. In support of the new directorate structure and to reflect a shift in focus to services, it is intended to recruit national directors in the areas of health and well-being, hospitals, primary care, mental health and social care. My intention is that the other directorate members will be drawn from these senior managers of services.

The HSE will continue to have operational responsibility for running the health service, but the Bill sets out parameters for the HSE. It provides that the directorate is accountable to the Minister for the performance of the HSE's functions and its own functions as the governing authority of the HSE. The process will be that the director general accounts on behalf of the directorate to the Minister through the Secretary General of the Department. In this way, the HSE will be required to account for its actions and decisions. The new provisions build on existing accountability arrangements under the Health Act 2004 which are being retained, for example, in relation to service plans, annual reports, codes of governance and the provision of information to the Minister.

The Bill also builds on accountability arrangements in the 2004 Act by allowing the Minister to issue directions to the HSE on the implementation of ministerial and Government policies and objectives relating to HSE functions where the Minister believes the HSE is not having sufficient regard to such objectives or policies in performing its functions. The Minister will also now be empowered to specify priorities for the HSE to which the HSE must have regard in preparing its service plan. The Minister may establish performance targets for the HSE in regard to these priorities. However, directions, priorities and targets may not be specified for individual patients or service users.

As is the case with the CEO, the Bill provides that the director general will be the Accounting Officer for the HSE. This is a temporary arrangement as my intention is to return the Vote to the Department of Health from 1 January 2014. At that point, the director general will no longer be the Accounting Officer. This will require further legislation to disestablish the HSE Vote and fund the HSE through the Vote of the Office of the Minister for Health. In the meantime, the Health Service Executive (Governance) Bill has new provisions for a statutory audit committee to advise the director general on financial matters relating to his or her functions and other related matters. This committee will report in writing to the director general and will provide a copy of that report to the Minister.

I will now deal with the details of the Bill. Part 1 has the standard provisions dealing with the Short Title of the Bill, commencement and definitions. It also provides for the repeal of those parts of the Health Act 2004 providing for the board and CEO structure.

Part 2, sections 4 to 22, contains provisions to amend the Health Act 2004 to reflect the new directorate structure and accountability arrangements. Some of the key elements are sections 5, 6, 7, 12, 14 and 17.

Section 5 amends section 10, on directions from Minister, of the Health Act 2004. Section 10 of the Health Act 2004 allows the Minister to give general written directions to the HSE in respect of the Act and to give specific directions on the submission by the HSE to the Minister of reports and information with regard to the performance of its functions. Section 10 is amended to provide also for ministerial directions on the implementation of ministerial and Government policies and objectives relating to HSE functions where the Minister believes the HSE is not having sufficient regard to such objectives or policies in performing its functions. As I stated earlier, directions may not be made with regard to individual patients or service users. Section 6 inserts two new sections into the Health Act 2004, namely, section 10A on setting of priorities by the Minister and section 10B on limitation as to exercise of power under sections 10 and 10A. Under section 10A, the Minister will be empowered to determine priorities to which the HSE must have regard in preparing its service plan and to establish performance targets for the HSE. Before specifying priorities or performance targets under this section, the Minister must have regard to best practice as respects the service, the subject of the priority or performance target, outcomes for patients and recipients of services likely to be affected by the priority or performance target which the Minister is considering specifying and the effect that specifying the priority or performance target concerned would be likely to have on other services provided by or on behalf of the executive. Again, priorities and targets will not apply to individual patients.

Section 7 inserts a new part in the 2004 Act to provide for the establishment of the new governing authority for the HSE, namely, the directorate. This new part will form sections 16A to 16M of the Health Act 2004. Section 16A provides that the directorate will consist of a director general and other persons referred to in the Bill as appointed directors. Section 16B sets out the detail regarding the term of office of an appointed director. The term of office for a member appointed to the directorate is three years and he or she may be re-appointed by the Minister for a second or subsequent term. As I outlined, appointed directors will be drawn from employees in the grade of national director in the HSE. An appointed director will cease to be a member of the directorate if they cease to be a national director in the HSE. Section 16C sets out the role of the directorate, which will have collective responsibility as the governing authority for the HSE and the authority to perform the HSE's functions. Subject to any directions of the Minister, the directorate may delegate HSE functions to the director general. This section also sets out the accountability arrangements to the Minister about which I spoke. Section 16D sets out eligibility for appointment and reasons for removal from office of persons appointed to the directorate. These are similar to the provisions in other legislation in respect of board appointments and removals. Section 16E provides for the appointment by the Minister of the director general. It is my intention, subject to the Bill being passed by the Oireachtas, to appoint Mr. Tony O'Brien, who is currently deputy chief executive officer of the executive, to be the first director general, as permitted by section 16E(4). Subsequent directors general will be appointed by the Minister following a recruitment process under the Public Service Management (Recruitment and Appointments) Act 2004. The appointment of the director general will be made on terms and conditions as determined by the Minister, with the consent of the Minister for Public Expenditure and Reform.

Section 16F sets out the eligibility requirements for appointment as director general, as well as circumstances in which the director general may be removed from office. Section 16G provides for the general functions and role of director general. These include managing and controlling the business of the HSE. In the operational aspects of his or her role, the director general is answerable to the directorate, as the governing authority of the HSE. On a day-to-day basis, national directors, even if appointed as members of the directorate, will be accountable to the director general for the performance of their functions as employees of the HSE. Section 16H sets out the arrangements for the delegation of functions by the director general. A key objective of the new HSE governance arrangements is to facilitate a system whereby authority to make operational decisions is delegated as closely as possible to the point of service delivery. Delegated functions may be subdelegated by the director general to HSE employees. This will be subject to any directions from the directorate. Section 16I provides for the attendance by the director general before Oireachtas committees. Other aspects of section 7 deal with procedural and related matters for the directorate.

I will now turn to section 12 which amends provisions in the 2004 Act in regard to service planning. Currently, the HSE prepares a service plan in line with certain requirements, adopts the plan and submits it to the Minister for approval. The Minister must either approve the service plan or issue a direction to amend the plan if requirements are not met. The 2004 Act is now amended to provide for the HSE to prepare a plan in line with current criteria, while also taking account of priorities determined and targets set by the Minister. While the Minister may direct the HSE to amend the plan if requirements are not met, the Minister may now also amend the plan, following consultation with the HSE. Section 14 provides for the 2004 Act to be amended in order that the Minister may direct the HSE to take specified measures with regard to the implementation of the plan. I have already spoken about section 17, which provides for the director general to be the Accounting Officer and sets out provisions for a new statutory audit committee. Other sections in Part 2 of the Bill deal with technical amendments to the Health Act 2004 consequential to the establishment of the directorate. Part 3 of the Bill has the standard provision for savers following on from the repeal of sections relating to the board and the chief executive officer.

I will conclude by stating the reform programme is about the patient. While this Bill is only one element of a legislative and administrative reform process aimed at ensuring a better health service for patients, it is an important one. Accountability and service delivery are fundamental tenets of the health reform programme. I believe this Bill, together with the new management arrangements, will help bring greater focus on service delivery and ensure more accountability during the time the HSE continues to exist. I also believe it will help to make sure the patient is at the centre of the service and the service is reminded continually of its obligation to serve the patient. The HSE is an experiment that has not worked. The Bill is doing what I promised to do when I stated last year that I would change the governance structure for the HSE. This is a step towards the overall reform of the health service that will see the eventual dissolution of the HSE as an entity and will facilitate the introduction of universal health insurance as included in the programme for Government. The new structures will improve patient care and will lead to sustainable performance improvement by the HSE. It will give better control of financial and clinical systems. It will lead to more integrated care and integrated governance, crucially with a clear line of accountability from the HSE to the Minister. As stated previously, it is an important step on the way to universal health insurance.