John Gilroy (Labour) | Oireachtas source

I welcome this important legislation. No one could argue it is overdue. It offers hope that at last, and without prevarication, the Government is trying to get to grips with something often charitably described as a monolith. The Minister promised he would take this step and it demonstrates the determination of the Minister and the Government to have a working health service at last. Many local and national politicians have made a career out of criticising the HSE. Much of the criticism is well merited. It is remarkable that the previous Government, with such apparently innocuous legislation entitled the Health Act and acting out of the best motivation, managed to create something so unwieldy that we must take down the entire edifice after a mere eight years in existence. If it is remarkable, it is not particularly surprising when we reflect on the words of a former Minister for Health and Children who referred to the Department as Angola. It gives us a glimpse into the thinking that informed the decision to establish the HSE. The decision to create the HSE was driven as much by a desire to insulate the Government, which lacked political vision, from the inevitable criticism that would arise from an unreformed organisation as much as it was motivated to achieve reform. We have seen problem following problem and crisis following crisis in the HSE. The responses seem only to paper over the cracks without achieving real reform. It should not surprise us and we should not profess surprise.

The HSE was established on a premise guaranteeing that it could not succeed. In abolishing the old health boards and creating the HSE, all that was achieved was to lay down another layer of administration and management on top of a dysfunctional management structure. For good measure, we removed any trace of political accountability or transparency. We can cite a number of examples, such as the number of grade 8 administrators, a senior managerial post. The number of positions, which was in single figures under the old health board system, increased to 700 after the creation of the HSE. After the massive increase in managers, there was no discernible improvement in the delivery of health care. Matters became steadily worse until, despite spending up to 27% of the entire tax take, we have inherited a system that is not fit for purpose.

Although it is an interim measure, the Bill goes a long way to delivering on the health reform agenda set out in the programme for Government. Another example is the removal of local representation from the old health board system. This was heralded as a step into modern Ireland, where the fingerprints of local lobby groups could be found all over the map of the health service. It was a good idea and one that went some way to removing the overbearing nature of local interest at the expense of the national interest. However, like many things done by the previous Government, in making one reform and failing to replace it with the alternative, we fell into the double misfortune of having no political representation and no oversight.

When the HSE was established, one of its grand sounding platforms was the regional health service consultative forum, comprising local representatives, which met at quarterly intervals. Elected representatives had the opportunity to question officials on the operation of the service but without any input into policy decisions. This became a farce and remains so, but it served a useful political purpose to insulate the Government from any political fall-out that would inevitably arise from the unreformed service. I was a political representative on one of the fora and I was told in 2007 that, despite a projected ¤18 million overrun in September, no single person was accountable for the multi-billion euro budget.

Therefore, there was no financial officer available to appear before the board to explain how the circumstances could have arisen.

This is what the HSE and previous Government have bequeathed us. We have taken away political transparency at local level and added in, for good measure, a diminution of accountability at national level. With this, one could hardly be surprised to hear politicians of all parties, local and national, and service users complain that they cannot obtain even relatively insignificant information about the operation of services. We have even heard the Minister complain from time to time that the service is unbelievable.

It is very good that this Bill is appearing before us now. It strengthens the ability of the Minister to give policy directions to the HSE. We need to reflect for a moment on the ability of the Minister to give policy directions to the agency responsible for the highest expenditure, in excess of ¤13 billion in taxpayers' money. That the Minister has taken this on board demonstrates clearly what was wrong with policy-making measures of previous Administrations. It beggars belief that we must include such a provision at all. We must examine what the designers of the Health Act 2004 were thinking when they omitted to include such a critical provision in the legislation. That the Minister is taking upon himself direct accountability for the health service is a move that contradicts directly the policy initiatives of previous Governments, and it will be seen as politically courageous and demanding. It is a vital step in ensuring that the Government's policy decisions and commitments are properly implemented.

There will be criticism, of course. The health service problems will not be cured overnight and I suspect the Minister will fall in for much criticism during the period of transition. It is right to expect the Minister to be criticised if there are developments that are contrary to his plan.

Political generosity will be required from our political opponents. When I hear Senator MacSharry's mixed metaphors, I am not hopeful about gaining such support or even generosity. I will not labour the point-----