Sean Barrett (Independent) | Oireachtas source

I welcome the Minister. As I said the last time he was here, he occupies probably the most demanding post in Irish public life. Perhaps "disagencification" might be the word for this in that we are trying to get rid of agencies and restore ministerial responsibility which, as the previous speaker said, we were discussing with the Minister for Public Expenditure and Reform earlier.

Looking at the numbers employed in the health service, between 1980 and 2011, it went from 55,000 to 104,000. The rate of increase in the administration was to an index of 295 and the total staff was to an index of 187. We have a bureaucracy problem. With Senator Crown, I fear Sir Humphrey has had more of a say in this Bill than we would want him to have. That is where the expenditure has gone. In 1980, the number of non-doctors employed in the health service was 51,000 and it is now 96,000. We have to remove these layers.

I wonder if what we might call the "J Crown" model of hospitals, financially standing alone with their own management, preferably very little, and their own accountant, might not be a much better idea. I realise what is before us today is an interim measure to get rid of the layers of bureaucracy from the HSE but I put that forward for the Minister's thoughts when he is preparing for the next stage. When we are sick, we want to see a doctor and not the 15,500 bureaucrats who are employed in the system.

I was a member of the Brennan commission. Maurice Tempany was also a member. He was seriously concerned about the number of people with financial and accounting titles in the health services but with no qualifications, a point raised by Senator Burke. The Comptroller and Auditor General has also had that problem. It took some time to get the management letters from outside accountants commenting on what was going on. We really must be aware of all of that.

On page 67 of Health in Ireland: Key Trends 2011, one can see that the German health system - praise for which I am mindful of - spends 11.5% of gross national income and we spend 11.4%. Therefore, we are entitled to expect that kind of service and are duty bound to support the Minister in any measures he has to remedy that situation. The report also shows that our spend of ¤3,781 per capitais not that far short of Belgium, is bigger than Finland and Italy and about the same as France. Therefore, we are spending a lot of money and are entitled to ask why the service is not being delivered. The Minister deserves the support of the House for tackling issues related to very short working hours and restrictive practices in the health service under the Croke Park agreement and on his own initiative.

I am concerned about some sections, namely, section 16A(4), which states: "A person may not be appointed as an appointed director unless he or she is a person who is an employee of the Executive holding the grade of national director in the Executive." In the Brennan report, we were critical of that common recruitment pool. Why can other people not come in and help in this important task? Is that a restrictive practice? Like other Senators, I will see whether we will table amendments in respect of this. Section 16D concerns qualifications, which could help the Minister develop those points, but most of the qualifications are disqualifications as listed. One cannot be a Member of the Seanad or the European Parliament. What can one be to assist the Minister in this important task? Much the same is true of eligibility for appointment to the post of director general. We need to think outside the box in the same way as Senators Crown and Burke have spoken about. We have spoken about reform of governance and there has been reflection on why the Brennan report failed. In the other House, the Tanáiste said that no economies were achieved. One had a Health Service Executive into which every single person in the health boards was absorbed. That must be looked at because we have problems.

This debate must take place openly. I am concerned about section 16I(2), which states: "The Director General is not required to give an account before any Oireachtas Committee of any matter relating to the general administration of the Executive that is, or is likely to be, the subject of proceedings before a court or tribunal in the State." We know there is a sub judicerule but we now have the potential sub judicerule in order that they can refuse to participate in anything, which could happen in the future. This gets more draconian in section 16I(9) where it states that: "In carrying out his or her duties under this section, the Director General shall not question or express an opinion on the merits of any policy of the Government or a Minister of the Government or on the merits of the objectives of such a policy." We are all doing it but under that section, this person will be the only person in the country who does not engage in active debate with the Minister on these issues, much of it supporting him in the reforms he seeks to make.

Section 16J(1) states: "Notwithstanding his or her functions as an appointed director, an appointed director shall be accountable to the Director General for the performance of his or her functions as an employee of the Executive." Does that make for a board of people who all think the same way and demonstrate the herd instinct? We have had to investigate the problems caused by and deal with the consequences of this herd instinct in so many other areas of Irish life as we attempt to retrieve ourselves from the IMF and others. Section 16K(9) states: "A meeting of the Directorate shall not be quorate unless at least half of the persons who for the time being are members of the Directorate are in attendance at the meeting." That should be up around 90%. These people must attend board meetings and participate in these discussions. They have been let off far too lightly in section 16K(9). I became confirmed in my fears about the Sir Humphrey factor because under section 16M(8) the director will be called the director general, not the chief executive officer. I worry about people always looking for fancier titles. If they would just do the job, that would satisfy us much more.

In respect of the first step towards universal health insurance, I hope we will not continue the mistakes we have made in this area. We have lost in the Supreme Court, the European Court of Justice-----