John Gilroy (Labour) | Oireachtas source

Indeed the Senator did. The record should read that in the past 17 years, there were 14 years with overruns. This year's overrun of €158 million, as quoted by Senator MacSharry, represents 0.0166% of the budget. In a demand-led system, that is not the disaster it has been portrayed to be by my good friend, Senator MacSharry.
The Bill is highly technical and gives expression to the Government's objective of retaking financial control of the HSE. Not many people know that under the terms of the Health Act 2004, the HSE is funded through a separate process to the funding process for the Department. Under the Act, the Minister has no legal role in setting budgets, which is a remarkable thing. When the Health Act 2004 was enacted, this was considered a good thing in that it allowed the HSE to have a greater level of autonomy. However, in the absence of robust - or any - reforms to create an accountable system of health care, the grand idea of HSE independence created a situation in which accountability to the Minister was weakened entirely. It is difficult at this remove to understand the thinking that informed the decision to go down this route. Political expediency may have had a little to do with it. The hands-off model of administration which the 2004 Act establishing the HSE created probably suited the then-Minister who was generally thought to have been the least competent Minister for Health that we have had for a great many years. He continues to act as leader of the Opposition.
Some of us at the time who were involved in the HSE consultative fora, which were established at that time, realised that a bureacracy as large as the HSE was a disaster waiting to happen in the absence of ministerial control and accountability. I was very vocal about this when I was a member of HSE South's consultative forum, as were many of my colleagues. Warnings by mere county councillors fell on deaf ears, which is a reason I welcome the legislation as part of the Minister's work to regain control of what many commentators have always described as a bureaucratic jungle. The creation of a new financial structure is one part of the administrative jigsaw. It comes on top of the decision to abolish the board of the HSE in 2012, which the Minister was bold enough to do. He received criticism at the time, but he has turned out to be 100% right. I commend him for that. In setting up a statutory funding framework, the Minister takes us a step further, as Senator Crown has acknowledged, towards delivering the wide-ranging reforms set out in the programme for Government. Change in one area is always felt in another, which is why section 8 provides for the adapting of the service plan to take account of the changes.
I am particularly happy with the insertion of sections 34(a) and 34(b) of the Act of a statutory obligation of the Director General of the HSE to appear before the PAC. It is very welcome in light of what we have seen recently among other senior civil servants appearing in front of the same committee. I have been critical of the HSE for a long time, mainly due to the difficulty in obtaining information, the cumbersome nature of decision-making and the perceived lack of accountability. The Minister might advise me as to whether it would be possible in this or another Bill to introduce changes which give real bite to the regional consultative fora which are established in local government. HSE South's consultative forum is comprised of 39 members of local authorities from seven or eight counties. All other regions have the same set up. I was a member and the leader of the Labour Party on HSE South's consultative forum for a number of years and I note the frustration felt at stonewalling by the HSE regarding the provision of relevant information. Any reform in that regard would offer bottom-up accountability as well as the accountability of the HSE to the Minister. We would have accountability on both sides of the equation.
The Bill is an important step in redressing the weaknesses in the HSE. Many Bills contain references to the Minister for Public Expenditure and Reform. How will that work out in future given that previous Governments have not established such an office holder? Does it mean wide-ranging reforms will fall or will one Bill repeal all mention of the public expenditure and reform ministerial responsibility? What way does it work?
We will reflect on those questions and discuss them in more detail on Committee Stage. I commend the Bill to the House.