Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I want to begin today by sending my deepest sympathies to the family of Emma Mhic Mhathúna and especially to her children. Ar dheis Dé go raibh a h-anam dílis. Emma was a woman who strongly advocated for a better health service and shone such a bright light on why that is required in areas such as oversight, governance and accountability that clearly need so much improvement. We think of Emma today, her family and community and we all pledge to build a better health service in her memory.

I am pleased to have the opportunity to introduce the Health Service Executive (Governance) Bill 2018 to the Seanad. It is important to say that this legislation is directly relevant to Dr. Gabriel Scally's scoping inquiry report and our overall response to his recommendations, which we are determined to implement in full. The focus of the Government now is on working to try to eradicate cervical cancer and ensure we have a screening and vaccination programme worthy of women like Emma.

The Bill before us is an important step on a long journey of reform, as committed to by the Government in A Programme for a Partnership Government, and the delivery of a world-class health and social care service for Ireland as envisaged in the Sláintecare report of the Oireachtas Committee on the Future of Healthcare. With a budget of €17 billion, as of yesterday, and a significant workforce, the HSE is our largest State agency and one of our most important. It has a range of functions under legislation and provides essential services across the health and social care spectrum to citizens in every city, town and village in the country. It plays a vital role in each of our lives, often when we are at our most vulnerable or in times of crisis. Therefore, it is essential that we ensure good governance, accountability and transparency across all layers of the HSE. This Bill, as introduced to Senators here today, plays an essential role in the reform process by providing for independent board oversight of the HSE.

The Health Service Executive (Governance) Act 2013 established the directorate governance system. This system was of its time and allowed for intensive co-ordination between senior management teams in the Department of Health and the HSE. However, by its very nature and design, and by intent, it was always envisaged as an interim measure. Therefore, the core objectives of this Bill are to establish an independent board governance structure for the HSE and to dismantle the current directorate governance system. This board will be the governing body of the HSE and will be accountable to me as Minister for the performance of its functions. All board members must maintain high standards of integrity and probity and develop clear expectations concerning culture, values and behaviours and ensure personal and corporate compliance with any relevant legislation. The new governance structure will set the tone for the culture of the organisation and how the HSE must operate in the future. Therefore, it is essential that the implementation of this new structure is based on some key fundamental principles.

The first is independence. A board as the governing body supports transparency and accountability of actions in order that people can have confidence in the decision-making and management processes in the HSE. The board must ensure that it challenges the management, and itself, to demonstrate value achieved for the very significant public funds provided to health and instill an organisational culture of continuous improvement.

The second is inclusiveness. The board will act in the collective good at all times, ensuring that all stakeholders' perspectives are taken into account, be they patients, the taxpayer and staff. The HSE must welcome and take on board differences of opinion, while ultimately taking decisions based on the public good.

The third is compassion. I think none of us here today was not moved by recent events, or do not have our own personal experiences, perhaps good or bad, which have highlighted the need for compassion to underpin all layers of the health service and everything that happens with it. That only strengthens my resolve to ensure the HSE core values of care, including compassion, are embedded throughout our services and evident every day for every patient. As we establish a new board we must make very clear that independence, inclusiveness and compassion must underpin all of the board's work.

I expect the board to introduce and operate effective board governance processes, to play a central role in the direction, leadership and corporate and clinical governance of the HSE, to foster a positive relationship with the CEO of the HSE and the HSE executive team in order to facilitate the conduct of good governance, and challenge and support them to deliver priorities and improvements while holding them to account in doing so. I also expect the board to support and challenge the CEO and the HSE executive team in establishing an effective performance management and accountability system in the HSE, to promote a culture of accountability, and ensure that the HSE demonstrates value achieved for the very significant public funds provided. I further expect the board to develop constructive relationships, including with the Minister for Health, the Department of Health and the Government, and to drive and oversee a significant programme of reform in a challenging environment.

The board will have a membership of highly-skilled people with strong competencies across key areas. I think it is important to have a competency-based board, which will provide the leadership to guide, challenge and support the CEO and the HSE executive team to deliver major organisational transformation and reconfiguration within the health service.Members of the board will be expected to have experience and expertise in one or more of the following areas: corporate governance, patient advocacy, clinical governance, quality assurance and patient safety, strategic planning and change management, strategic human resource management, and public communications.

Last month, after a demanding Public Appointments Service, PAS, process, I was pleased to announce that Mr. Ciarán Devane is the chair-designate of the new HSE board. I am delighted with the outcome of this appointment process and the range of skills, experience and leadership that Ciarán will bring to this role. I cannot underline more strenuously the importance I place on this role as a key enabler of change and transformation in our services. I will work closely with the new chair-designate in this regard, and I have high expectations of what we can deliver together for the citizens of this country.

The PAS process for the other board members has now begun, and I look forward to the outcome of this process and appointing the full board. With the Seanad's and the Dáil's support, I hope to be able to do this before the end of the year in order that this new governance structure in our health service can take office at the beginning of 2019.

I would also like to make clear on the record of this House that I have accepted in full Dr. Scally's recommendations that there should be at least two patient advocates on the new board of the HSE. I commit today to fulfilling that recommendation in order that we can embed the voice of the patient at the most senior level of the HSE.

I wish to bring the Seanad through the main provisions of this Bill. Part 1 contains a number of standard provisions, including the Short Title and collective citation of the Bill. It also provides for the repeal of Part 3A of the Health Act 2004, which instituted the directorate governance structure.

Part 2 allows for the required changes in the Act to reflect the structural changes proposed in the Bill, which in essence are the establishment of an independent board and the appointment of a chief executive officer, CEO, of the HSE, and the values, principles and conditions which underpin this structure. Section 7 proposes to insert a new Part 3B, sections 16N to 16U, inclusive, in the 2004 Act to contain provisions for the membership and role of the new HSE board. Section 16N(1) provides for a board of management for the HSE comprising a chairperson, a deputy chairperson and seven ordinary members, all of whom will be appointed by the Minister for Health.

The appointments and functions of the CEO of the HSE are covered by the insertion of a new Part 4A, sections 21A to 21G, inclusive, in the 2004 Act. As Senators will be aware, we are in the process of recruiting a new director general for the HSE. The successful applicant, under this legislation, will become the new CEO of this important national State body and will be a pivotal appointment in improving the management, performance and quality of our health and social care services. The legislation also sets the accountability structure between the CEO and Oireachtas committees. Under the new section 21E, the CEO of the HSE is required to attend Oireachtas committees to give an account of the general administration of the HSE. The requirement for the CEO to appear before the Committee of Public Accounts is covered in the amendments in section 17. Sections 9 to 29, inclusive provide for other amendments to the 2004 Act, mainly consequential to the new board and CEO structure, and to take account of the move to a board and CEO structure from the directorate governance structure.

Part 3 comprises sections 30 to 34, inclusive, which amend references to the director general in primary and secondary legislation.

The establishment of an independent board and the appointment of a CEO are crucial components of a strengthened governance framework and new leadership for our health service. We must now look further and more deeply at how this new leadership can transform the accountability, culture and performance management of the HSE at all levels. Dialogue is ongoing between my Department and the HSE in this regard, and I am anxious for this work to continue in parallel with the passage of this Bill through the Houses. I will ensure that any amendments required as a result of this dialogue will be brought before the Houses as early as possible in the process.

The Sláintecare committee and the Sláintecare report concluded that an independent board for the HSE needs to be put in place. Therefore, this Bill meets a key recommendation of the Sláintecare report and constitutes one part of a broader package of measures that are intended to strengthen and improve governance, leadership and accountability within the health service. The revised governance architecture proposed in this Bill, however, is not an end in itself but rather a means to an end. The end that we all strive for is the real transformation of our health service to deliver, to the best of our ability, timely, effective and safe health services for the people. We are moving towards this with the implementation of Sláintecare. An executive director has been appointed, a programme office has been established, a new Sláintecare advisory group chaired by Dr. Tom Keane, who did amazing work on reforming our cancer services, is in place, and a detailed action plan will be published at the end of this year setting out the priorities for 2019.

As Senators will have seen in the budget yesterday, a huge priority has been attached to delivering on Sláintecare in the coming year. The establishment of the HSE board is only part of a broader package of recommendations in the Sláintecare report to revise our health structures. The geographic alignment of the community healthcare organisations, CHOs, and the hospital groups is also significant. This will allow for the creation of regional integrated care organisations which will provide for integrated care. I do not think that anyone in this House, regardless of his or her political persuasion, thinks the current construct of the HSE is fit for purpose. The way the HSE was designed is inappropriate. It is too large, too bureaucratic and needs to be reformed, which is not just my view but also the view of the former director general of the HSE, Mr. Tony O'Brien, who referred to the HSE as an "amorphous blob". The HSE needs to be reformed. It is too big in its current guise.

What we want to do under the Sláintecare report is devolve more to the regions, remove layers of bureaucracy, and create regional integrated structures where the community structure and the hospital structure are not at odds but rather form one structure delivering the full continuum of care for our patients. What we are doing today with the HSE's board structure is putting a better governance structure in place for what will ultimately be a leaner, more efficient national centre, which will still be called the Health Service Executive.

I look forward to moving ahead with these reforms as quickly as possible. As the Senators know, a public consultation on the geographic alignment of hospital groups and CHOs has been completed, and I intend to make a number of announcements on that by the end of this year. I recognise that the publication of this Bill and its passage through the Houses of the Oireachtas is only the beginning of the journey that we have all signed up to as part of Sláintecare. It is a significant milestone, however, which is crucial to moving from talking about transformational change in our health services to delivering this goal.

I commend this Bill to the House. With the assistance of Senators and Deputies, I hope we see its speedy passage in order that we can put this new structure in place.