Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister. The legislation is a welcome development. I disagreed with the abolition of the board some years ago because I believed it was not the best way forward. I am delighted that the board will be re-established.

I served on the board of the Port of Cork for ten years and found it to be a great experience. The board was comprised of people from various backgrounds and my background was in local government and the law. Likewise, when setting up a board like this one it is important to draw in people with expertise in management and good governance. It is extremely important that the structure of the board is properly established. I congratulate the Minister on choosing the person he has appointed chair of the board. He has made a very good appointment as the person has considerable experience.

The need for a board was highlighted when the Minister announced that €17 billion will be allocated to health in 2019. It is important that this large budget is managed appropriately and that we get good value in the management of that money so that we can deliver services.

One of the concerns that I have had over the past three to four years is about recruitment within the HSE. The number of people employed in the HSE has increased from 99,000 at the end of 2014 to more than 111,000 now. This means more than 12,000 people have been recruited to work in the HSE since December 2014. This exceeds the entire workforce of the Irish Army. A large number of people have been taken on and it is not clear that a strategy was set out to prioritise the areas where we need to employ people. One of the things a board can do is set out a clear strategy for priority areas and ensure value for money is achieved when delivering a service, thus ensuring that the maximum number of people benefit from the service that is being delivered.

This morning, at a meeting of the Oireachtas Joint Committee on Health, a colleague raised the important issue of ensuring patient advocates on boards are adequately remunerated for their time and efforts. Patient advocates normally have other commitments. It is important, therefore, to ensure they are adequately remunerated on boards or sub-committees they serve on. That is one of the issues raised at the committee meeting this morning.

Dr. Scally appeared before the Joint Committee on Health this morning. The implementation of reports is an important issue. It is great that Dr. Scally, supported by the Minister, is committed to remain here to implement his recommendations. One of the reports that was referred to this morning was the Madden report, which was published in July 2008. Some of its recommendations have still not been implemented. While it is fine to produce reports, and we have produced a large number of reports on the health service in recent years, the issue is the need to have a clear structure in place to implement their recommendations.It is important that the new board of directors of the HSE is clear on how to move forward in the context of reports that have already been produced. Rather than undertaking new reports, the focus must be on implementing the recommendations contained in existing reports.

I have raised on numerous occasions my concern about the moving of the deck chairs within the HSE, whereby people in particular positions move on to other positions within a very short period. I am concerned about the lack of continuity in the rolling out of particular services. Recently, for example, 12 people in the HSE were to meet to deal with a decision relating to an individual but that meeting was cancelled because one of those involved had moved on to another job. The issue to which I refer has been going around the houses within the HSE for 18 months but, as yet, no decision has been made in respect of it. The culture that has developed within the HSE during the past 15 to 20 years is such that people are afraid to make decisions because of the possible consequences of doing so. We need to change that culture. We all make decisions and sometimes we regret those decisions but that does not mean that we should be hung, drawn and quartered, which seems to be why people are afraid to make decisions. I have seen issues within the HSE starting off at one level of management but going through three or four different stages before a final decision is reached, which delays the entire process. This can relate to decisions on purchasing new equipment, undertaking refurbishment work, opening additional beds and so on. People always complain about a lack of accountability but my biggest concern regarding the HSE is its failure to make decisions in a timely manner. I hope that a new board will be able to generate a new culture in that regard.

The other issue of concern relates to appointments within the HSE. I am still a little concerned about the internal appointment processes in the HSE. I have issues with the way posts are advertised internally and the way in which interviews are conducted. It is not clear that the people in the HSE who are conducting interviews have adequate training. There are extremely good people in the HSE working in the administrative, medical, nursing, caring, cleaning and catering areas. We must work with them to reassure them that their work is appreciated. There is a lot of negativity surrounding the HSE which some people are taking very personally. Morale within the hospital system is low and that is something which must be improved.

We must also work on the issue of staff numbers in certain areas and, for example, on the ratio of nurses to patients versus care assistants to patients. Nurses who are highly skilled and highly trained are often doing work that care assistants could easily undertake. Furthermore, nurses could do a lot of the work that junior doctors are currently required to undertake. We need to look at that area more closely as it may be possible to deliver a better service while also appreciating the work that people are doing.