Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Senators for their amendments and constructive engagement on this Bill.

I shall briefly speak to the three amendments together. My understanding of amendment No. 1 is that it is intended to facilitate amendment No. 2 and the proposed inclusion of appointees by the Minister of the day of an Irish Congress of Trade Unions, ICTU, nominee to the board and, indeed, a person with experience in patient advocacy. I take the point that Senator Devine is likely to withdraw her amendments on this occasion. Therefore, I will focus mainly on amendment No. 3 because it focuses on providing for members with patient advocacy experience on the board. I thank Senator Ruane for her work on the matter, and for engaging with me on this today and in advance of Committee Stage. I thank Senator Lawlor as well who also raised the matter on Second Stage.

Let me state the following very clearly on the record of this House, as I did on Second Stage. I am absolutely committed, as Minister, to implementing the full recommendations of the Scally review. One of those recommendations, as the Senators will know, is very much to have a strong experience in patient advocacy on the HSE board.

I do believe one should be judged based on one's actions. We have already made an excellent start in this regard because I have, so far, appointed one person to the board in an interim or designate capacity. I refer to the new chairman designate of the HSE, Mr. Ciarán Devane. Let us consider his record. He is a chairperson who was the chief executive of the UK health charity Macmillan Cancer Support, as well as having been a member of the board of the NHS England at a time when it successfully transitioned into a new system. Therefore, he has a strong record in patient advocacy and working with patient groups, particularly patients in the whole area of cancer support.I also believe my Department has a record in wanting to involve the voice of patients in decision-making whether that is involving patients in the national cancer strategy or the national maternity strategy. I have continued that record in the process to recruit members for this new board. We have advertised for this new board through a Public Appointments Service campaign and we have listed patient advocacy specifically in the list of skills that are required as one of the key skills and experience needed in the board member. There is no doubt that we are going to make sure that patient advocacy is very much embedded in the new board of the HSE.

I share Senator Ruane's view that in the past the health service has fallen down when there has not been enough weight given to the voices and experience of patients right throughout every level of our health service. The question for me is how we get this right from a legislative point of view. I respectfully ask for time to reflect on how best to do this between now and Report Stage. I would be very happy to engage with Senators between now and Report State. We have to get this right. I did not get a chance to talk to either Senator Lawlor or Senator Colm Burke in advance of this debate. Both of them made a point I was going to make, namely, that patient advocacy is a skill but also patient advocates have more skills than just being a patient advocate. It is about making sure we get the right type of patient advocate. Defining what a patient advocate is, as Senator Ruane has undertaken to do some work on, is very important. We need to be careful when we speak about patient advocacy that we mean advocacy for all users of our health and social care services and not just a part of it. Getting the right patient advocates is going to be really important and defining what patient advocacy is and who is qualified to deliver it is a point worth reflecting on while also making sure we are not mistakenly perceived to be diminishing other essential competencies. I am very happy to work on this with Senators between now and Report Stage.

I will make a point on something I imagine will recur on Report Stage, namely, the issue of putting any named organisation on a board or giving it an entitlement to a seat on a board. I have serious difficulty with that and not with staff being represented on a board or anything like that. Patient advocacy is a very separate and distinct argument. It arises from the Scally report but it also arises from common sense. It makes sense to embed the values of patient advocacy on any board and any governance structure. I do not think that is what Senator Devine was trying to do but I am just making the point that if we were to go down the route of giving one named organisation a designated seat next week we would have another named organisation wanting a seat. Before we would know it, we would end up with a board constructed in the same way that we saw fail the people of this country in the past. If one looks at the board of FÁS in the past, there was a seat for every sectoral interest rather than looking at the overall competencies of the board. That would be a mistake. The Minister of the day has to make a value judgment when appointing members to the board and consider if the board as a collective has all the skills necessary to represent the broad range of skillsets that are needed on a HSE board. If we get overly prescriptive and say, for example, that seats are for ICTU or other specific persons, we will constrain the Minister of the day in his or her ability to do that. I ask that we could consider these matters further between now and Report Stage.