Seanad debates

Tuesday, 12 April 2005

5:00 pm

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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I thank the Minister of State, Deputy Brian Lenihan, for coming to the House to respond to the matter I am raising on the Adjournment. I ask the Minister of State to implement sections 41 to 44 of the Health Act 2004, which was signed into law on 17 December 2004. I would like him to outline details of the establishment of the consultative forum in this regard. I would also be interested to hear details of the mechanism for the establishment of the advisory panels.

There has been a democratic deficit since the demise of the regional health boards in 2004. The local authority members who were elected in June 2004 do not have a forum in which they can speak about health service matters affecting people in the regions. I refer, for example, to the delivery of health services by the new Health Service Executive, under the Department of Health and Children. Senators can raise issues on the Adjournment or at meetings of the Joint Committee on Health and Children, but in most instances we are unable to raise issues of a local nature. Certain structures and procedures are in place to prevent us from doing so on the Adjournment or at committee meetings.

When I was a member of the former Western Health Board, of which I was chairman between 2001 and 2002, I was allowed to raise local health issues. It was possible to discuss matters affecting Roscommon General Hospital, for example. The INO and SIPTU held a picket at the hospital today to highlight problems in its new accident and emergency department, developed at a cost of €8 million. Some €2.5 million was allocated last year to provide 40 staff to ensure that the new unit, which was opened by the Taoiseach in February 2005, is staffed fully. Nine observation beds in the unit have not yet been opened, however. There is no forum at which local representatives in the area can raise such issues. They would like to discuss the many proposals which were made in the Hanly report, for example. Those are the relevant issues. Councillors elected in June 2004 must have a voice in the delivery of health services in proportion to the representation of parties and independents elected then. It is vital that the Minister of State, the Minister and the Department implement the Bill passed and signed into law in 2004. We are well into 2005 but no progress has been made with implementing it yet. There is a need for a forum where local issues can be discussed.

I cannot see any change or improvement since the new Health Service Executive was established. Centralised delivery of health services is now the norm even though the health services in the health board of which I was a member were getting better. The establishment of a forum will assist in the delivery of health services and give councillors a new role in delivering them.

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Minister of State, Department of Education and Science; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Health and Children; Dublin West, Fianna Fail)
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I thank the Senator for raising this issue. He has spoken to me about the matter on numerous occasions and has asked me to raise it with the Minister for Health and Children. It is a matter to which he has attached great importance throughout his political career. He is a former chairman of a health board and is well aware of the importance of local accountability in the health services.

The Health Act 2004 provided for the establishment of a Health Service Executive on a statutory basis which took over responsibility for the management and delivery of health services from the Eastern Regional Health Authority, the health boards and a number of other specified agencies on 1 January 2005.

The Government takes very seriously the issue of democratic accountability throughout the health services and in the Health Act 2004 accountability at all levels of the system was a central part of the reform. The Tánaiste and the Government are particularly anxious to ensure proper accountability to public representatives at national and local level. In the Act, provision is made to ensure the accountability of the Health Service Executive to the Oireachtas Committee on Health and Children and, under section 79, provision is also made to regulate dealings between Members of the Oireachtas and the executive.

Section 42 of the Act provides specifically for the establishment of a number of regional health forums. These forums will facilitate local representatives in raising issues of local concern to health services within their region with the executive. Membership of the forums will be based on nominations from city and county councils within the functional areas of each forum. Putting such arrangements in place will ensure that the voice of local public representatives will continue to be heard in the development of health services.

These arrangements are designed to complement and reinforce the role of the Oireachtas Joint Committee on Health and Children in reflecting the views of public representatives in the ongoing oversight of the health system. The forums will be established by regulations which my Department is drafting. The regulations will specify the title of each forum and define its functional area, the number of members for each forum, the number of members from each city and county council to be nominated to each forum and the requirements relating to the manner in which the functions of a forum are to be performed.

They will also set out the procedures for appointing members to a forum, the election of a chairperson and vice-chairperson of a forum, the filling of casual vacancies, the meetings of a forum, the establishment of committees of a forum and the appointment of their members and ensuring the proper administration of each forum. It is the Tánaiste's intention that these regulations will be brought before the House shortly.

Section 43 of the Health Act 2004 provides for the establishment of advisory panels. It is a matter for the executive to determine the terms of reference, membership, rules and procedures for each panel. Section 44 of the Act provides that the Minister may direct the executive to establish an advisory panel for a specified purpose.

There are numerous consumer groups that play important roles in local service planning and delivery. The HSE has reported to the Department that it is starting the process of examining the different structures that exist in each of the former health board areas for involving consumers at local level. The HSE wants to build on the consumer panels that already exist, learn from the experiences and develop an improved model of consumer participation.

The HSE is also establishing a customer service division. A key challenge for this division will be to design an effective model of consumer involvement and an open approach to service user feedback and comment. The entire approach to consumer involvement will be brought together under the HSE customer service division. Consumer participation is a central objective of the National Hospital Office and the primary, continuing and community care directorates of the HSE.

Pending the full development of the service directorates, the structure in each former health board area is continuing under the leadership of a chief officer. Consumer involvement will continue to be managed through existing local arrangements. The HSE has indicated that there will be no change to these arrangements unless or until there is an improved model to replace them.

The HSE has recently advertised key management positions at national directorate level for corporate affairs and strategic planning and development. These key directorates will have responsibility for putting in place the administrative framework to support the regional health forums and the establishment of advisory panels.

Section 41 of the Health Act 2004 provides for the convening of a national health consultative forum to advise the Minister on matters relating to the provision of health and personal social services. This will involve the preparation of a statutory instrument to facilitate the convening of the forum this year and its organisation. The Department is currently preparing a position paper on how this matter might be progressed, which the Tánaiste will consider in due course.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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I thank the Minister of State for his reply and welcome the decision to implement the legislation. I urge that this be introduced as soon as possible because it is vital for local democracy.