Áine Brady (Kildare North, Fianna Fail)
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I will begin by briefly outlining the six distinct purposes of the Health (Miscellaneous Provisions) Bill 2009 in the order in which the relevant provisions appear in the Bill. I will then speak in more detail about the policy objectives underpinning the Bill.

The Bill advances Government policy on health service agency integration as put forward in the health service reform programme and more recently in regard to the rationalisation of State agencies generally, by providing for the integration of the National Council on Ageing and Older People and the Women's Health Council within the Department of Health and Children and the integration of the National Cancer Screening Service Board, the Drug Treatment Centre and the Crisis Pregnancy Agency within the Health Service Executive. As part of this overall process, the Bill progresses Government policy on the establishment of the office with responsibility for older people within the Department of Health and Children.

Second, the Bill provides for the transfer of ministerial responsibility for the local government superannuation scheme, health sector, from the Minister for the Environment, Heritage and Local Government to the Minister for Health and Children. The Bill also gives legal effect to amendments made to this scheme by the Minister.

The third purpose of the Bill is the amendment of the Hepatitis C Compensation Tribunal Act 1997, as amended, to remove age limits for travel insurance benefit provided in accordance with that Act. The Bill also provides for an amendment to the Mental Health Act 2001 to address difficulties in the operation of the Act which have arisen following a recent High Court judgment. In addition, the Bill makes technical amendments to the Health Act 2007. The Bill amends the National Cancer Registry Board (Establishment) Order 1991 in regard to the composition of the board. This amendment to the establishment order is intended to facilitate the integration of the registry within the Health Service Executive in due course.

Turning to the policy objectives of the Bill, I referred to the health service reform programme and, in this context, Senators will know that the rationalisation of health services agencies was one of the recommendations of the Prospectus report on the audit of structure and functions in the health system. A number of such agencies had been established over several decades by successive Governments. Each one of these played its part in the development of our health services. However, by 2003, with over 55 different agencies, it was acknowledged that we were working with a system that was, in overall terms, unnecessarily complicated and fragmented. A core principle underpinning this policy of streamlining was the achievement of better co-ordination and reduction in duplication and overlap of functions between agencies, through the amalgamation of bodies carrying out similar functions and operational work. In the case of advisory bodies, the thinking underpinning the health reform programme was that the role of assisting a Minister in policy development should not, where possible, be devolved to outside agencies.

As part of this planned rationalisation programme, several agencies were integrated within the Health Service Executive under the Health Act 2004 while provision was made in other legislation for the integration of a number of agencies within other bodies.

Since that time, following on from the efficiency review announced in 2007 and the publication of the OECD Review of the Irish Public Service, the Government agreed a process of rationalisation of State agencies. In the case of the health sector, the number of agencies is being reduced from 34 to 18.

In this Bill, the programme of rationalisation is moved forward through the integration of the National Council on Ageing and Older People and the Women's Health Council within the Department of Health and Children and the integration of the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency within the Health Service Executive.

The principle of integration in regard to these agencies had the general support of the Dáil. We must now build on what has been accomplished in the past by these agencies and work towards achieving all the advantages to be gained from coordination and integration. During the debate on the Bill in the Dáil, my colleagues made the point that efficiencies must be gained from the rationalisation process but that the primary aim of agency integration under the Bill is to streamline service delivery and policy making. Efficiencies will be achieved over time from economies of scale and the elimination of duplication in areas such as recruitment, procurement, payroll and ICT systems.

I stress that it was also made clear that the integration of the staff and work of these agencies will be carefully managed to ensure a seamless continuation of important services they provide. Staff transferred under the Bill will bring their expertise and experience to the Department and the Health Service Executive.

Before moving on to the other aspects of the Bill, I would like to pay tribute to the boards of these agencies and their employees for the work they have carried out over the years. The National Council on Ageing and Older People has made a key contribution to policy development in respect of services for older people. The Women's Health Council has had a significant part to play in facilitating policy formulation on women's health. The work of the National Cancer Screening Service Board in early detection of cancer is well known and valued. The Drug Treatment Centre Board has made an important contribution to the delivery of services for drug misusers. The Crisis Pregnancy Agency has played a critical part in the delivery of strategies to reduce the number of crisis pregnancies. I have no doubt that Senators share my views in this matter.

I will deal with the transfer of ministerial responsibility for the local government superannuation scheme (health sector) from the Minister for the Environment, Heritage and Local Government to the Minister for Health and Children. Part 7 of the Bill confers the same powers on the Minister for Health and Children as were conferred on the Minister for the Environment, Heritage and Local Government under sections 2 and 4 of the Local Government (Superannuation) Act 1980 in respect of a range of health sector organisations. All powers exercised by the Minister for Health and Children under sections 2 and 4 of the Local Government (Superannuation) Act 1980 since 1 February 2001 are confirmed and apply to all of the organisations mentioned in section 60.

On the amendment of the hepatitis C legislation dealt with in the Bill, the position is that the Hepatitis C Compensation Tribunal (Amendment) Act 2006 provides for the setting up of an insurance scheme for persons infected with hepatitis C and HIV through the administration within the State of infected blood or blood products. This provision is intended to assist persons with hepatitis C or HIV to obtain insurance where they would otherwise have difficulty in doing so on the open market.

This amendment will provide for the removal of the 65 year age limit when applying for travel insurance under the scheme. The scheme encompasses mortgage and life assurance and travel insurance. The current legislation limits entry age to the scheme to 65 years. The Minister has agreed that the age limit for travel insurance only should be removed, as this age restriction under the Act may make the availability of travel insurance cover to the relevant claimants under the scheme more limited than for persons who are not infected.

The Minister is satisfied that any additional cost, which would be spread over many years, will be modest and can be met from within the costs originally provided for the scheme.

On the amendment to the Mental Health Act 2001, the 2001 Act provides for the involuntary admission to approved centres of persons suffering from mental disorders. The legislation also provides that where a person is acutely mentally ill and requires admission to hospital but is unwilling to travel to hospital voluntarily, the person may be brought to the hospital. Section 13(2) of the 2001 Act places a statutory obligation on the clinical director of an approved centre to provide such assisted admissions where necessary, using "staff of the approved centre".

In recent High Court proceedings, a patient sought and was granted a declaration that her removal to a psychiatric hospital in April 2007 was not in accordance with section 13(2) of the Mental Health Act 2001. The patient had been removed to the psychiatric hospital by an external agency contracted by the HSE to provide assisted admissions, where these could not be provided by the local service. In his ruling the judge found that the meaning of the term "member of staff" is confined to an individual, and a corporate entity such as the external agency could not be a member of staff.

This narrow interpretation of the term "staff of the approved centre" presents difficulties in the ongoing provision of an assisted admissions service. In 2008 there were 2,004 involuntary admissions of which 604 were assisted; 42% or 250 of those assisted admissions were provided by the external agency and it is worth noting that all the assisted admissions in the Dublin-mid-Leinster region were provided by the external agency.

I am satisfied that the external agency has provided a very professional, high quality and safe assisted admission service for both the HSE and two private psychiatric hospitals since 2006. To date, over 600 people have been safely brought to hospital by this agency and no complaints have been made about the service during that period, which is noteworthy when one considers the sensitive and potentially difficult nature of the service.

The provision of the assisted admissions by a central agency enables the development of specialised expertise in the de-escalation of difficult situations, which is of immense value and ultimately makes the situation easier for the patient and the patient's family. The company employs only fully qualified psychiatric nurses, all of whom have received intensive, specialised training, including appropriate interaction with service users and training on de-escalation and "talk-down" techniques. The company complies with all Mental Health Commission guidelines and standards in its work. It provides special transport with trained drivers and co-operates effectively with the Garda Síochána when its assistance is required.

The amendment proposed is necessary to ensure that acutely mentally ill persons who require hospitalisation and who refuse to come to hospital voluntarily can be brought to the hospital by specially authorised persons, where the local service is not in a position to provide the necessary assisted admission. It is proposed to amend sections 13 and 27 of the 2001 Act to provide that a clinical director can arrange for a person to be removed or returned to the approved centre by members of staff of the approved centre or by authorised persons. The amendment provides that the registered proprietor of an approved centre may enter into a contract for the purposes of arranging externally assisted admissions; persons who are employed by the external agency will then be authorised in writing by the clinical director to provide assisted admissions to his or her particular approved centre for a period not exceeding 12 months.

It is also proposed to amend section 9(2) of the Mental Health Act 2001 to disqualify authorised persons from making an application to detain a person under the Act and thus ensure that no conflict of interest can arise.

A question has arisen as to whether assisted admissions by the external agency to date are valid. Counsel has advised that the Legislature has the power to ratify previous breaches of sections 13 and 27 and in these circumstances, and for the avoidance of doubt, a validation provision is included in the amendment to confirm all external agency assisted admissions to date.

It is without question that we need an assisted admission service so that vulnerable people in need of care and treatment are not left in the community when they should be admitted to hospital. It is also fundamentally important that such a service is available uniformly throughout the country. However, to ensure the continuation of externally provided assisted admissions in circumstances where the local service is not in a position to provide the necessary assisted admission, we must amend our current legislation on the lines proposed.

I have mentioned that the Bill makes technical amendments to the Health Act 2007. That Act provided for the establishment of the Health Information and Quality Authority, the Office of the Chief Inspector of Social Services and a new inspection and registration system for residential centres for older people, children and people with disabilities. Amendments to the Act in the Bill are technical drafting amendments.

I also indicated that the Government's rationalisation programme for agencies included the integration of the national cancer registry within the Health Service Executive. To prepare for this, the establishment order for the National Cancer Registry Board is being amended to change its provisions relating to board composition which currently provide for the Minister to appoint a board of up to ten persons nominated by various bodies. The smooth integration of the registry with the Health Service Executive in due course will be facilitated through the forging of closer links at this point between the registry and the Health Service Executive's national cancer control programme. The Bill, therefore, amends the provisions of the establishment order for the registry to allow the appointment of a seven person board with knowledge or experience of the functions of the board, including those related to Government policy on cancer control.

Turning to the details of the Bill, Part 1, sections 1 to 3, contains standard provisions dealing with the Short Title, commencement date, definitions and expenses.

Part 2 consists of sections 4 to 14. Section 4 provides for the dissolution of the National Council on Ageing and Older People. Section 5 dissolves the council. Section 6 transfers rights and liabilities of the council to the Minister for Health and Children. Section 7 transfers land, other property and any moneys, stocks and shares and securities of the council to the Minister. Section 8 requires the Minister to cause final accounts of the council to be prepared and submit them to the Comptroller and Auditor General for audit. Copies of the audited accounts and the Comptroller and Auditor General's report on the accounts must be laid before each House of the Oireachtas. Section 9 requires the Minister to cause a final report on the council's activities to be prepared and lay copies of the report before each House of the Oireachtas.

Section 10 substitutes the name of the Minister for Health and Children for the name of the council in any pending legal proceedings to which the council is a party immediately before the commencement of Part 2. The proceedings shall not abate by reason of such substitution. Section 11 provides that every contract or agreement made between the council or any trustee or agent thereof acting on its behalf, and any other person, which is in force immediately before the commencement of Part 2 shall continue in force and shall be construed and have effect as if the Minister were substituted therein for the council and shall be enforceable against the Minister.

Section 12 provides that every person who, immediately before the commencement of Part 2, is an employee of the council shall, on the commencement of Part 2, hold an unestablished position in the Civil Service. Save in accordance with a collective agreement negotiated with a recognised trade union or staff association concerned, a person transferred shall not, on the commencement of Part 2, be brought to less beneficial conditions of remuneration than the conditions of remuneration to which he or she was subject immediately before the commencement of Part 2. The previous service of a person transferred shall be reckonable for the purposes of the employment legislation set out in section 12(3), subject to any exceptions or exclusions in that legislation. Any superannuation benefits awarded to or in respect of a person transferred and the terms relating to these benefits shall be no less favourable than those applicable to or in respect of that person immediately before the commencement of Part 2. The pension payments and other superannuation liabilities of the council in respect of its former employees become, on the commencement of Part 2, the liabilities of the Minister for Finance. A person transferred under section 12 shall undertake such duties as the Minister may from time to time direct and shall be subject to and employed in accordance with the Civil Service Regulation Acts 1956 to 2005.

Section 13 transfers each record held by the council immediately before the commencement of Part 2 to the Minister. Section 14 revokes the establishment order for the National Council on Ageing and Older People.

Part 3, sections 15 to 25, provides for the dissolution of the Women's Health Council. The provisions of Part 3 are similar to those in Part 2 in regard to the National Council on Ageing and Older People.

Part 4 consists of sections 26 to 36 and provides for the dissolution of the National Cancer Screening Service Board. Section 28 transfers rights and liabilities of the board to the Health Service Executive. Section 29 transfers land, other property and any moneys, stocks and shares and securities of the board to the Health Service Executive. Section 30 requires the Health Service Executive to cause final accounts of the board to be prepared and submit them to the Comptroller and Auditor General for audit. A copy of the audited accounts and the Comptroller and Auditor General's report on the accounts shall be submitted to the Minister who shall lay copies of the audited accounts and the Comptroller and Auditor General's report on the accounts before each House of the Oireachtas. Section 31 requires the Health Service Executive to cause a final report to the Minister on the board's activities to be prepared. The Minister shall lay copies of the final report before each House of the Oireachtas.

Section 32 substitutes the name of the Health Service Executive for the name of the board in any pending legal proceedings to which the board is a party immediately before the commencement of Part 4. The proceedings shall not abate by reason of such substitution. Section 33 provides that every contract or agreement made between the board or any trustee or agent thereof acting on its behalf, and any other person, which is in force immediately before the commencement of Part 4 shall continue in force and shall be construed and have effect as if the Health Service Executive were substituted therein for the board and shall be enforceable against the Minister.

Section 34 provides that every person who, immediately before the commencement of Part 4, is an employee of the board shall, on the commencement of Part 4, be transferred to and become an employee of the Health Service Executive. Save in accordance with a collective agreement negotiated with a recognised trade union or staff association concerned, a person transferred shall not, on the commencement of Part 4, be brought to less beneficial conditions of service, including conditions in relation to tenure, or remuneration to which he or she was subject immediately before the commencement of Part 4. The previous service of a person transferred shall be reckonable for the purposes of the employment legislation set out in section 34(3), subject to any exceptions or exclusions in that legislation. Any superannuation benefits awarded to or in respect of a person transferred and the terms relating to these benefits shall be no less favourable than those applicable to or in respect of that person immediately before the commencement of Part 4. The pension payments and other superannuation liabilities of the board in respect of its former employees become, on the commencement of Part 4, the liabilities of the Health Service Executive. A person transferred under section 34 shall be subject to and employed in accordance with the Health Acts 1947 to 2008.

Section 35 transfers each record held by the board immediately before the commencement of Part 4 to the Health Service Executive. Section 36 revokes the National Cancer Screening Service Board (Establishment) Order 2006.

Part 5, sections 37 to 47, provides for the dissolution of the Drug Treatment Centre Board and the provisions are similar to those in Part 4 for the dissolution of the Cancer Screening Service Board.

Part 6, sections 48 to 59, provides for the dissolution of the Crisis Pregnancy Agency. Again, the provisions are similar to those in Parts 4 and 5. In addition, however, there is provision under section 50 for the transfer of functions from the Crisis Pregnancy Agency to the HSE in view of legal advice that the HSE may not currently have the statutory authority to carry out these functions. Functions transferred under the Bill are: the preparation of a strategy to address the issue of crisis pregnancy in consultation with Departments of State and other appropriate persons; to work with appropriate agencies to promote and co-ordinate the attainment of the objectives contained in the strategy; to produce periodic reports on progress and to propose remedial action where required; to further the attainment of the objectives of the strategy by promoting public awareness, developing, promoting and disseminating information and information material and by fostering the provision of education and training; to draw up codes of best practice for consideration by agencies and individuals involved in providing services to women with crisis pregnancies; to promote and commission research into aspects of crisis pregnancy, as considered necessary; to furnish advice to the Minister and other Ministers on issues relating to crisis pregnancy; and to perform any other function in relation to crisis pregnancy that the Minister may assign.

Part 7, section 60, confers the same powers on the Minister for Health and Children, from 1 February 2001, as were conferred on the Minister for the Environment, Heritage and Local Government under sections 2 and 4 of the Local Government (Superannuation) Act 1980 in respect of the organisations set out in that section. Part 8, sections 61 to 64, provides for miscellaneous amendments to other legislation. Section 61 provides for the amendment of the Hepatitis C Compensation Tribunal Act 1997 to remove the age limits in respect of the travel element of the insurance scheme established for persons infected with hepatitis C or HIV through the administration within the State of infected blood or blood products. Section 62 amends the Mental Health Act 2001. Section 63 makes technical drafting amendments to the Health Act 2007. Section 64 amends article 5 of the National Cancer Registry Board (Establishment) Order 1991 to provide for the appointment by the Minister of a seven person board with knowledge or experience or relating to particular functions and other relevant competencies to assist the board in the performance of its functions.

I conclude by again acknowledging, on behalf of the Minister and myself, the work of the agencies to be dissolved under this Bill and the commitment of their boards, past and present. I commend the Bill to the house.

Liam Twomey (Fine Gael)
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This legislation is quite straightforward. The only surprising thing about it is that it took so long for this work to start. The Prospectus report which was published in 2001 or 2002 discussed rationalising services and agencies in all areas of Government. Deputy Micheál Martin, the then Minister, has the distinction of managing to set up the largest number of agencies while he was Minister. We are now dismantling many of them. The International Monetary Fund, IMF, has said it had little confidence in the Government in this country between 2002 and 2007 and alluded to the setting up of agencies to deal with everything and anything.

Many of the agencies we are discussing today are incredibly good, and it is important the corporate memory of each is not lost when they are subsumed into the HSE. The Government needs to move a little quicker to deal with the many other agencies, bodies and groups it established over the last decade which appear to serve little function when compared with the agencies being discussed in this legislation. Perhaps the Minister in her reply will discuss the corporate memory of these agencies. Once the agencies are subsumed into the HSE their employees will become like any other employee of the HSE and might find themselves transferred or moved around. There is also the issue of the ethos of a good organisation. The national cancer registry has a great ethos, is very well run and delivers great results. One can rely on the registry; it is impartial and its results are accurate and can be quoted in comfort. The crisis pregnancy agency has not shrunk from its responsibilities and often receives negative media coverage from certain vested interests that do not agree with what it is doing.

On the other hand, there has been a litany of corporate disasters in the HSE. It responds to criticism by either trying to bury or cover up the problem or by misleading the public on what has gone wrong. I am concerned that the negative corporate memory that has developed in the HSE would seep into some of these agencies and that the information they produce would be tampered with, altered or changed to present the Government of the day in a more favourable light or that they will shrink from making difficult decisions or implementing difficult policies simply because they might be told to do so, not necessarily by a politician or Minister but by senior managers within the larger organisation.

There is a problem with the senior management of the HSE. Many people do not quite know what we mean but there is a serious problem with how senior management makes decisions, implements those decisions and shrinks from taking responsibility for crises in the organisation. I have mentioned the Leas Cross report previously and I thank the Minister of State for providing me with a reply when I commented on that report. When the Leas Cross report was published its release was delayed for months because every individual mentioned in it was given the right to reply. The replies from some of the senior members of the HSE were an exercise in self defence and passing the buck. They never accepted the responsibility that they might have had a part to play in what happened in Leas Cross. Although I fully support rationalising and getting rid of some of these quangos, my greatest fear is that the agencies that were doing a good job will become like the HSE when they get sucked into that organisation. If that happens, they might as well have been abolished. They will become another group of employees pushing paper and getting shot down by senior management whenever they come up with a good idea that is considered controversial or difficult. I hope that does not happen.

Every agency of the State, including the Cabinet, should put the quote from the Ombudsman, Ms Emily O'Reilly, over the door of its organisation. She said: "Public bodies and agencies begin to go bad when they begin to lose sight of why they are there in the first place." It is an excellent quote. Agencies and organisations are established with the best intentions but as soon as they allow internal or external politics or the criticisms of vested interests to intrude, they cease to function in the way that was expected when they were established. We see this all too often. The problem has become worse in the last number of years and especially since the Freedom of Information Act was dismantled to some degree by the Government.

There is always an element of secrecy within an organisation, whether it is a small private sector business, a big organisation such as the HSE or even politicians. However, it has become all-pervasive in the sense that we try to bury every piece of information. We have killed transparency and accountability to an extent because we are not prepared to accept any form of criticism or accountability when something happens. It has worsened over the last decade. The IMF spoke about the problems with Ireland's economy and poor Government policy making. The Governments led by Deputy Bertie Ahern contributed hugely to that secrecy, which has been very bad for the public sector and the Civil Service. Many of the people who work in organisations in the public sector and in the Civil Service should fight back to secure their autonomy.

I said previously on the Order of Business that what the Governor of the Central Bank did on the day of the local and European elections was nothing short of a disgrace. He started to talk about the green shoots in the economy although he clearly knew everything we now know about the regression of our economy, rising unemployment and the mess of our public finances. He knew all these factors and was clearly trying to manipulate a result. Even if he denies that charge he should have had enough cop-on not to have issued statements of that kind on the day of an election. Even if he was completely innocent he should not have said such things because I and others like me will see his speech for what it was, as being far too political for somebody of his stature and with his role in Irish society. This attitude appears to have percolated through the civil and public service in such a way that people are no longer prepared merely to say things in the way they are supposed to, making themselves less political. This issue will become very important. The HSE has become too political and because these kinds of organisations are being subsumed into it there is a genuine fear they may lose their independence and the good corporate structure they have had for so long. When the Minister of State is discussing such matters in the Department perhaps she should be a little bolder and decide not to subsume the people and the organisations.

Perhaps it is time to look at the role of the National Treatment Purchase Fund. The NTPF has been great for the approximately 50,000 people who received procedures under it but it has added very little to the overall health care of this country. It is a private organisation set up by the Minister for Health and Children, Deputy Harney, to try to show the private sector as something special. What should have taken place during the lifetime of the NTPF was significant and serious reform of the public health services to make them more efficient and work better. The funding for the NTPF should have been used in that way. During the NTPF's lifetime, the health services in Northern Ireland experienced much the same problems as those in the Republic. Theirs were not as bad because more resources have been put into the national health service for a longer period but they were similar. When the services in the North set out to deal with those problems they did not seek the solution of diverting money towards the private sector but set up small groups under clear ministerial direction. These were not quangos but were very much the responsibility of the respective Ministers. They dealt with many of their problems in a very effective way, using public resources and delivering for the public.

In recent years when money was sloshing around under this Government - a false economy as we know now - we did not tackle the very serious problems in the delivery of health care. It is amazing that only one third of our people are entitled to free primary health care services, namely, free access to a general practitioner, and they must pay €100 per day for hospital services. It costs every taxpayer approximately €3,000 to deliver that service, but north of the Border people have free GP and primary care, free hospital care, delivered and achieved. This is not an ideological point but is about getting the best value for money and being able to deliver for the people whom one is supposed to serve. Perhaps the Minister of State should begin considering whether the days of the NTPF are over and whether we should focus on delivering and working and making the public health service work for the country. When the Minister of State replies perhaps she will give an indication of how much she expects to save when this legislation is passed and the changes are applied.

Geraldine Feeney (Fianna Fail)
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I welcome the Minister of State, Deputy Áine Brady, to the House and thank her for her very comprehensive presentation. She outlined the Bill line for line in a very clear and coherent manner.

I am delighted to have the opportunity to speak on the Bill, which is very technical and much needed. There is not a man, woman or child in Ireland who did not want a reduction in the number of State agencies. We spoke earlier on another Bill with the Minister of State's colleague, Deputy John Moloney, the Minister of State with responsibility for mental health, during which time I agreed with many points made by my colleague on the opposite side, my good friend, Senator Twomey. We laughed because I agreed with so much of what he said, but I do not agree with what he said on this Bill.

Liam Twomey (Fine Gael)
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They got to Senator Feeney over lunch.

Geraldine Feeney (Fianna Fail)
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Senator Twomey must not have had a good lunch because he really had a go at the HSE. I smile because the Senator welcomed the Bill and acknowledged that rationalisation is needed, for all the right reasons. However, having said that, he had a right old barney at the HSE to which I will respond later.

Like Senator Twomey, I believe the Bill is very good and much needed. It may have been long awaited but I am glad it is here. It will certainly bring more clarification to what is going on and will bring together the people who served on councils such as the National Council on Ageing and Older People, the Women's Health Council, the National Cancer Screening Service, the Drug Treatment Centre and the Crisis Pregnancy Agency. This is in addition to dealing with superannuation, for example, which the Minister of State rightly said should be taken from the remit of the Department of the Environment, Heritage and Local Government and placed under the auspices of the Department of Health and Children. There are also the many changes to the Mental Health Act, which arose from that court case last summer.

One of the important points, especially in the bad economic downturn we are experiencing, is value for money and the efficiencies that can be achieved. There is no doubt the Bill's measures will bring these about, resulting in value for money and money being better spent.

Senator Twomey has a fear the agencies now going into the HSE may be contaminated by it. I do not agree they bring bad press on themselves. Paper will not refuse ink. The majority of those who work in the HSE are very hard-working public servants who do not deserve the bad press they get from irresponsible reporters. I say to Senator Twomey that the councils and boards to be incorporated into the HSE will bring their expertise to that body and it will also be beneficial for them because they will be at the coalface, a very important strategic move for them.

I am glad to see there will be a reduction in the number of agencies in the health service, from 34 to 18. As the Minister of State presented her speech, it struck me that everything has been done in a very methodical and well thought out way. She discussed the transfer of lands, other properties, moneys, stocks, shares and securities of the board to the HSE and it sounded almost like a will. I was beginning to wish I was a member of the HSE, getting some of these goodies that are coming. The final accounts will be prepared and submitted to the Comptroller and Auditor General for audit and ultimately the audited accounts and the report of the Comptroller and Auditor General will be presented to the Minister and then to both Houses of the Oireachtas. It appears to be, and I am sure it will turn out to be so, a well thought out process and will go through in a coherent and simple way.

Senator Twomey agreed with the IMF's advice on a reduction in the number of agencies. Everybody does, and we have no problem with that, but I disagree with his statement that from 2002 to 2007 agencies mushroomed and were set up in considerable numbers. A great deal of work was done. Senator Twomey was in the Lower House then but we both sat on the Joint Committee on Health and Children and had many meetings regarding this matter. He will remember that much good work was done within the Department by the Ministers, Deputies Martin and Harney.

As the Minister of State made her presentation, my attention was drawn to the Health and Social Care Professionals Act 2005 which regulated a group of ten or 12 professions, including dieticians, physiotherapists and chiropodists, for the first time. This was done with patient safety and care in mind. Ground-breaking provisions were introduced in terms of health. Between 2002 and 2007, the Department of Health and Children was doing many good things in which Senator Twomey and I played a role.

The Minister of State has rightly pointed out the wonderful successes that are BreastCheck, the Drug Treatment Centre Board and the Crisis Pregnancy Agency. From a woman's point of view, I must take my hat off to the breast screening facility and BreastCheck. The latter has been rolled out in my area. Only one other area remains to be covered, namely, Donegal. That roll-out is either in progress or is imminent. In County Sligo where I live, women are availing of BreastCheck and are glad to have it. It is a great service and I would love to see the screening of other cancers about which we have spoken in the House, but that matter is for another day.

The Bill is important, but the case of a young mother involuntarily detained in a mental hospital, which was highlighted in the courts last summer, was scary to say the least. From reading newspapers, we all know what occurred. She was out walking when she was taken to a mental institution. I could never understand what constituted "staff of the approved centre" until I read the Bill and realised that the reference was probably to agency staff. As we know, nursing involves a lot of agency staff. Many private and public hospitals and nursing homes use a considerable number of agency staff personnel. As the Minister of State pointed out, there is a greater usage of agency nurses in the mid-Leinster and Dublin regions.

Liam Twomey (Fine Gael)
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I do not mean to correct Senator Feeney, but the staff are not agency staff as she and I may know them. There is an agency, but its staff are permanent. It is a trained team that collects the patients in question.

Pat Moylan (Fianna Fail)
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Senator Feeney, without interruption.

Geraldine Feeney (Fianna Fail)
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They are specially trained for mental-----

Liam Twomey (Fine Gael)
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It is a specially trained agency.

Geraldine Feeney (Fianna Fail)
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I thank the Senator for pointing that out, as I did not realise. As the Leader would say, one is learning something all of the time. I am glad to hear Senator Twomey's point. At the time, I read that the woman needed to be taken in that manner to ensure the safety of the patient and the wider public. The situation is always improving, in that mental health carers, be they nurses or doctors, are highly trained and no one else could do that type of work. I welcome the amending legislation is this regard, given the issues of patient and public safety.

There is no doubt we are gone from the days of long ago when people who acted in a way that was other than the norm as it was then known were put in mental institutions because there was nowhere else to put them. Who decided the norm? In some cases, they were incarcerated. I have finished reading a good book, The Secret Scripture. Given that other people are smiling, other Members have read it as well. It tells the story of a woman who, as with those to whom I have just referred, grew up normally, got married and had stuff go wrong. It is a true story and I recommend it to everyone. It is a great read, but frightening. When I finished it, I said, "Thank God", because I knew what occurred to her could never occur in the Ireland of today.

I thank the Minister of State for outlining every section and provision of the Bill in a clear and coherent way. I look forward to the Bill's remaining Stages in the House next week.

David Norris (Independent)
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I welcome the Minister of State. This is one of a flurry of Bills arriving in the House. In this area, we sometimes get miscellaneous provisions Bills, such as the Criminal Justice (Miscellaneous Provisions) Bill. There is an outbreak of miscellaneous provisions Bills. It is rather a pity that there is such a rag-bag approach because the Bill before us contains important elements, some of which I welcome and others I will probe further.

The Minister of State used the word "rationalisation" repeatedly. I hope it will be rationalisation in the full sense as opposed to just a mathematical division. I note her comment that, following the efficiency review of various agencies, "the Government agreed a process of rationalisation of State agencies" and that, in the health sector, "the number of agencies is being reduced from 34 to 18". That cut of 50% will be admirable if it is accompanied by real rationalisation, namely, retaining appropriate staff, preventing damage to the professional relationships within the area and, most crucially, maintaining delivery of service to the public. I would like to believe this will be the case.

The Minister of State referred to the integration of the National Council on Ageing and Older People and the Women's Health Council within the Department. I take it that they will be individually integrated as opposed to being merged, which would not be rational. Speaking as a 65 year old pseudo-male, there are also elderly male persons.

Liam Twomey (Fine Gael)
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What does the Senator mean by "pseudo"?

David Norris (Independent)
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I am not claiming total macho credits. As a matter of principle, the rationalisation should be rational and should have full intellectual justification unlike the Government's decentralisation programme, which is really a disintegration programme, in that people were moved inappropriately and some valuable skills were lost. It is important we retain the most significant skills.

I am concerned about some aspects of the Bill. For example, the Drug Treatment Centre Board was mentioned. We all know that cities such as Dublin are on the brink of another heroin epidemic, yet there does not even seem to be enough money to cope with the current situation. The street prices of heroin and other opiates are decreasing. We are in a serious economic crisis and it is inappropriate for people such as me to keep telling the Government that it must spend more money here and cut money somewhere else, but mere economising would worry me.

My colleague, Senator Feeney, referred to the question of people who are mentally ill. She referred to Sebastian Barry's remarkable novel. He started his writing career while he was a tenant in my basement in North Great George's Street. Simultaneously, Anne Enright was a tenant. I believe they both won the Booker Prize. Both the attic and the basement won the Booker Prize and I was the boring bit in the middle.

There is another book that has not been mentioned but which is at least as striking, namely, Bird's Nest Soup, the autobiography of a woman from County Westmeath called Hanna Greally. She was incarcerated because she was perceived as a little bit socially awkward by her family. She was kept in an institution for about 40 years but her human personality remained unfractured. A remarkable young doctor discovered the woman was totally sane and had just been institutionalised for social reasons. That is why I listened with some interest to the coy euphemisms employed by the Minister of State in her speech. She referred to persons who are acutely mentally ill and require admission to hospital but who are "unwilling to travel to hospital voluntarily". That is a very nice euphemistic phrase. The people are probably admitted kicking and screaming, with their foot up against the ambulance door in some cases. We therefore need to be absolutely realistic.

The Minister of State referred to "assisted admissions". I can imagine what the assistance consists of. She referred also to the use, where necessary, of "staff of the approved centre". She mentioned well-known recent proceedings in the High Court pertaining to the case of someone who did not like being "assisted voluntarily" in being admitted. The lady took a case and part of her case, focusing on the legal inadequacy of the admission process, concerned the fact that she was admitted with the assistance of some external agencies, in other words, hired help. I am not impugning these agencies as I am sure they may be very well qualified but the intriguing point was that the judge found in his ruling that the meaning of the term "member of staff" is confined to an individual and that a corporate entity such as an external agency could not be a member of staff. The Minister of State commented that this is a "narrow interpretation" of the term "staff of the approved centre". Narrow my fanny: it is perfectly obvious that the interpretation is correct. Anybody reading that would know perfectly well one cannot just define a franchise as a member of staff. It is not a member of staff and the judge was making a perfectly straightforward and obvious comment. It may be the case that there is room for external agencies but I caution against going too far, for financial reasons, in the direction of franchising and privatisation. The Americans have gone down that road in every area, from medical services to prison administration, with consequences that are not always humane.

It was very interesting that there were 2004 involuntary admissions in 2008, of which 604 were assisted. In other words, 604 of those admitted were resisting so vigorously that they had to be pushed in. We should obtain as much information as possible on this. It is very interesting that a cross-party group has been established on mental health. It met some days ago in the audiovisual room. We should investigate the matter because we do not want to repeat the mistakes of the past.

Let me say a few words about the Crisis Pregnancy Agency, which emerged in troubled times after the decision on the X case. It is a very important institution. I said in a previous session of Parliament that I was a tutor in Trinity College for ten years. The university authorities were a bit anxious about me and concerned for the moral welfare of the students, with the result that I never had anything in trousers in my chamber of students. I got a collection of skirts - I got 80 female students, with not one man among them. They obviously believed I was such soiled goods that I would be non-judgmental. Once a year a young woman would come to me with a crisis pregnancy and I was able to tell her of the existence of non-directive counselling agencies. Of probably ten such women, one had an abortion. I am convinced this is because I was able to give the girls information dispassionately and access to a place where the hysteria would be removed, where the appropriate questions would be put to them and where arrangements would be made if they decided to have the child, although there would possibly be emotional consequences. It is essential that there is some advice available before and afterwards. This is really important, regardless of what people believe about abortion, which is always sad. Sometimes it may be the better of two options. It is terribly important that women have treatment, therapy or advice after termination.

I welcome the fact that the Crisis Pregnancy Agency has a non-directive approach. It cannot and does not recommend abortion to clients but can give information. The Minister of State should, for God's sake, maintain this position because it is the best way to reduce the number of abortions. There are puritan ideologues outside and within the Houses who are so extreme in their views on this subject that they would say one should not give out information on abortion. This is foolish and counterproductive because the best way to reduce the number of abortions is to allow people the dignity of having as much information as possible. The Crisis Pregnancy Agency has been able to produce figures showing this is the case.

The agency is mandated to reduce the number of crisis pregnancies and reduce the number of women choosing abortion as an outcome of pregnancy. Nothing is said about condemning abortion. The agency is also mandated to safeguard women's physical and mental health following termination of pregnancy. What progress has been achieved in this regard? There has been a decrease of 30%. This is not just vague waffle from a retired tutor from Trinity College because I refer to a fact, an actual percentage. The reduction is the result of giving information and of being adult and mature. There has been a 20% decrease in the number and rate of births to teenagers and a 43% decrease in the number of teenagers travelling from Ireland to the United Kingdom for an abortion. It is worthwhile pausing to thank the agency. It has done a remarkable service, not just to the women of Ireland but to the population as a whole. I hope the Government will continue to support the agency in every way.

The Crisis Pregnancy Agency has, in these very difficult times, managed to increase its contact hours and services to women, which I very much welcome. The Minister of State, I am sure, is familiar with the kind of brief I have received on the agency. The agency has a number of issues and targets. The targets include achieving better access to information on contraception and contraceptive services for those identified to be at special risk of crisis pregnancy and improving the standards and quality of contraceptive services. It is not just enough for one to have actual contraceptives as one needs to be given information on how precisely to use them. Not providing this information is the reason for the failure of some of them. Proper information, guidance and policies on human sexuality and relationships are required in schools. We have not progressed nearly far enough in this regard.

My briefing note states that the chairperson of the Crisis Pregnancy Agency is Katherine Bulbulia, who was a distinguished Member of this House but who is now no longer directly involved in party politics. It is very heartening to see that somebody of her calibre is chairperson. She was an excellent advocate for women's health in this House, as was my former colleague, Dr. Mary Henry. Ms Bulbulia is continuing her valuable work through this excellent agency. I urge the Minister to ensure the Government continues its support for this work.

Maria Corrigan (Fianna Fail)
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I join my colleagues in welcoming the Minister of State. I also welcome the reduction in the number of agencies from 34 to 18. In the times we are in, this is a welcome rationalisation provided the services continue to be delivered but more efficiently. It is an opportunity to streamline and focus on these issues in an effective way. I especially welcome the Minister of State's reassurance that the skills and expertise of the staff attached to these agencies will not be lost because the staff will join the Department of Health and Children.

In respect of the amendment to the Mental Health Act 2001, the Minister of State highlighted the specialisation required to ensure patient safety in dealing with involuntary admissions. The amendment provides for expert and skilled assistance. The Minister of State's speech gave us pause to reflect that on occasion involuntary admissions are resisted. The changes in recent years have made us much more cognisant of the circumstances that make such admissions permissible which has been in the best interest of the patients and in accordance with best practice. It is useful to remind ourselves that involuntary admissions can take place only under the clear criterion that the person represents either a danger to him or herself or to others. While the criterion is more clearly defined we have not had much opportunity to consider the admission process. This can be a highly distressing and traumatic event for someone who is quite ill and it is useful for us to consider that the patient should come into contact only with skilled people. The Minister of State's focus on the need for these people to be skilled and trained in this area is welcome. That helps to minimise the trauma and distress and the risk of injury to the person, to the staff or to others. I welcome that focus.

I also welcome the removal of age limits for travel insurance for people who are infected with hepatitis C. This will have a practical and positive impact on people's quality of life. The legislation makes technical amendments to the Health Act 2007 which provided for the establishment of the Health Information and Quality Authority, the office of the chief inspector of social services and a new inspection and registration system for residential centres for older people, children and people with disabilities. While I accept a great deal of work is involved in implementing this important Act, it has a real impact on the protection of these groups of people. I welcome the continued commitment to the implementation of that Act.

The Bill provides for the transfer of several functions of the Crisis Pregnancy Agency to the Department, including the preparation of a strategy to address the problem of crisis pregnancy in consultation with Departments and other appropriate persons. In all the debates on this sensitive and upsetting topic there has tended to be a focus on abortion whereas the real problem has been crisis pregnancy. It is of much greater benefit to keep a focus on how to address that issue. The Crisis Pregnancy Agency sent us some briefing notes on the Bill. It states that one purpose of the agency has been to ensure women faced with a crisis pregnancy would be offered "real and positive alternatives to abortion". It is important we keep that focus. One service that provides a very real alternative is Cura. Last year there were concerns about its funding. It is very important that such an agency receives funding. What is the impact of the dissolution of the Crisis Pregnancy Agency on service providers such as Cura? I welcome the Bill and wish the Minister of State well.

Brendan Ryan (Labour)
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The Labour Party has no major difficulty with the substance of this legislation but we are concerned about its results and the work carried out by the various agencies to be subsumed into the Department of Health and Children and the HSE. We must preserve the functions carried out by the agencies and ensure such functions continue while not being in any way reduced. As the Women's Health Council says, we must safeguard the knowledge or institutional memory built up by these organisations. A significant number of people work in the Department of Health and Children and that number decreased only a small amount when the HSE was set up. We strongly endorse proposals for the rationalisation of the HSE, especially in the middle and other management grades.

The Crisis Pregnancy Agency was established in 2001 following the fifth report of the Oireachtas all-party committee with a remit to offer real and positive alternatives to abortion. Contraceptive services were and still are poorly developed in this country. According to the Crisis Pregnancy Agency, crisis pregnancy is not tracked or measured internationally. Irish research indicates that 28% of women and 23% of men are affected by a crisis pregnancy in their lifetime. It is not something that just affects teenagers. Less than 1% of pregnancies end in adoption; 15% end in abortion while the remainder end in parenting the child.

Progress has been measured and is detailed as a decrease of 30% in the number of women travelling to the UK from Ireland for abortions; a 20% decrease in the rate of births to teenagers and a 43% decrease in the number of teenagers travelling from Ireland to the UK for abortions, a decrease from 6% to 3.8%.

The Crisis Pregnancy Agency has succeeded in bringing to the table services with opposing ideological viewpoints, keeping them there and encouraging them to work in collaboration on developing standards, resources and advertising. In this context, the Labour Party is concerned that the work of the agency should continue. The agency had an extremely precise brief; it promoted public awareness and brought together those with opposing points of view in its efforts to reduce the number of abortions carried out on Irish women.

The decline in front-line services is evident throughout the entire spectrum of services provided by the State. Mental health services are affected; I refer to the addiction and counselling services being cut in certain areas by as much as 50%. The HSE must honour its promises on mental health and fill all vacant nursing posts. I am aware of the very great need to save money in all sections but cutting services to children with special needs, particularly those on the autistic spectrum, is seriously flawed. It will create a considerably heavier burden in the future with a far greater cost and will do a huge disservice to these children.

I see great merit in eliminating the duplication of services throughout all Departments if the savings can be invested in vital front-line services. On this point, will there be a monitoring system to ensure the work of these agencies will continue and that top-class services will be provided? What tools will be used to measure effectiveness? Will the Bill save money?

I continue to be concerned that funding which is supposedly red circled for specific health programmes such as palliative care, physical and intellectual disability and Traveller health has been diverted to other areas of health. It is a matter of continuing regret that the €10 million announced last year for a cervical screening programme was pulled. We will continue to insist that preventive life-saving vaccines should be a priority and we feel very strongly that this screening programme should go ahead.

The National Council on Ageing and Older People is a very necessary group and I and other Members of my party have met many of its members. Its voice should continue to be heard in the Department. Better health outcomes were a positive benefit of medical cards for the over 70s as they allowed people to avail of checkups, which in turn prevented a deterioration in health. Carers have many well-founded concerns, with many people now contacting my office with concerns about a reduction in home help hours. I am informed that respite is increasingly more difficult to access and this is a retrograde step because we know how necessary it is for those who take care of people with challenging conditions.

The cancer strategy for the country has given cause for concern as a line from Galway to Dublin sees a lack of centres of excellence above it. Has any audit been done on the National Treatment Purchase Fund? What has been its effect? Since 2002, the Labour Party has been proposing a universal health insurance scheme. It is a fair system and should be re-examined. We should examine models that work in other countries and implement policies which put patients first.

Jerry Buttimer (Fine Gael)
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Hear, hear.

Brendan Ryan (Labour)
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I have been pursuing the case of an 89 year old Balbriggan woman who is ready for release from Beaumont Hospital. Her family has identified an available public bed in Gormanstown, a couple of miles away. She cannot be released because no funding is available from the HSE. Unfortunately, she is not alone as 130 older people are in a similar situation in Beaumont Hospital holding up beds in the system. I understand no one in similar circumstances has been released from Beaumont Hospital since 15 January and this is July. This is a disgrace and something must be done about it. It is a false economy and cannot be allowed to continue.

Déirdre de Búrca (Green Party)
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The Health (Miscellaneous Provisions) Bill is the first of a number of legislative measures that will come before us in an attempt to rationalise and introduce greater efficiencies in the agencies and statutory bodies we have established over the years. It is interesting to hear the squeals of outrage already coming from the other side of the House from parties which state that if they were in Government they would implement greater efficiencies and on the need to ensure that the public service delivers more effectively. We are all aware that there are less resources available to us and that we will have to rationalise and implement efficiencies. The aim of the Bill is to do so in a way that will not see their functions significantly diminished in any way but that will recognise the need to be more efficient and achieve cost savings in the way the services are run.

From the discussions we have had about our health services, we are all aware that over the years perhaps there has been an over-concentration on administrative infrastructure and much less on front-line services. Whatever efficiencies we implement now we must ensure the front-line services of our health system in particular are protected and supported. We must ensure this legislation works in a way that will not negatively impact on front-line health services. When we consider how the health boards were dissolved to establish the Health Service Executive, which was supposed to be about rationalisation and making more efficient the administration of the health services, particularly at local level, I do not believe those efficiencies were achieved and part of the reason was that the emphasis was more on preserving administrative structures than on the more important issue of front-line services. Let us learn from this experience and ensure that the way in which the necessary rationalisation that will occur over the coming years happens in a way that prioritise front-line services.

The Long Title of the Bill describes it as "an Act to provide for the dissolution of the National Council on Ageing and Older People, the Women's Health Council, the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency". Effectively, we are discussing merging these bodies with the Health Service Executive and in two cases, those of the Women's Health Council and the National Council on Ageing and Older People, redeploying the staff into the broader Civil Service. It would be a mistake to assume that because these bodies are being restructured that any lesser priority will be given to these policy areas.

I am a little concerned that two of the bodies are concerned with women's health. I hope the Minister of State will reassure me that their functions will be just as effectively delivered in the new form in which they will exist, particularly those of the Crisis Pregnancy Agency. Other speakers have discussed the importance of the role and function of the Crisis Pregnancy Agency and just because it is being absorbed into the HSE does not mean it has to perform or deliver its services in any less effective way. The dissolution of these bodies will mean the transfer of their functions, assets, liabilities, officers and staff members. The legislation has attempted to look after all of the issues that might arise in this transfer.

I wish to focus on the Crisis Pregnancy Agency because it has performed a very useful function since it was established in 2000. In this country, the strong right to life protections for the unborn, the right to life provision that exists in our Constitution and the very difficult and prolonged debates we have had on the subject of abortion mean we are obliged to back up our rhetoric on such constitutional protections with resources and services. In terms of the establishment of the Crisis Pregnancy Agency, that was done. Its establishment was recommended in 2000 and it was specifically charged with reducing the number of crisis pregnancies and ensuring women who faced a crisis pregnancy were offered real and positive alternatives to abortion. It was established in 2001 and at that time there was clearly a deficit of services, resources and public health campaigns aimed at empowering men and women with the skills and knowledge to prevent unwanted conception.

We know from the research that has been carried out that crisis pregnancy affects 28% of women and 23% of men. The research also suggests women may be experiencing crisis pregnancy at a younger age than before. The average age for women tends to be approximately 23 years of age and 24 years of age for men. Approximately 15% of women experiencing a crisis pregnancy will have an abortion. Those are the figures we need to keep them in mind when we are examining the continuance of the services provided by the Crisis Pregnancy Agency.

The agency was mandated with reducing the number of crisis pregnancies, reducing the number of women choosing abortion as an outcome of crisis pregnancies and safeguarding women's physical and mental health following the termination of pregnancy. Its progress and achievements have been considerable to date. It reported a decrease of 30% in the number of women travelling from Ireland to the UK for abortion, a 20% decrease in the number and rate of births to teenagers and a 43% decrease in the number of teenagers travelling from Ireland to the UK for an abortion. In 2001 the figure was 932, which dropped to 530 teenagers in 2007, a considerable drop.

Other improvements brought about by the agency include more than a doubling in the number of crisis pregnancy counselling services nationwide, free services being provided in 50 locations nationwide, and providing for a range of choices for potential clients in terms of the range of services offered on a geographic basis. There has been an increase in crisis pregnancy counselling hours of 35% and an increased provision and uptake in post abortion medical services of 37%.

Other contributions for which the agency has been responsible include delivering and evaluating the first strategic plan on crisis pregnancy. It is midway through the implementation of its second strategy. It developed a standardised framework and associated NUI-accredited training programme to improve counselling provision. It published 25 research reports related to crisis pregnancy prevention and support and built research capacity in the field of sexual research. It also worked with the Department of Education and Science to increase the implementation of relationships and sexuality education in post-primary schools.

The Bill concerns dissolving the agency and merging it with the Health Service Executive. The onus on the Government now is to ensure the proud track record of the agency since 2001 is continued in the new form in which it finds itself within the structures of the HSE. Some recommendations made by the agency on sustaining and progressing the advances it has made to date include the need for better access to and information on contraception and contraceptive services, especially for identified groups at risk of crisis pregnancy, and the need for measurable improvements in knowledge about relationships and sexuality amongst adolescents, a lot of which depends on the programmes we are implementing in our schools. Other recommendations include the need for improved access to and delivery of crisis pregnancy counselling services and post-abortion medical and counselling services throughout the country, the need to introduce recognised standards and regulation for crisis pregnancy services, and the need to improve the range of supports to make the continuation of pregnancy more attractive. A range of areas need to be progressed further and require considerable work to be done to ensure the track record of the agency to date as a stand-alone agency is continued and its very important work and achievements are continued into the future.

I am happy to support this Bill, subject to the points I made on the continued delivery of the excellent service to date under the new structures proposed.

Paudie Coffey (Fine Gael)
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I welcome the Minister of State and his officials to the House to debate this very important Bill. I want to focus on specific aspects of the Bill, those being the dissolution of the Women's Health Council and the National Cancer Screening Services board and the transfer of all their rights and liabilities to the board of the HSE.

We are all aware of the national cancer strategy and a lot of faith has been placed in it by the Government under the stewardship of the HSE and Professor Tom Keane. I want to focus on the south east and on Waterford Regional Hospital which has been identified as a regional centre of excellence. Recent studies have noted that the word "excellence" needs to be re-examined owing to the many shortcomings identified in the delivery of cancer care in the region, due mainly to a lack of resources, staffing and other issues. Questions still need to be answered on the appropriate and proper delivery of cancer care in the region.

All the cancer care disciplines are delivered in Waterford Regional Hospital, bar one very important treatment, namely, radiotherapy. It is currently delivered through a private contract with the HSE and the Whitfield Clinic in Waterford. It has been reported in local media that there are contractual problems between the HSE and Whitfield Clinic with regard to the clear understanding of the radiotherapy services that are available and are being delivered in the region. It is something the Minister and the HSE need to focus on to iron out any difficulties or problems.

There have been many public rallies in Waterford calling on the Government to provide public radiotherapy facilities at Waterford Regional Hospital. That is the position of many people in the region and remains so. They will not be happy until there are full public radiotherapy treatment facilities available at the centre of excellence, as the HSE likes to call it, in Waterford Regional Hospital.

With regard to women's health and cancer care, I have raised the issue of BreastCheck on a number of occasions in the House, as have some of my colleagues in the Dáil. My understanding is that BreastCheck is not fully rolled out in Waterford. It is in Dungarvan, a larger county town, but not in Waterford city and many of the county areas.

There is no better way to display how a service is delivered than to see the evidence locally. I was contacted by a lady in her late 50s who has a long history of cysts on her breasts and, unfortunately for her and her family, there is a history of the same cancer in the family. She is considered a very high risk patient. Since the discovery of the cysts on her breasts, she has had a mammogram every 12 months in Waterford Regional Hospital until two years ago. When the consultant, Mr. Gordon Watson, retired - he had delivered great service to Waterford - a replacement was appointed. BreastCheck was then supposedly implemented and brought into the Waterford area. The lady was told by the HSE in Waterford Regional Hospital that she had been transferred onto the BreastCheck list for her annual check-ups. When she enquired with BreastCheck as to when she would be examined, she was told examinations were held occasionally in Dungarvan and not in Waterford city, and no date was given to her. She has now been waiting almost three years for a mammogram, which is totally unacceptable for a women in her position.

We are discussing women's health. She is a women who has a history and has already had cancer identified in her and her family. She cannot present for an annual mammogram in Waterford Regional Hospital unless she already has a lump. If we are discussing early detection of cancer, it is a disgrace for a person who is already high risk and has been identified as such not to be allowed to have a mammogram in the public service. When she went where she had been referred to, she again could not get a date from BreastCheck. It is not acceptable that this situation is pertinent. This is the state of play of our cancer care and is how we are looking after our women in the present climate. I appeal to the Minister of State and his officials to bring this to the attention of the Department and the HSE to find out whether this issue can be resolved once and for all. BreastCheck must be fully rolled out for those women who present with real concerns and who are not sleeping at night due to the worry of their cancer history. This issue should be prioritised by the HSE and the Department so that when women present for BreastCheck, they will be seen and their minds put at rest. Early detection will save the State money, save lives and improve health. If it is implemented properly, it will do justice to the health needs of all in this country.

Waterford city has the largest population base in the south-east region but it still does not have BreastCheck. The cancer care services, while they have developed to some degree in the region, are not the centre of excellence the HSE would like us to believe they are. We should strive for that excellence. This side of the House will co-operate when we see the results delivered.

Jerry Buttimer (Fine Gael)
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I welcome the Minister of State and his officials. I remind Senator de Búrca that the Fine Gael Party is in favour of greater efficiencies and creating better value for money, be that in health or any other sphere of the public service. However, we will oppose and resist the issues causing legitimate concern to many organisations and people with regard to the quality of service for patients. People matter. It is extraordinary, given Senator de Búrca's contribution, that the Green Party has now become so embroiled in Government and so subsumed into Fianna Fáil that we might see them as one entity before the end of this Dáil term.

To deal with the Bill, it is important that we preserve the function of the agencies. They cannot be allowed to disappear within the HSE or the Department of Health and Children, or simply evaporate. I note the lexicon of the HSE now includes "reconfiguration" and "rationalisation". In plain language, this means the elimination and reduction of services. I am fearful we will have a loss of autonomy and a loss of policy-driven focus in these agencies so it is important we safeguard their functions and roles. What review mechanism will be in place to ensure the policies and functions of these agencies are implemented? The Minister of State might respond to this question.

I have grave reservations about the subsuming of these five critical agencies. Although it looks good on paper and reads well, if one goes through the functions of all the five agencies, there is a genuine fear they will get lost within the HSE or the Department of Health and Children. One of the issues I have with the HSE is that it has become a superstructure, which none of us envisaged when it was created. There is very little accountability and a democratic deficit. If one puts down an Adjournment matter, it is often deemed not to be the responsibility of the Department, but one cannot question the HSE on the issue.

Mental health is rightly becoming a central part of the health services. An all-party committee was set up yesterday, on which I commend Senator Fitzgerald and the Minister of State, Deputy Barry Andrews. I have a concern with regard to the Mental Health Act and I am not reassured by the Minister of State's contribution. The agency that carries out involuntary admissions for the HSE has worked well up to this point - there is no argument about that - but there are no ministerial regulations or protocols governing how it carries out its duties. The section would be more appropriate in a mental health Bill because it would benefit from an expanded explanation in a separate Bill. I look forward to the Minster of State's reply in this regard. I emphasise that there should have been a separate Bill purely to discuss mental health and mental health services.

In the context of women's health and the national cancer strategy, like Senator Coffey, I want to raise a core matter with which I have a fundamental issue. It concerns the insistence on the policy of the Government and the HSE with regard to the transfer of breast cancer services from South Infirmary-Victoria University Hospital to Cork University Hospital. This is a fundamentally flawed policy. Nothing that has been said in Adjournment debates or parliamentary questions, or by the HSE, has changed my mind or the minds of expert specialist clinicians, the women of Cork and the staff who work in the South Infirmary-Victoria University Hospital.

If we are genuinely serious about women's health, the reduction of cancer and early detection, this would be a flawed move. The South Infirmary-Victoria University Hospital is by far the best, the largest and the most specialised unit in the south, with a proven track record that is second to none. Its statistics in diagnosis and the way it treats people have been well documented. If we are talking about creating better efficiencies and value for money, I cannot understand why we invested millions of euro and then suddenly decided to move from campus A to campus B in Cork University Hospital. It does not make sense. It is a waste of money, is a vote of no confidence in the staff of South Infirmary-Victoria University Hospital and does not instill confidence in the women of Cork. I have reams of e-mails and copious volumes of notes from public meetings where woman after woman has raised these issues.

If the Government wants greater networking and two hospital campuses, that is fine, but let us keep services at the existing campus where BreastCheck was invested in by the Government. Why move to the already packed and straining campus of Cork University Hospital? It does not make sense. If we are talking about the whole issue of HSE accountability, Professor Drumm and his merry men and women are saying one thing but, on the ground, the staff working in the HSE, of all grades, are diametrically opposed to their view and have no confidence whatsoever in the operation of the HSE. I challenge any staff member of the Department of Health and Children or the HSE, or the Minister of State, Deputy Moloney, and the Minister, Deputy Harney, to tour the front-line services of hospitals throughout the country. Morale is low and confidence is critically low. Yet, we are today subsuming five agencies into the HSE and the Department. While I accept we must create efficiencies and achieve value for money, at what cost and risk?

Senator de Búrca gave an eloquent speech about the Crisis Pregnancy Agency and I would like to be associated with Senator Corrigan's remarks concerning Cura. I hope Cura will continue to be funded because the reduction or elimination of abortion should be on all of our political agendas. While I do not have access to figures on the issues raised by Senator de Búrca, I suggest we need to visit the schools and give detailed consideration to how best we educate young people. I would go a step further and move beyond the schools to the youth cafes and youth clubs. We have an obligation to educate our young people, irrespective of their sexuality, as Senator Norris said, with a view to eliminating abortion and looking after our young people.

I thank the Minister of State and his officials for attending and for their patience. I appeal to the Minister of State at this eleventh hour to go back to the Minister, Deputy Harney, and the HSE with regard to the national cancer strategy and the proposed transfer of services at South Infirmary-Victoria University Hospital to Cork University Hospital.

Ivana Bacik (Independent)
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I am grateful for the time and I wish to say some brief words about the Bill which amalgamates several different areas within it. As I stated previously, I am always somewhat wary when a Bill is introduced to the House with the words "miscellaneous provisions" in the title because usually it indicates that many rather significant changes are proposed. It is unfortunate that it has been introduced this late during the two or three week period in July in which we have before us a great volume of legislation. It does not allow the level of reflective or considered debate that would be preferable. Rushed drafting was evident in the Local Government (Charges) Bill debated yesterday, which will return to the House this evening. Changes were made by the Government to that Bill last night and I hope further changes will be made to address people's concerns about that Bill and to address such matters as the unintended inclusion of entities such as mobiles homes in its scope.

Turning to the Health (Miscellaneous Provisions) Bill, there is a range of areas, including a rather last minute amendment to the Mental Health Act, which other Members have addressed. I refer especially to Part 6 of the Bill and the dissolution of the Crisis Pregnancy Agency. As I stated on the Order of Business, it is worth placing on the record our appreciation of the work of the Crisis Pregnancy Agency, including Katherine Bulbulia and her staff, since its inception in 2001. I express the hope in the strongest terms that the functions the agency has been discharging during the past eight years will continue to be discharged, albeit under the auspices of the Department of Health and Children, to which I understand the functions will be transferred.

Questions must be asked about the dissolution of the agency and the transfer of its functions into the Department. What happened to the functions of health education when they became part of the Department of Health and Children? Will the Minister of State to address this point? As a mother of very young children and as someone who is very conscious of the need to take folic acid during pregnancy, I have a particular interest in this area. There has been a real concern that since the functions of health education were transferred to the Department of Health and Children we have seen very little in terms of public information campaigns on such matters as taking folic acid during pregnancy. I simply use the folic acid campaign as an example because I understand the importance of informing the public of the need to take folic acid during pregnancy to prevent spina bifida in young babies. The campaign has been handed over to the voluntary spina bifida organisation and it must now carry out a public information campaign but without adequate resourcing to do so. Will the Minister of State confirm if this is the case? If it is true I wish to hear it confirmed. It is an example of the difficulties which can arise when the functions of an agency specifically set up and with a particular health related agenda are transferred to the Department of Health and Children. Such functions may become lost in the bigger Department or they may be transferred inappropriately to bodies which do not have adequate resources to carry out the work. There is a strong argument to ensure the particular functions of the Crisis Pregnancy Agency remain fulfilled, albeit under the auspices of the Department of Health and Children. On the spina bifida issue, will the Minister of State provide the dates of the last public information campaign? This is of great concern to women looking to conceive or who are pregnant, many of whom are unaware of the evidence about the importance of taking folic acid during pregnancy.

I refer to the functions and work of the Crisis Pregnancy Agency. I am grateful to the agency for providing a briefing document, to which other colleagues referred during the debate. The document sets out in clear terms the important role of the Crisis Pregnancy Agency since its establishment. Without going into the detail of the origins of the agency and the position before its establishment, there was a clear need for some centralised regulatory mechanism to deal with the provision of information to women in crisis pregnancy. I know such a need existed because for a time in the late 1980s I provided such information as an officer of the Trinity College Students Union. I was taken to court and threatened with prison in 1989 simply for providing information to women in crisis pregnancy. I will never forget the experience as a 20 year old student of being placed in the position of being one of the only people openly giving information to women in crisis pregnancy. We had the very difficult and often traumatic experience of dealing with women, some younger and some older women, in crisis who rang and called in to us in great distress seeking information on the options available. In particular they sought information on where they could access termination of pregnancy or abortion abroad. This followed the Hamilton judgment in the Open Door Counselling case and there was a constitutional difficulty with the provision of such information and a suggestion that by providing it in breach of a court injunction we could have been regarded as being in breach of criminal law. There was also a threat of jail hanging over us for breach of an order, carrying with it a penal sanction.

I have a particular personal interest in noting appreciation for the work of the Crisis Pregnancy Agency and ensuring information is available openly, publicly and in a professional manner to women facing crisis pregnancy. We should never again have to face a situation in which student union officers are the only people openly offering such information to women. Clearly there is a need for the provision of such information. All the figures provided by the Crisis Pregnancy Agency support this claim. Some 136,000 women among the present population have experienced crisis pregnancy. We know it affects women of all age groups and all social classes. That is my direct experience, having provided such information in the past.

Since its inception the Crisis Pregnancy Agency has been able to offer information in a more open, accessible and transparent manner and to ensure other agencies do so. The agency itself does not offer the information but it provides information on the agencies through which crisis pregnancy information may be made available. It has achieved remarkable results, which are testament to its work. It has achieved a decrease of 30% in the number of women travelling from Ireland to the United Kingdom for abortion. There has been a continuous seven year drop in the abortion rate, a very welcome outcome for all of us who have a concern about women's reproductive health. I speak as someone who has been on the board of the Irish Family Planning Association in the past. The IFPA has been a pioneer in its work, supporting women in crisis pregnancy throughout the years. Since the inception of the CPA there has been a 20% decrease in the number and rate of births to teenagers and a 43% decrease in the number of teenagers travelling from Ireland to the UK for abortion. These figures show the importance of having an agency in place or an entity which provides information for women in crisis pregnancy and to ensure such information is provided to such women in a professional, open, transparent and accessible manner.

For many years those on the right in the country, including the conservative side, and especially the Catholic Church, sought to create a framework where such information was not available to women. As a result when sex education and information on abortion and pregnancy options were not available, the abortion rate was higher and the rate of crisis pregnancy was higher. We all wish to see these rates decreased and it is very important we ensure there is a transparent and professional counselling agency that can provide such information. There is a good deal more I could say on the matter but I urge the Minister of State to ensure the functions so ably carried out by the agency do not simply disappear once it is dissolved through the Bill.

Paddy Burke (Fine Gael)
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I welcome the opportunity to offer some brief words on the legislation. I welcome the Minister of State at the Department of Health and Children, Deputy John Moloney, to the House and I compliment him on his knowledge of various aspects of Bills he has brought through the House.

I refer to the national cancer strategy, Mayo General Hospital and the transfer of services from Castlebar to Galway. We should receive a report at this stage to outline how the strategy is performing. Is it all it is cracked up to be? Has it progressed as the Minister for Health and Children intended when she first outlined it in the House 12 or more months ago? How is the national cancer strategy working throughout the country? I am led to believe there are still complications and issues of funding and people travelling long distances to and from the various designated centres. I refer also to the ongoing problem with Sligo where people want to hold onto the cancer services being provided there and where the hospital is achieving good results. There should be an open debate on this issue.

The Bill provides for the amalgamation of six bodies in to the HSE and the Department of Health and Children. The National Council on Ageing and Older People, the Women's Health Council and the Crisis Pregnancy Agency will go to the Department of Health and Children. The National Cancer Screening Service Board and the Drug Treatment Centre Board will go to the HSE. I compliment all those who have worked in these areas over the past ten years as they have done tremendous work. They have gathered valuable information for the HSE, for the Department of Health and Children and for the people.

I agree with Senator Bacik that there is a role for specific agencies and I hope that when these bodies are amalgamated into the HSE and the Department of Health and Children that they would still have an identity. Each body has specific expertise which has been gathered over many years and the systems are in place. It would be wrong to amalgamate them for the sake of amalgamation alone and to cut down on the number of agencies. They should retain their own identities within the system. I ask the Minister of State to say the number of staff who will go to the Department, the number who will go to the HSE and the annual saving.

I refer to the 2008 annual report of the HSE which does not make reference to amalgamation of those agencies. The HSE has its own remuneration committee. Will the staff of these bodies be on different levels of pay to HSE staff? There could be a situation where staff transferred from an agency would be on different levels of pay and this should be examined. They are all classified as civil servants, by and large, but there could be different levels of pay.

The Minister of State stated in his contribution that the rationalisation programme was set up under the Health Service Executive Act 2004 and provision was made in other legislation for the integration of a number of agencies within other bodies. There has been an explosion in employment in the HSE. I hope that under this amalgamation process there will not be a further explosion of numbers of staff. Are there any planned redundancies as a result of the rationalisation programme which reduces the number of agencies from 34 to 18?

I wish the Minister of State well with this Bill. I suggest we should be given a report on the performance of the national cancer strategy at national level and at regional level.

John Moloney (Laois-Offaly, Fianna Fail)
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I thank Senators for their contributions. I take Senator Bacik's point that miscellaneous provisions in themselves can cater for so many different issues. I will try to deal with as many as possible. I am particularly interested in the mental health provisions of the Bill.

I am aware that Members of this and the other House have expressed concerns about the possibility of rushed legislation. The reason for the rush is the High Court judgment delivered on 21 May 2009 and also because the Houses will be beginning the summer recess soon. By that I do not mean that we should rush legislation because of the recess. The judgment delivered on 21 May 2009 has given rise to particular difficulties in the Dublin area, parts of the east and Clonmel and Cork, where up to 90% of the assisted admissions are undertaken by the external agency. In order to ensure the continuation of externally provided assisted admissions, an amendment to the Mental Health Act 2001 is required. I made the point in the Lower House that the review of the Mental Health Act is due next year and we can then tease out specific issues. Lest people are of the view that the external agency does not have any qualification and there have been queries as to the protocols involved and the level of standards involved, I will deal with these specifics. There is only one agency involved. All the employees of the external agency are qualified psychiatric nurses. A qualification as a qualified psychiatric nurse is not in itself sufficient. The status of all employees is reviewed annually.

This is not a case of outsourcing and privatising the service. Protocols had not been agreed with SIPTU and the PNA and often the required staff were not available. The concern would be that people might harm themselves or others so there is a need for involuntary admissions. This is an interim measure. The external agency is working in close co-operation with the Garda Síochána. I will give Members some background in respect of the numbers. The narrow interpretation of the term "staff of an approved centre" presents a difficulty in the ongoing provision of an assisted admission service. In 2008 there were 2,004 involuntary admissions, of which 604 were assisted. A total of 42% or 250 of these assisted admissions were provided by the external agency. It is worth noting that all of the assisted admissions in the Dublin-mid-Leinster region were provided by the external agency.

The point was raised by a number of Senators, and I appreciate it, that when we are dealing with mental health issues we must be twice as cautious as with any other area. The issues raised by Senators on all sides of the House are genuinely founded and it is up to us to try to persuade Senators to realise that we are acting in patients' best interests, with safeguards provided also.

I am satisfied that the external agency has provided a professional, high quality and safe assisted admission service for both the Health Service Executive and the two private psychiatric hospitals since 2006. To date, over 600 people have been safely brought to hospital by this agency. The fact that there have been no complaints either from family, gardaí, advocates or anyone else shows that a standard has been set and that people have been safely brought to hospital by the agency. The fact that no complaints have been made is noteworthy when one considers the sensitive and potentially difficult nature of the service.

The provision of the assisted admissions by a central agency enables the development of a specialised expertise in the de-escalation of difficult situations, which is of immense value and ultimately makes the situation easier for the patient and the patient's family.

I reaffirm what was said in the opening statement by the Minister of State, Deputy Brady. Points were raised in the Dáil about the nature of the company, the company setting up its business and in terms of advertising, interviewing or whatever. The company employs only fully qualified psychiatric nurses, all of whom have received intensive specialised training, including appropriate interaction with service users and training on de-escalation and talk-down techniques.

The most important point I can make on this area, before I deal with the other issues involved, is that the company complies with all Mental Health Commission guidelines and standards in terms of its work. Guidelines and standards meet the minimum test. I appreciate that protocols or guidelines are not sufficient but on balance, and the fact that so many involuntary admissions are required each year, I stand over this measure as being safe.

The amendment proposed is necessary to ensure that the acutely mentally ill person who requires hospitalisation but refuses to go to hospital can be brought to hospital involuntarily by specially authorised persons.

On the wider miscellaneous areas, as indicated earlier, the proposals in the Bill on the integration of agencies within the Health Service Executive and the Department of Health and Children are consistent with and build upon progress to date under the overall health reform programme. I take the point raised by Senator Buttimer regarding his area but it is about recognising the mission statements of the six agencies and retaining their purposes. Unfortunately, because of the economic situation we find ourselves in this is a way of amalgamating services, while not curtailing services.

The health reform programme acknowledged that there was a need to streamline the number of health sector agencies to ensure we have a better co-ordination of services. That objective was a cornerstone of the plans announced last June on the rationalisation of State agencies generally.

On the points raised about value for money and the money that will be saved by dissolving the agencies, the primary aim in rationalising these bodies is a streamlined service delivery and to promote service integration. The proposals are consistent with and build upon progress to date on agency rationalisation within the sector under the health reform programme. However, efficiencies will derive over time from economies of scale and the elimination of duplication in areas such as recruitment procurement, payroll and ICT systems.

On the cancer strategy, while not specifically dealing with that area I accept the point made by Senator Burke on the need for a progress report. I will bring that point to the attention of the Minister, Deputy Harney. I recognise the Senator's concerns about the reform programme and the cancer strategy. I will suggest an interim report on the progress on that to the senior Minister.

On the National Cancer Screening Service, it is intended that the service will be integrated into the HSE's national cancer control programme. The National Cancer Screening Service works closely with the HSE. The Minister is confident that high quality national cancer screening programmes will continue and be expanded when the service is fully integrated into the HSE's cancer control programme. I will put that position also to the Minister.

Senators Maria Corrigan, Ivana Bacik and others raised the issue of the Crisis Pregnancy Agency. The Bill expressly provides for the transfer to the HSE of certain functions of the crisis agency in line with legal advice. It is important to state that the work of the agency will continue, and steps have been taken to ensure that happens. The Minister will expand on later Stages on the steps involved in that.

The HSE is examining how best to integrate and carry on the work of the agency. The Crisis Pregnancy Agency, the HSE and the Department have already had a number of meetings to make plans in that regard. In addition, the HSE has set up an internal group to progress and report on the matter.

Senator Twomey asked about accountability. There are well-established accountability arrangements in place. The Minister for Health and Children is accountable to the Oireachtas and the chief executive of the HSE is required to appear before Oireachtas committees. Those of us who have served on the Joint Committee on Health and Children are aware of the rigorous questioning by Oireachtas Members on foot of presentations. There is accountability in that respect.

Jerry Buttimer (Fine Gael)
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There is none.

John Moloney (Laois-Offaly, Fianna Fail)
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There is of course. Is the Senator a member?

Jerry Buttimer (Fine Gael)
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I was a member of a regional health forum, and there is none.

John Moloney (Laois-Offaly, Fianna Fail)
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This is the Oireachtas and there is major accountability.

Jerry Buttimer (Fine Gael)
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A vacuum has been created that has not been addressed.

Maurice Cummins (Fine Gael)
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The Minister of State, without interruption.

Jerry Buttimer (Fine Gael)
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I apologise.

John Moloney (Laois-Offaly, Fianna Fail)
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The Oireachtas is informed of the activities of both the Department and the Health Service Executive through the publication, which is laid before the Oireachtas, of the Department's statement of strategy. On a yearly basis the HSE service plan on spending is laid before the House. That in itself is an element of accountability.

I cannot comment on the issues raised by Senator Buttimer concerning Cork because I am not familiar with the issues in that county. The normal practice is that I would bring the Senator's concerns to the attention of the Minister and deal with it on the next Stage.

I wish I was more knowledgeable on the issues raised by the Senator Bacik regarding-----

Paudie Coffey (Fine Gael)
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What about the provision of cancer treatment services in Waterford?

John Moloney (Laois-Offaly, Fianna Fail)
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I am dealing with issues raised in my own-----

Paudie Coffey (Fine Gael)
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Sorry, that was raised before the other issue.

John Moloney (Laois-Offaly, Fianna Fail)
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I am not aware of the issue raised by Senator Bacik concerning folic acid. I will respond directly to the Senator on it when I have raised it with my officials.

Ivana Bacik (Independent)
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I thank the Minister.

John Moloney (Laois-Offaly, Fianna Fail)
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I do not know when the last information campaign occurred. The Senator asked a question about a future campaign. I will respond to the Senator on this matter before the House goes into recess.

On the issue of cancer treatment services in Waterford raised by Senators Coffey and Burke, perhaps an interim report on the cancer strategy should be made available. I will take up that proposal with the Minister and Professor Keane and look for an interim report to check on progress being made. That is important given that Professor Keane is operating within a certain timeframe. He is on secondment here from British Columbia for a certain period. Rather than simply waiting until the end of that period it would be important to assess the level of support for and success of the programme to date. I will raise that with the Minister at the first opportunity.