Seanad debates

Thursday, 10 May 2018

Commencement Matters (Resumed)

HSE Staff Recruitment

10:30 am

Photo of Maire DevineMaire Devine (Sinn Fein)
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While I asked for the Minister for Health, Deputy Harris, to attend the House, I welcome the Minister of State, Deputy Catherine Byrne.

The office of the director general of the HSE is in disarray. Public confidence in high level management in the HSE is at an all-time low and we are all distressed at what is unfolding in the agency. Only last month we had the Garda Commissioner debacle and now the cervical smear story which is harrowing for the women of this island and their families. I see an opportunity to revolutionise the way that the Department of Health operates. However, it will take real tenacity.

I concur with the sentiment of the upcoming motion in the Dáil that Tony O'Brien, the director general of the HSE, should step down. Irreparable damage has been caused to public trust. The whole situation is drenched in secrecy. We must look to a positive future for not just women's health but everyone's, as well as for the health services. The Irish Timesreported the recruitment process has already been stalled as the HSE is struggling to define the job description. If this is not indicative of the complete mismanagement and lack of governance in the HSE, then I do not know what is. It is bizarre and preposterous to imagine that for years the HSE could not describe the director general's role? How can there be proper checks and balances, as well as accountability for a role if there is no job description?

It is a year since the Sláintecare report was published. Will the Minister of State give the House an update on where we are with the board of the HSE? The accountability issue is glaring and it is inconceivable it has been left wide open for so long. According to the World Health Organization, good governance for health must include transparency, accountability, participation, integrity and policy capacity. It is obvious to everyone that the HSE administration fell far short of these. These values must be ensured for the next appointee.

How the Minister manages this process is vital, not only for the general public, but for the warriors on the ground in the health service. They want someone with a true capacity for leadership and who would be inspiring. Will he ensure a new fresh face for this post? Will he ensure the successful candidate will not come from the same toxic environment? According to media commentary, both deputy director generals and the chief strategy officer could be in the running for interim director general, as could the current HSE finance chief. In terms of culture, I have grave reservations about this. The process for finding a new director general should be open, accessible and revolutionary. The successful candidate must be a progressive agent for change. The chance is coming to change the captain of the ship. I hope this process is managed well. It is interesting to note that none of the current names floating around as possible candidates for Mr. O'Brien's replacement is a woman's. That raises a point in itself and should require some reflection.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I apologise on behalf of the Minister for Health, Deputy Harris, who is unable to take this Commencement matter raised by Senator Devine.

The current director general of the HSE will be vacating the post towards the end of July. Preparations are at an advanced stage regarding the process for appointing his replacement. This will be done in accordance with the provisions of the governing legislation, section 16E of the Health Act 2004, as amended by the Health Service (Governance) Act 2013. This requires that the recruitment process will be undertaken in line with the Public Service Management (Recruitment and Appointments) Act 2004. The recruitment will be carried out by the Public Appointments Service and will include an international executive search. The post is expected to be advertised shortly.

The importance of attracting the highest possible calibre of candidates cannot be overemphasised. The director general's role is to lead the HSE and to manage and be accountable for the administration and business of the executive. The HSE has a budget of €14.5 billion in 2018 with over 115,000 staff in whole-time equivalent terms.

The Sláintecare report sets out an ambitious plan to transform and enhance health services over the next decade. The report advocates a reorientation of the health service towards a high-quality integrated system providing care on the basis of need. The Government has committed to a significant programme of health reform arising from the report and an implementation plan will be submitted to the Government shortly. The next director general will, therefore, need to deal with a changing governance environment.

Under the current system, the director general is the chairperson of the directorate. The directorate is the governing body of the executive with authority to perform the functions of the executive. Work is ongoing to bring forward a Bill this year to legislate for the establishment of a governing board for the HSE. The Minister for Health, Deputy Harris, will be bringing a memorandum to the Government next week with the general scheme for a Bill. He hopes to receive the co-operation of the Oireachtas in getting the legislation passed this year in recognition of its importance to the reform agenda.

All Members will agree we need to ensure more robust and transparent structures of accountability across our health service. The appointment of a strong board is essential to achieving this. Subject to this proposed legislation, it is intended the directorate will be replaced by a board and the post of director general will be replaced by a chief executive officer who will be accountable to the board. The next director general will be required to contribute fully to the successful transition in organisational governance structures; to support the new board in its duties; and to fully discharge their accountability as chief executive officer to the board when established.

It is the Minister's intention that the post of director general will be advertised as soon as possible. The Department of Health is engaging now with the Public Appointments Service to progress this as a priority.

Photo of Maire DevineMaire Devine (Sinn Fein)
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I know section this and section that of the governance Act and so forth. The director general post will revert to chief executive officer again. Cathal Magee left this post because he did not really agree with the idea of a chief executive officer. We are going back for some reason.

We do not want somebody parachuted in as has happened. The interim director general cannot become permanent as happensde factothroughout our public services. We need somebody who not only has managerial experience but has proven clinical experience. They must also have hands-on experience to ensure they can stay in touch with the workers and patients on the ground.

Who is on the interview panel? Who chooses them? Will it be somebody parachuted in as has happened before? This is a massive opportunity to introduce change and an agent for change to the health system.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I do not have the information on who is on the interview panel to hand. I am sure when the Minister brings the memorandum to Cabinet, matters about that will become clear.

I do not know who is running. I hope there will be women with the relevant qualifications from here and further afield who would be interested in the job. I do not agree with the Senator, however, about proven clinical experience. It is important that whoever gets the job understands the ins and outs of the medical profession, whether it is in hospitals, primary care centres and across the HSE. Such a connection will be important.

I do not have the exact date as to when the board will be in place. I know the Minister for Health is anxious to proceed to ensure when the incumbent, Tony O'Brien, leaves his post, his replacement will fit into the vacancy as soon as possible. I will ask departmental officials to come back to the Senator on some of the matters she raised.