Emmet Stagg (Kildare North, Labour)
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Question 67: To ask the Minister for Health and Children if she will extend the remit of the Health Information and Quality Authority to include private health care facilities and hospitals; her plans to review the structures of the Health Service Executive in the context of growing concern among the public and health workers that it is not delivering improved care to patients; and if she will make a statement on the matter. [16321/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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A core function of the Health Information and Quality Authority (HIQA) is to set standards on safety and quality of health services and to monitor enforcement of those standards in an open and transparent way. The Health Act 2007 currently gives HIQA strong powers in this area in relation to services provided by the Health Service Executive (HSE) and bodies funded by the HSE to provide services on their behalf. The process by which such a regulatory regime is introduced first in the public sector is a feature of similar developments in other jurisdictions. The extension of this type of monitoring and control to the private sector would involve further legislation of a complex nature.

However, the Commission on Patient Safety and Quality Assurance was established last year to develop proposals for a health service wide system of governance based on corporate accountability for the quality and safety of all health services. One of its terms of reference is to specifically examine and make recommendations in relation to a statutory system of licensing for public and private health care providers and services. The Commission is due to report by the end of July this year.

In relation to HSE management structures, the 2001 Health Strategy highlighted the need to strengthen existing delivery structures at local level within a framework of national standards for the whole health system. Following on from this, the HSE was established to manage and deliver health and personal social services, or to arrange for such services to be delivered on its behalf. Its primary statutory responsibility is the operational delivery of health and personal social services.

The Fitzgerald report for the Board of the HSE about the management of events at Portlaoise identified systemic weaknesses of governance, management and communication within the HSE. Arising from that report, I asked the Chairman of the HSE to consider whether the lessons arising from the report have wider application across the HSE and to let me have the Board's assessment of the overall situation, and its proposals to address matters, as soon as possible.

I am aware that the HIQA report into the misdiagnosis of a particular individual includes various findings and recommendations about the management and governance of acute hospitals. I am confident that these recommendations will also be taken into account by the Board in responding to my request. I am also aware that the HSE has engaged McKinsey & Co. to undertake some work for it on organisation design.

In my view, the focus should be on improving the operational capability of the existing organisation structure. This requires robust governance/management structures, processes and procedures, incorporating clear reporting relationships and lines of accountability, with permanent top level managers in key posts, good systems of delegation, and a strong sense of corporate identity which permeates all levels of the organisation. I am aware that the Board of the HSE are addressing these issues and I look forward to receiving their proposals in the near future.