Speech – Health Service Executive (Governance) Bill 2012


Dáil Éireann 29th January 2013


Thank you for the opportunity to speak on this Bill.


I believe that the abolition of the current board structure of the HSE and its replacement with a system of directorates, alongside a provision for the Minister to give policy directions to the HSE is most welcome.


I acknowledge that the Directorate structure is an interim measure pending the dissolution of the HSE, which is something that this Government committed to as part of the move to Universal Health Insurance.


Under the provisions of the new Bill, the Director General will be accountable to the Minister through the Secretary General of the Department of Health and the Minister may issue written directions to the HSE around policy implementation if he or she believes that insufficient regard is being paid to a policy or objective.


It also allows the Minister to give specific priorities to the HSE, which must be taken into account in the service plan. An audit committee will advise the Director General on financial matters and this report must be provided to the Directorate and the Minister.


In many respects, the HSE, established in January 2005, has proved to be a runaway train and this Bill will hopefully provide welcome direction to the Executive in terms of priorities and will also make the HSE more accountable. In too many instances, important decisions are being taken by middle management within the HSE, without proper recognition being given to the long-term impacts on the service.


When the HSE was being established, it was hoped that a centralised service would prove more competent than the individual health boards which it replaced. Two reports in 2003, the Brennan Report and the Prospectus Report, criticised regional decision making and called for the health service to be managed by a single entity. The setting up of the HSE in January 2005 on foot of legislation passed in 2004 reflected the recommendations of that report.


Much criticism had been levelled at the practice of health board meetings which took place around the country, but in fact they did provide an opportunity for public representatives to hold health service personnel to account for decisions. The Regional Health Fora, which replaced the old health boards, were given representative rather than executive functions and became toothless bodies and thus an important element in terms of regional accountability was lost.


The per capita spend of the HSE has been reduced by 11% in the past two years, a hugely significant sum and it is increasingly important that every cent spent in health is spent wisely for the benefit of the patient, be they in hospital or in the community.


A key mistake that was made at the time of the creation of the HSE was the lack of action in terms of amalgamating management positions, which resulted in hugely increased management numbers and a bloated and costly bureaucratic set-up, which hoovers up millions in terms of budgets, without providing real benefits where it is needed most, at the coalface.


Successive Governments have failed to grasp this nettle and until such time as the numbers of administrators in the system are reduced, we will continue to have an overly-bureaucratic system where too much of the salary cost is going to administrators as opposed to doctors, nurses and front-line healthcare staff.


Issues also arose in terms of transparency and politicians of all hues have found it incredibly frustrating to get answers from the HSE. Unlike all other state bodies, the HSE has proved virtually opaque in terms of getting answers on even the most simple questions and I hope that the regime ushered in with this legislation will allow public representatives to have questions on health matters answered in a more timely and constructive fashion.


The issue of the money following the patient is also an important part of Government policy and that change is being prepared for through new governance structures. An important element of these new governance structures is the fact that HSE hospitals will become autonomous providers of care.


I sincerely hope that the regime ushered in through this legislation will result in a more coherent and cohesive health service, where important elements of Government policy get acted upon and where the service plan reflects the priorities of those appointed by the people to steer the country on a particular course.


For example, this Government, in the recent budget, placed great emphasis on ensuring that front line disability services were protected from the harsh cuts that had to be made across a variety of sectors and while this emphasis is laudable, what is key is that it is properly reflected in the HSE service plan and carried through in terms of disability services all across the country.