Health Service Executive Bill 2012- Second Stage Debate- 6/3/2013

Deputy Joe O’Reilly: I am delighted to welcome the Bill to the House. In doing so, there is a statement of an ongoing need for reform, reorganisation and refinement of services for the patient, although this in no way reflects on the professionalism, commitment and wonderful work done by individual HSE employees at all levels in recent years. There is no implicit criticism of their professionalism in the legislation or its objectives, which is concerned with structure, future direction and ambition to deliver a single-tier health services.

Today marks the Government’s second anniversary in office. In that context I salute and compliment the achievements of the Minister for Health, Deputy Reilly, and his Department in those two years which have led to the Department being overhauled. Since 2011, the Minister, Deputy Reilly, and his Department have cut the cost of medicine by €400 million, which is a very significant achievement. They have allocated a further €35 million to mental health services and filled 246 new mental health posts, which is another great achievement. They have also established a special delivery unit to work with hospitals to reduce the number of patients on trolleys and waiting times. In 2012, the number of people waiting on trolleys decreased by 23.6% and although this is not where we wish to be, it is a true reflection of the work done and tangible evidence that we are going in the right direction. It means much to those who are affected and it is a great achievement in the context of very stringent economic times. The Minister has achieved much with significant budgetary constraints.

There has been a 98% decrease in the number of adults who must wait more than nine months for inpatient and day surgery, with a 95% decrease for children. I am pleased to report that in Cavan General Hospital, the number of patients waiting on procedures has fallen by 48%, which is a very significant development. A new 34-bed cystic fibrosis unit was opened in St. Vincent’s hospital and we have established a site for the new children’s hospital. The Bill is being brought forward against that backdrop of real reform and achievement, with tangible differences for people. The ambition of the Bill is to continue the reform and build on it.

There are two essential objectives of the Bill. The first is to make the HSE more accountable to the Minister for Health and the second is to restructure the HSE in line with the programme for Government commitments, specifically the move towards universal health insurance. The Bill is a transitional measure with the intent to implement the proposals as set out in the programme for Government. It aims to ensure there is more accountability between the Department and the HSE and, more importantly, it will ensure that there is greater accountability and involvement by the Department of Health and the Minister, who is answerable to the electorate. It is an important component of the legislation.

The Minister has already started a process of change in this way. In 2011, he made changes to the composition of the HSE board, ensuring greater co-ordination and a higher level of dialogue between senior officials in the Department and the HSE. The fundamental flaw of the HSE as introduced in 2004 and 2005 was that a structure was imposed on an existing health board process, meaning there was not a sufficient link to the greater resource that is the Department of Health. It is a fundamental difficulty that became more of an issue in a number of ways over the years.

The Minister, Deputy Reilly, has referred to this as a unity of purpose, with the changes made guaranteeing a higher level of integration between the Department and the HSE. The Bill will seek to eventually dissolve the current board structure and establish a new arrangement of governance. The HSE will have operational responsibility in the interim but accountability will be strengthened.
The second objective is to begin dissolving the HSE board and move towards universal health insurance. The new HSE structure will have directorates and a director general, with a flexibility about the number of directors in that the minimum will be three and the maximum will be seven. That will allow adaptability and a response to certain circumstances. The directorate will be fully accountable to the Minister, which is important. The Minister may issue directions to the HSE and the directors regarding the implementation of Government policies relating to specific priority areas, which is important.

Section 10 refers to levelling the balance of power between the Minister’s Government policy and the HSE’s operational responsibility. The Minister has indicated that the HSE has a responsibility under the Health Act 2004 for the provision of health and personal social services. However, the HSE also has a statutory obligation to have regard to ministerial and Government policies and objectives when performing functions. The new structures are intended to strengthen that process inherently. The Bill is only an element in a reform process that is moving toward a single-tier health system in which access to and quality of health care will be available to everyone, irrespective of means. That should be the objective.

I will refer to one or two specific areas within health policies as we are given such scope on Second Stage of a Bill.
I am delighted with the developments in primary care. My colleague, Deputy Ó Caoláin, who will be speaking later, and I are aware of recent openings of new health care centres in our area, namely, in Bailieborough, Cootehill and Cavan town. Another, in Kingscourt, is already functioning but the opening is pending. It is entering the full development stage. The primary health care centres have enormous potential to allow for the effective treatment of people in the home, which is where they want to be. They allow people to remain in their community and have treatment brought to them.

The home help service is a great resource with enormous potential to augment the primary care service and keep people in their own homes. Dovetailed with this is the carer’s allowance, which I know is the direct responsibility of the Minister for Social Protection. The allowance has great potential to facilitate people being looked after at home. It should be made more attractive and easier to access, and it should be advertised and recommended more. This could make it very attractive for people in lower-paid occupations who have sick relatives to become full-time carers. It has inherent advantages already but could be improved further. The Department of Health and the Department of Social Protection should consider the carer’s allowance as a vehicle to achieve more with a view to keeping people at home, reducing institutional care and, ultimately, reducing costs. It will allow for people to be cared for at home, which is where they prefer to be.
We should be very careful not to reduce home help hours where possible. It is reasonable to redistribute them and examine their allocation. It is reasonable to ensure they are targeted according to need but it is not a good proposition to reduce the number of home help hours in absolute terms. We should be increasing the number. It is through the provision of home help, the use of the carer and home care packages that we will reduce institutional costs, make patients happier and allow patients to remain in their own homes. This is why I salute this measure.

The €35 million extra for mental health services represents wonderful news. I ask the Minister to elaborate on the plans to spend this immediately to implement the recommendations of A Vision for Change and to have community services developed. That is very important. I look forward to the Minister’s response.

Senator Joe O'Reilly representing Cavan & Monaghan 2010. | An ExSite website