Proposed Health Service Reform
5. Mr. Gormley asked the Minister for Health and Children the legislative package he intends to introduce to implement the new health reform strategy; when this legislation will come before the Cabinet and the Oireachtas; and if he will make a statement on the matter. [22744/03]
Minister for Health and Children (Mr. Martin): There may be some repetition here. I have outlined to this House in some detail the scale and scope of the reform programme in the health sector. This programme affects almost every aspect of the system, in terms of structures and in terms of governance, accountability, planning, monitoring and evaluation.
It has implications for every organisation in the system and, of course, there will be new structures in some cases. Inevitably, this will require a fundamental reform of the existing statutory provisions for the roles, functions, organisational structure and management of the health system. In line with the Department’s approach on the reform programme, an action project has been established to prepare this legislation, which will provide the statutory basis for the establishment of the new agencies, consistent with the Government decision on the implementation of the Brennan and Prospectus reports’ recommendations. The new legislation will also incorporate any other consequential changes which may be necessary to give effect to the new reformed health system. It will also incorporate legislative proposals arising from the other action projects. I envisage that I will be in a position to introduce the necessary legislation next year.
Mr. Gormley: The Minister is right, the reply is somewhat repetitive. I want to know when this legislation will appear on the list of promised legislation so that we can hold him to account. It is still not on the promised legislation, as he knows. Perhaps I can be repetitive too and ask the Minister, as Deputy Neville asked but I would like an answer, how will this reform package result in savings? Would he agree that the reform programme will not deal with the real problem in Irish hospitals, which is capacity? Is he aware of the recent statement by Dr. Colm Quigley President of the Irish Hospital Consultants Association that no matter how one redesigns a litre bottle it is still a litre bottle? How are he and this reform package going to deal with the capacity problem? Is it not really a matter of investment and is it not the case that he has failed to convince the Minister for Finance, Deputy McCreevy, to invest more in our health service? Finally I would like the Minister to react to the statement by Mr. Maurice Neligan that the services are now in such a state of chaos that the Minister should resign.
Mr. J. Bruton: That is going to happen. Like a Buddhist monk he will go into the woods and burn himself.
Mr. Martin: Since Deputy Bruton’s arrival I am having great difficulty trying to speak but I admire his enthusiasm. In the context of the reform package—–
Mr. J. Bruton: It goes with youth.
An Ceann Comhairle: These are Priority Questions.
Mr. Martin: Eternal youth.
Mr. J. Bruton: Hope springs eternal.
Mr. Martin: As a man of great experience Deputy Bruton knows that in a matter—–
An Ceann Comhairle: This question is in the name of Deputy John Gormley.
Mr. Martin: A matter so fundamental as a new health Act is not produced in a matter of three months. There is fundamental change in the legislative underpinning of health for the future. That is envisaged by the health reform package, and as I said in my reply, it will be next year before the full outline of that new Act will be ready. We have appointed people specifically to look at the legislative framework because when one dissolves some organisations one creates others and one has to look at the sets of relationships between them and the Oireachtas and the Executive, and the remaining agencies within the service.
If the Deputy reads the Prospectus Report he will see that it points to the complexities in any health system globally. It says in particular that this is a major undertaking in terms of reform of this health package. It cannot be understated and therefore needs a considered, detailed and planned approach to its execution. That is what is in hand. Prior to the drafting of the legislation we will appoint an interim health services executive board which will prepare the ground for the appointment of chief executive officer and other officers and will put out the fledgling board itself. In tandem with that, the legislative work will continue. No one ever said we would achieve this under a new health Act in four or five months. We all have enough experience in this House to know that even legislation far less significant than this has taken a considerable time to prepare, draft and pass through the Oireachtas.
Whether the issue is investment or capacity—–
Mr. Gormley: Capacity.
Mr. Martin: No one can argue with the fact that in recent years we have secured very significant additional funding for health particularly since 1997, rates far above those of any other country’s annual rates of increase and investment. Health covers much more than acute hospitals it includes disability, childcare services, the elderly and homelessness. That said, the increase has been staggering by any yardstick and has brought significant improvements in service.
Mr. Gormley: Capacity is still a problem.
Mr. Martin: Capacity has also increased in many areas. We need both investment and reform. It would be wrong to say—–
Ms McManus: What about the James Connolly Memorial Hospital?
An Ceann Comhairle: This is a Priority Question.
Mr. Martin: It is wrong to say that it is just investment. We need to reform the way we do things in the health service. It is a combination of both. We need ongoing investment. Of course, we also need economic growth conditions to facilitate and supply that investment.
Mr. Gormley: I am concerned that the Minister is not addressing the capacity problem. I also have another concern which I ask him to address: Will this result in less accountability? Will questions be disallowed on the basis that they are not a matter for the Minister for Health but for the Health Services Executive? Is this a way of passing the buck?
Mr. Martin: Already, the stock reply to questions on operational matters or health board policy or strategy is that the Minister has written to the chief executive officer of the relevant health board, with a request to communicate directly with the Deputy concerned.
Mr. Gormley: Will it not go even further in future?
Mr. Martin: No. In the operation of the health services, the Health Services Executive will be responsible, but will be accountable to the Minister of the day and, through the Minister, to the Oireachtas. The legislation will have to reflect this. In addition, we have signalled in our reform programme that the Joint Oireachtas Committee on Health and Children should have certain oversight roles in relation to accountability of the Health Services Executive.