Health Service Executive (Governance) Bill 2012: Second Stage

Wednesday, 6 March 2013

I welcome the opportunity to speak on this Bill. The Government is committed to the eventual dissolution of the HSE. However, this is a complex process which will take time and this Bill is a transitional measure along that path. The Bill is all about accountability and its aim is to make the HSE more directly accountable to the Minister for Health. The provisions of this Bill will see the abolition of the board structure of the HSE and a directorate created as a new governing body, headed by a director general. The directorate does not have a fixed number of members – the Bill provides for a maximum of seven and a minimum of three. This should allow flexibility for the directorate to deal with circumstances as they arise. It is important to stress here that the HSE will continue to have operational responsibility for running the health service. The director general will account, on behalf of the directorate, to the Minister. As with any large corporate structure, one needs to have good governance practices and structures in place in order to implement the changes that are necessary.

This Bill will aim to make sure that Government policies and objectives relating to the HSE functions are implemented and this is no mean task. The Minister will specify his priorities for the HSE and the HSE must have regard for these in preparing its service plans. Like any good plans, they must have performance targets and metrics for measuring performance. The HSE must pay particular regard to these targets as they are set out for it. These operational changes will ensure that the HSE, which is a very large organisation, will have greater flexibility and will be able to react more quickly, as change is required.

I wish to stress that while this Bill is about making sure the HSE reacts faster and in the direction that the Minister wants, my experience of the HSE in the south has been very positive. Everybody likes to criticise the HSE but it certainly has a lot of good points. It would be wrong of anyone to suggest that all areas of the HSE are not performing. Only last week, the reconfiguration plan involving Cork University Hospital and Mallow General Hospital reached the point of implementation. The HSE and its staff played a pivotal role in this, liaising with all of the consultants and everyone else involved, in drawing up a very detailed strategy and everybody is on board, I am glad to say. I am delighted to say that this will probably form the template for how small hospitals work in the future and will allow for a future for them.

Until now we have been worrying about the future of all our small hospitals. Most importantly, this will see better service delivery to the patient, with shorter waiting times and the freeing of emergency surgery wards for emergencies requiring specialist care. I particularly thank the regional director of operations in HSE south for his tireless work in ensuring that the Minister’s aims are being delivered on the ground.

We must move forward toward greater accountability and transparency in health care delivery. The Minister, Deputy Reilly, has succeeded in reducing waiting times and time spent on trolleys, with individual performances across the HSE to be monitored and accessible for all. If three surgeons can perform the same procedure, the waiting times for each surgeon should be available online so a patient can decide which surgeon to go to. With prescription drugs, there should be a list of those who give prescriptions, particularly general practitioners, taking into account those who prescribe cost-effective generic medicine in preference to high-cost brands. That would generate best value for the patient. We must also move to a system where prices of drugs can be published online so that patients who pay for drugs with minimum subvention can have access to the information that will allow best value for money.

I congratulate the Minister on the establishment of the medicines management programme, which is concerned with the spend on medicines. The Minister is tackling the issue with the programme, which will evaluate medicines under the headings of safety, efficacy, access, and savings for the State and patient. It is an holistic process as part of a broader remit, with co-ordination between the National Centre for Pharmacoeconomics and the National Medicines Information Centre, coming together with collaboration of the HSE under the primary care reimbursement services.

In private business, getting policies delivered is important; it is done quite quickly in small business but doing it in a large organisation is very difficult. Delivering such change can take time. I congratulate the Minister on the establishment of the national early warning score. All these initiatives may sound like they are more jargon but they are well thought through and will deliver for the patient and, in time, bring cost savings.