Health (Amendment) Bill 2004 – Second Stage Speech
I move “That the Bill be now read a Second Time”.
I am pleased to have the opportunity to address the House today on the Second Stage of the Health (Amendment) Bill 2004. This is the first of two Bills, which I intend to bring before the House this year, to give legislative effect to the proposals contained in the Government’s Health Service Reform Programme, announced last June. The Bill represents a further phase of the implementation of the Reform Programme which has been underway since that time.
Origins in the Health Strategy
At the outset, it is important to remember that the Reform Programme has its origins in the National Health Strategy – Quality and Fairness A Health System for you. This Strategy sets out the vision and goals to guide planning and activity in the health system up to 2010.
While the Strategy acknowledged that the current structures have served us well for over thirty years, it recognised the need to review these structures in order to ensure that they were appropriate and responsive to the needs and challenges of delivering health services in the changing environment of the 21st century.
Using the underlying principles of equity and fairness, a people-centred service, quality of care and clear accountability, the Strategy identified the four goals of:
- Better health for everyone
- Fair access
- Responsive and appropriate care delivery
- High performance
as goals which should guide and shape the strategic direction for the future development of health services. It also identified the need to have a consistent, national approach to the delivery of health services based on clear and agreed national objectives.
Reform of the system
Arising from the commitment to reform the health system, three reviews were undertaken – one by Prospectus entitled “An Audit of Structures and Functions in the Health System” and the other commissioned by my colleague, the Minister for Finance, entitled the “Commission on Financial Management and Control Systems in the Health System”.
In tandem with these reviews, the reform of the acute hospital sector was being advanced by the National Task Force on Medical Staffing (the Hanly Report). This Report set out recommendations on how to plan for the reduction of average working hours of NCHDs by 1 August, 2004 to meet the requirements of the European Working Time Directive. Its recommendations also covered planning for the implementation of a consultant-provided service and the medical education and training needs associated with the Working Time Directive and the move to the consultant-provided service.
Health Service Reform Programme
One of the central findings of the review of the system was that there were too many agencies and that as a result the delivery of services was too fragmented. In June 2003, the Government announced the Health Service Reform Programme, which was based on the recommendations of the Brennan and Prospectus Reports. The Programme´s priority focus is improved patient care, better value for tax payer´s money and improved health care management. It is the most ambitious change programme for the Health Service in over thirty years involving as it does an organisation with over 100,000 staff and a budget in excess of€10bn. The key elements of the Reform programme include:
- A major rationalisation of existing health service agencies including the abolition of the existing health board/authority structures.
- The establishment of a Health Service Executive which will be the first ever body charged with managing the health service as a single national entity.
- The establishment of a Health Information and Quality Authority to ensure that safety and quality of care is promoted throughout the system.
- The reorganisation of the Department of Health and Children to ensure improved policy development and oversight.
- The modernisation of the system’s supporting processes (service planning, management reporting, etc.) so that they will be in line with recognised international best practice.
- The strengthening of governance and accountability across the system. The cornerstone of the Reform Programme is the establishment of a Health Service Executive which will be the first ever body charged with managing the health service as a single national entity.
The establishment of a Health Information and Quality Authority (HIQA) is also proposed in the Reform programme. The HIQA will be established as an independent statutory agency, directly accountable to the Minister for Health and Children. It will provide an independent review of quality and performance and its analysis will inform policy development within the Department of Health and Children. It will also support the Health Service Executive in the development of high quality health information systems to enable it to plan and arrange delivery of health services based on evidence-supported best practice. Other functions will include responsibility for promoting and implementing quality assurance programmes nationally and for overseeing health technology assessments.
The Department of Health and Children will also be reorganised to remove its current involvement in day-to-day matters so as to support the Minister in focusing more on strategic and policy matters. One of its fundamental roles will be responsibility for holding the service delivery system to account for its performance.
The Reform Programme also proposes the consolidation and rationalisation of 27 existing agencies to be subsumed by the HSE, HIQA or the restructured Department. Implementation of this recommendation will help reduce the fragmentation of services in the health system and streamline services so as to make them more accessible to the public.
Progress to date
The implementation of the Reform Programme is being undertaken on a project management basis. Phase 1 which has now been completed included:
- a communication and consultation process;
- the establishment of the National Project Office within the Department of Health and Children;
- the establishment, work and output of 13 Action Projects;
- the establishment of the Interim Health Service Executive and appointment of the Chairman and Board of the Interim Executive; and
- the development of a high-level programme plan identifying key milestones for 2004.
National Steering Committee
Also part of Phase 1 was the appointment of a National Steering Committee, whose role is to oversee the different strands of the Reform Programme. This Committee has already begun its work. Its task is to drive in a co-ordinated manner the overall Reform Programme, involving the Interim Health Service Executive, the Department and the Hanly Group. It also provides guidance on programme planning and ensures that direction and progress are in line with the Government’s decisions. The Steering Group reports to me and to the Cabinet Committee on Health and Children on progress achieved. It is a useful conduit for drawing attention to any issues which may require a response at Government level.
Interim Health Service Executive
The Interim Health Service Executive has been established as a corporate body and its work is well underway. Its functions include drawing up a plan, for my approval, for the establishment of a unified management structure for the proposed new Health Service Executive.
Other functions of the Interim Executive include putting in place procedures for the development of a National Service Plan for the delivery of health services on a national basis and the establishment of appropriate structures and procedures to ensure the proper governance and accountability arrangements for the proposed Health Service Executive. The Interim Executive is also tasked with making the necessary preparations to implement the plan, on its approval, so as to ensure as smooth a transition as possible from the existing structures to the new Health Service Executive structure.
The successful implementation of the Reform Programme leading to the subsequent successful operation of the reformed health service is dependant on all these participants working together in partnership and having a willingness to welcome change. We must remember that the primary purpose of this major reform programme is to have a health service which will improve patient care by providing a responsive and high-quality service while also providing an improved working environment for all those employed in it.
Legislation to underpin the Reform Programme
As I said at the beginning, this is the first of two Bills I intend to bring to the House this year, to provide the legislative basis to the recommendations of the Reform programme. The second Bill will provide for the establishment of the Health Service Executive to replace the Eastern Regional Health Authority and the health boards. It will also provide for the establishment of the Health Information and Quality Authority. The legislation will make provision for improved governance and accountability as well as planning, monitoring and evaluation.
I also intend that the second Bill will set out a statutory framework for the handling of complaints in the health services. The need for such a statutory framework was identified in the Health Strategy. The Strategy recommended that the framework should provide for greater clarity and uniformity of approach in dealing with complaints and should also provide for structured local resolution processes with an opportunity for independent review.
It is my intention that these structures will be in place from January 2005.
Health (Amendment) Bill 2004
I wish to turn now to the Bill before us here today. This Bill is very much interim legislation pending the legislation I am bringing forward later in the year which I have just outlined for the House. This Bill provides for:
- the abolition of the membership of the ERHA, area health boards and health boards, while retaining the Authority and boards as legal entities;
- the termination of office of all members of the health board from the date on which an Order is made bringing the Act into operation;
- the assignment of the Authority/boards’ reserved functions to the CEOs or the Minister for Health and Children, as appropriate;
- the amending of existing legislative provisions regarding the acquisition and disposal of property by the health boards and the ERHA by re-introducing the need for Ministerial consent prior to the acquisition and disposal of property.
There is a need to modernise the current health care system to achieve the objectives set out in the Health Strategy, so as to allow the health system to meet the numerous challenges facing it in the years ahead.
I am aware that concerns have been expressed regarding the issue of public participation within the restructured health system. I have already indicated my intentions to bring forward proposals to provide opportunities for democratic input in the context of the new structures. I have given some consideration to the most appropriate mechanisms to support the development of appropriate interfaces at regional and local level between locally elected representatives and the Health Service Executive, with a view to including provisions for these mechanisms in the legislation currently being drafted.
The provisions are likely to include establishment of a series of regional fora to facilitate local representatives in raising issues of concern in relation to health services within the region with the new Executive. These fora would allow local representatives to comment on and raise issues related to the development and delivery of health services locally. Membership of the fora would be based on participation of a small number of nominees in respect of each local authority in each regional forum. Members of the fora would also have the facility to raise particular issues with the Executive.
My overall objective in putting in place such arrangements is to ensure that the voice of local public representatives will continue to be heard in relation to the development of Health Services. These mechanisms would be designed to complement and reinforce the role of the Joint Oireachtas Committee on Health and Children in reflecting the views of public representatives in the ongoing oversight of the health system.
In addition to providing fora for local representatives there will be arrangements in place to allow professionals involved in the delivery of services to express their point of view.
The Health Strategy set as one of its objectives the greater community participation in decisions about the delivery of services. The Health Boards Executive in association with my Department issued guidelines to the health boards on community participation which set out the principles and framework for structures for such participation. To date most of the health boards have set up consumer panels that deal with a wide range of issues such as development and delivery of services. Two boards have also established regional advisory panels for older consumers and their carers. It is my intention that these structures will be established on a statutory basis in the Bill which I intend to bring before the House latter this year.
Details of the Bill
In the main, the Bill amends the 1970 Health Act 1970, which established the health boards, the 1996 Health
(Amendment)(No.3) Act which deals with accountability issues and defines ´reserved´ and ´executive´ functions and the 1999 Health (Eastern Regional Health Authority) Act which established the Eastern Regional Health Authority and the area health boards. I will now deal with the main provisions of the Bill.
The definitions used in the Bill are dealt with in section 2 and the sections of the Acts proposed for repeal by this Bill are provided for in section 3 and the Schedule.
Section 4 of this Bill amends section 4(1) of the 1970 Act by deleting the reference in that Act which enabled the Minister to specify the membership of health boards. The provisions specifying the membership of the boards, the application of certain rules in the nomination of members by county or city councils and the obligation to consult such councils before making regulations defining functional boundaries of the boards are being repealed.
Section 5 of the 1970 Act deals with the rules that shall apply in relation to membership and meetings of health boards and authentication of the board’s seal. These provisions (subsections 1(d) and (e), 2 and 3 and the Second Schedule) are being repealed. Currently, the Chairman’s signature or that of another member of the Board is required to authenticate the seal. However because of the removal of the membership of the Board, ssection 5 of this Bill provides that the board’s seal shall be authenticated by the signature of the CEO and another officer authorised to do so.
Sections 6 to 8 delete the requirements on the part of CEOs to consult or agree with the chairman or vice-chairman of a health board on any matter.
Sections 9 to 14 make amendments to the 1996 Health (Amendment) (No.3) Act. Currently, under the 1996 Act, reserved functions of a health board are functions exercised directly by the Board and the Authority, while executive functions are those exercised by the CEO. Section 9 of this Bill assigns all functions of health boards to the CEO.
Section 10 provides that the CEO must provide the Minister with any information in relation to the performance of his or her functions which he might request from him or her.
Sections 11, 12 and 14 make amendments to the provisions relating to the adoption of services plans by health boards and the Authority and to the provisions relating to the submission of accounts to the Comptroller and Auditor General and the publication of the annual report.
Section 13 assigns the board’s function in regard to the appointment and removal of the CEO to the Minister.
Section 15 amends the 1947 Health Act and provides that the Board and the Authority must obtain the consent of the Minister prior to the acquisition or disposal of property. This reverts to the position pre the enactment of the 1996 Act, which had introduced an amendment permitting the boards and Authority to acquire and dispose land subject only to general directions by the Minister.
Sections 16 to 24 make the necessary amendments to the 1999 Health (Eastern Regional Health Authority) Act to abolish the membership of the ERHA and the area health boards.
Sections 18 and 21 deal with the authentication of the seals of the Authority and the area health boards. Sections 20 assigns the functions relating to the appointment of the Regional Chief Executive to the Minister. The functions relating to the appointment and removal of an area chief executive are assigned to the Minister in section 23.
Section 25(a) assigns the functions of the Authority to the Regional Chief Executive and section 25(b) assigns the functions of an area health board to an Area Chief Executive.
Under section 220 of the Local Government Act 2001, Local Authority members are empowered to nominate members to specified linked bodies. Section 220 is amended by section 26 of this Bill by deleting the inclusion of a health board, the Eastern Regional Health Authority or an area health board from the definition of‘linked body’. The effect of this amendment is that Local Authority members will no longer have nominating rights to health boards, the Authority or to area health boards.
Section 27 of the Bill terminates the membership of all members of the boards, the Authority and the area health boards from the date on which an Order bringing the section into operation is made. As the terms of office of the members vary for the different categories, the purpose of this section is to ensure that the term of office of all members is terminated at the same time.
Section 28 makes provision for work commenced by the members of the boards, the Authority or an area health board to be carried on by the CEO without having to begin the process again.
As I said at the outset, this interim Bill marks a further step in the process of the implementation of the Reform Programme and is a further sign of the Government’s commitment to the delivery of a reformed health service to maximise the level and quality of care provided to patients and clients.
I commend this Bill to the House.