Sinn Féin spokesperson on Health, Caoimhghín Ó Caoláin TD, has claimed that planned health service reforms contained in the Health Service Executive (Governance) Bill will leave Minister James Reilly with increased sweeping powers and accountable to no-one.
Speaking in the Dáil debate on the Bill, Deputy Ó Caoláin said:
“This Bill may increase accountability to, and the powers and responsibilities of, the Minister. But is this particular Minister worthy of such responsibilities? And will it make the Minister more accountable to the Dáil and to the people? I regret that the answer to both questions is ‘No’.
“We cannot expect real, progressive reform from a Minister that tells young graduate nurses that they can accept his yellow pack contracts or else emigrate or work in fast food outlets, nor from a Minister who has gone to extraordinary lengths to dodge questions on primary care centre selection and capital projects funding.
“This Minister, like his predecessor Mary Harney, hides behind the HSE when it suits and pushes the HSE aside when it suits.
“We are all for more accountability from the HSE. But what about the accountability of the Minister to the people and to the Oireachtas?
“The resignation firstly of former HSE CEO Cathal Magee and then of Minister of State Roisín Shortall exposed the deep dysfunction at the very top of our public health services. The problem is, I believe, three-fold. There is the unsuitability of this Minister for office; there is the fundamentally flawed policy approach of this Government; and there is the unreformed structure of the HSE and the health services.” ENDS
HSE Governance Bill 2012 –2ndStage – 30.1.13
Caoimhghín Ó Caoláin TD, Sinn Féin Health & Children spokesperson
This Bill is supposedly another step in the Government’s Health reform programme. People have quite rightly grown wary of the word ‘reform’ in the mouths of this Government, and especially from this Minister.
What we are getting is the rhetoric of reform but the reality of regression and retrenchment.
When the HSE was established we in Sinn Féin said it represented bureaucratic change rather than real reform. It was not the replacement of the inequitable and inefficient two-tier system with a truly equitable and efficient universal system based on need alone.
Like the legislation establishing the HSE, this Bill represents more bureaucratic change. It may perhaps deliver a more stream-lined bureaucracy but nothing more.
The Bill may increase accountability to, and the powers and responsibilities of, the Minister. But is this particular Minister worthy of such responsibilities? And will it make the Minister more accountable to the Dáil and to the people? I regret that the answer to both questions is ‘No’.
We cannot expect real, progressive reform from a Minister that tells young graduate nurses that they can accept his yellow pack contracts or else emigrate or work in fast food outlets. The Minister has not withdrawn that remark nor has he been repudiated by any of his Cabinet colleagues. Perhaps they are waiting for a nod and a wink approval for capital projects in their constituencies.
We had a taste of so-called accountability here yesterday in the Topical Issues debate. This is very relevant to the Bill before us because it is about the relationship between the HSE and the Minister.
This Minister, like his predecessor Mary Harney, hides behind the HSE when it suits and pushes the HSE aside when it suits.
He hid behind the HSE when it made the announcement last August of a further €130 million in health spending cuts – cuts for which he and his Government colleagues were directly responsible, including the cuts to personal assistance for people with disabilities which they were embarrassed into reversing by disabled people camping outside Government Buildings.
The Minister pushed the HSE aside when he fast-tracked hospital capital projects at the behest of his Cabinet colleagues Ministers Howlin and Hogan.
The Explanatory Memorandum for this Bill claims it is essential that the HSE is properly accountable to the Minister for its performance. We are all for more accountability from the HSE. But what about the accountability of the Minister to the people and to the Oireachtas?
Minister Reilly yesterday was asked repeatedly about the way the decision was made on the capital projects in Wexford and Kilkenny. He doggedly refused to answer.
He refused to account for the fact that the Ministers in these constituencies, Deputies Phil Hogan and Brendan Howlin, announced the commencement of the hospital projects before the HSE Board met or before the Board was even aware that these projects were going to leap-frog others.
Minister Reilly simply ignored my question about what contact he had with his two Cabinet cronies before they so confidently made their announcements. It may be a case of ‘if there’s no written record it didn’t happen’.
I hold no brief for the HSE and its current structures – quite the opposite in fact. It is top heavy and over-bureaucratic.
The passing of the HSE Board under this legislation will be lamented by few and I will not be opposing its abolition.
But the hospitals controversy does raise an important question. It came to light because journalists were able to obtain minutes of the Board meetings under the Freedom of Information Act. Will there be the same transparency and accountability under the new Directorate appointed by the Minister?
Section 12 of the Bill gives the Minister increased powers to amend the HSE service plans. In principle that is not objectionable but we have no confidence in how it will be used in the hands of this Minister and this Government.
The issue is not the procedure for formulating the Plan; what is important is its content and the strategy and policy that guide it. In the case of this Government it is the fundamentally wrong economic strategy of austerity and the fatally flawed health policy of Fine Gael, which clearly holds the whip hand as far as health is concerned in this Coalition.
On 10 January the Minister approved the HSE’s National Service Plan, a plan I have described as a plan for slashing services.
The plan implements the savage cuts to public health services imposed by the Fine Gael/Labour Coalition in Budget 2013.
Of the total of €721 million in cuts in this plan a massive €323 million is cut from primary care. This makes a mockery of the Government’s so-called reform programme with primary care trumpeted at its centre.
Minister Reilly has signed off on a plan that will deprive some 40,000 people of medical cards in 2013 and many more thereafter as the income criteria for receiving a medical card are changed. This is a further attack on people on low incomes.
It is scandalous that the plan imposes a cut to disability services (1.2%) which is four times what was expected by the sector (.3%). This will severely affect disability services that are already reeling from cuts in previous years.
The plan also implements the increase in the medical card prescription charges and the reduction in the monthly subsidy for medicines under the Drugs Payment Scheme.
This plan will deepen the staffing crisis in our public health services. The plan itself admits that given the level of staff reductions in recent years and 4,000 more staff due to be cut this year, planning for services is ‘particularly difficult in 2013’. This is an understatement and the staff crisis will be compounded by the Government decision to attempt to introduce a cheap labour scheme for nurses which has been rejected by the nursing unions and by the overwhelming body of newly qualified nurses.
It almost beggars belief that the Minister is actually proposing to extend this yellow pack scheme to other professions within the public health services even though the scheme is so grossly unfair and is a hopeless failure from the Minister’s point of view as the boycott by the nursing union is being widely adhered to.
I call on the Minister once again to withdraw this totally unacceptable scheme and to sit down at the table with the nursing unions. They have proposed alternative ideas for savings which would respect the existing salary scales for all nurses/midwives.
Compare the slashed salaries that Minister Reilly expects graduate nurses to work for with the salaries at the top of the HSE.
This Bill will not address excessive salaries at the top heavy upper and middle management of the HSE.
There are 129 managers and administrators in the HSE receiving salaries of over €100,000 per annum. That is obscene when, for example, already inadequate home help hours and homecare packages for our older citizens have again been cut this winter.
Bureaucratic change, as in this Bill, is meaningless without real policy change and also a change in the culture of privilege at the top.
The resignation firstly of former HSE CEO Cathal Magee and then of Minister of State Roisín Shortall exposed the deep dysfunction at the very top of our public health services. The problem is, I believe, three-fold. There is the unsuitability of this Minister for office; there is the fundamentally flawed policy approach of this Government; and there is the unreformed structure of the HSE and the health services.
Last year marked the centenary of the Titanic sinking and this 2012 Bill, in the context of the crisis in our public health services, is rearranging the deck chairs.
The public health services are now struggling from day to day. Even before the €721 million cuts in Budget 2013 they were reeling from the cuts of €130 million last August, on top of the €750 million cut in Budget 2012 and the billion in 2011.
Last week in the Health Committee we heard nurses describe the reality of reduced service and increased risk in hospitals as a result of short-staffing. The recruitment ban, together with the further restrictions on overtime and the hiring of agency staff, are having a dire effect.
The increased flexibility and potential productivity from consultants achieved in talks last year were welcome but could be scuppered by the other cuts. If there are not sufficient nurses and other staff, not sufficient theatre time available and not sufficient in-patient beds open, many consultants will simply not be able to provide the extra treatments, operations and procedures required of them.
I want to return again to the lack of transparency and lack of accountability from this Minister. This is central to the issue of governance addressed in this Bill.
I raised a Topical Issue last week on the failure of the Minister to fill 64 vacancies on nine boards under his remit, including the Food Safety Authority. In the case of that Authority, 25 people applied under the new open procedures for a position on its board. The Minister continues to hold off on appointments despite our being reliably told the overwhelming number of those applicants are suitably qualified and eminent to take on any position of responsibility required by the board.
All this raises questions about the future of the various authorities and boards, as well as undermining public access to the appointment system. But the Minister refuses to address these concerns.
Minister of State Kathleen Lynch was sent in here by Minister Reilly to reply to us and she was clearly embarrassed. She admitted she did not think the reply she was given shone any light on the question raised.So much for accountability.
Finally, I want to mention a very important issued raised by Mental Health Reform regarding this Bill.
While welcoming the Government’s intention to improve the accountability of the HSE through the Bill, Mental Health Reform states that the current draft does not ensure that a Director for Mental Health who has the competence to drive implementation of the Government’s mental health policy will be appointed.
Mental Health Reform is concerned that the Bill limits the recruitment of the new Directors of the HSE to those who already hold the position of National Director within the HSE.
Mental Health Reform believes that it is vital to have the opportunity to appoint the best person for the job, whether that person be internal or external to the HSE. The new Director for Mental Health must have a proven track record of leading change in mental health services and competency in the recovery ethos that underpins A Vision for Change.
This is extremely important and I urge the Government to bring forward amendments to rectify this matter or to support Opposition amendments which will seek to do so. ENDS