Government parties vote against Labour’s HSE proposals
Last night, Labour’s motion to reform the HSE were voted down by Fianna Fáil, the Greens and the PDs. Minister Harney was present for most of the debate and defended the HSE’s slow moving reforms by explaining that it was merely in its infancy.
The proposals would have sought to establish clear lines of authority in the HSE, made the Minister for Health and Children more accountable to the Oireachtas and implemented parts of the HIQA report into the Rebecca O’Malley case.
The health service is a subject which is brought up again and again in the Seanad, with members complaining of bureaucracy and that the HSE is an impenetrable organisation. It was a pity, therefore, that the government side of the house voted against the Labour proposals. I have no doubt that the complaints about the HSE from government senators will continue.
Below, you will find my speech from last night.
It is my pleasure to second this motion and welcome again the Minister for Health and Children to the House. I am interested to hear her response and those of our colleagues opposite in respect of the proposals we are bringing forward.
I will repeat a challenge I threw down to the colleagues opposite yesterday. Hardly a day or week passes without one or other of our colleagues opposite coming into this House and quite correctly criticising an aspect of the health services that has come to their attention. Time and again they make the point about the system being dysfunctional and there being a lack of clarity in terms of responsibilities and management lines. They express their frustration in this House in respect of particular problems that arise and, more seriously, the inability to obtain clarity and answers to genuine issues which arise.
The picture inevitably painted by colleagues on all sides of the House is of an almost Kafkaesque system which is impenetrable to public representatives, to say nothing of members of the public or citizens who seek to make sense of it. The frustration people have in trying to make sense of it has been echoed at the highest level in Government, as we know. A number of the Minister’s colleagues have reflected this in recent months.
There is a fundamental difficulty to be addressed and we do not bring this motion forward to have a go – as might be suggested – or level criticism in a gratuitous way. We approached this issue genuinely and my colleague in the Lower House, Deputy Jan O’Sullivan, has brought forward these proposals in a genuine attempt to have the chaos which characterises much of the operation of the health services addressed in a meaningful and practical way.
I repeat my challenge to my colleagues opposite, including those who raise these issues every day. I am disappointed with the response by way of the amendment to the motion. I, along with others, yesterday indicated our proposals and if there are specific aspects with which the Government has a problem, it should amend them so we can have a realistic and meaningful discussion. What we have instead is the usual response, which is to delete everything in the motion after “Seanad Éireann” and insert something entirely different that does not address the issues we are attempting to deal with.
If colleagues are frustrated and believe the system is dysfunctional, they can see a practical answer in the first paragraph of our motion in respect of establishing clear lines of authority, responsibility and reporting within the HSE. That issue is not dealt with in the amendment to the motion. There is a reference in a bullet point to yet another review. It may be there is a need for ongoing reviews in all organisations but we seem to be in a permanent state of review in the case of the HSE. The matter is not dealt with.
A second issue is the frustration people feel in respect of accountability for delivery of services, for example. We know we have the model of the Minister dealing with policy and the HSE dealing with implementation and delivery, as Senator Prendergast pointed out. At least, that was the vision at the outset, but it has not worked. The Minister has found herself having to deal with everyday issues and it appears the HSE, almost inevitably, strays into the policy area. How could it be otherwise?
If people feel, as I do, that the matter should be addressed, one would imagine it would addressed in the amendment. It is not, apart from a generalised acceptance that the Minister accepts full accountability. There must be accountability at the core as the Minister must constitutionally be responsible to the Houses for what happens under the rubric of her brief. There is no real everyday and meaningful accountability. There is a proposal to deal with it but there is no response from the other side.
For example, with regard to the HSE, the motion points to the fact that there is a statutory requirement on the HSE to manage its budget within its approved Vote. This is the constant response one gets the whole time. This gives rise to a genuine belief in many people – not just those on this side of the House – that the HSE is driven more by budgetary concerns than it is by real patient need. To corral into the HSE not just the responsibility for doing the everyday job but to be the Accounting Officer for its own funding is quite wrong. There is a democratic issue in this also. It is unprecedented that a body the size and importance of the HSE, which is tasked with the health services of the country, would have the power of answerability for its budget. There must be an issue at the core of these problems that we should examine.
It was a spectacle when Members of the Oireachtas, both Senators and Deputies, gathered in the restaurant downstairs and vied to put questions to the head of the HSE and his staff.
Putting up one’s hand in the hope that one can ask a question is not serious accountability in any real democracy or constitutional system.
People sometimes say the Department of Health and Children was too weak before the HSE came about to make its writ flow, as it were. The answer to that was to strengthen the governance in the Department of Health and Children and the way it managed the system rather than removing the power and corralling it within the HSE along with all its other responsibilities.
If the Members on the other side of the House are concerned about staffing, the two constant refrains one hears about the health service, whether it is on radio, television, in this House or outside it, is that it is overstaffed and that we are throwing money at it and getting nowhere. This is the conventional wisdom one hears every day of the week but let us consider it. If the executive is overstaffed and the Minister believes it is, we should take an honest approach to the problem and go with a redundancy programme. We should see the case in that regard. People might find it odd that the Labour Party is advocating that but we do so in the sense that if there is a need for redundancies, we should have them. Let us see the case made and have consultations, as Senator Prendergast said. We should do it instead of maintaining the criticism of the health service that it is overstaffed. If it is overstaffed we should address the problem. At that stage we will see whether there is a need for redundancies and if there is not a need, that argument should be left aside. It either is or is not overstaffed.
The second point is that we are constantly throwing money at the HSE. The notion has found its way into the public discourse that money is being thrown at the HSE and we are not getting anything back. We have had very little discussion about outcomes. All the discussion is about costs, as somebody said on the “Prime Time Investigates” programme the other night, but there is little about what we are achieving. We do spend a great deal of money on our health services. We are right to do that and the Minister should defend that.
One of the most remarkable observations made in the course of the “Prime Time Investigates” programme the other night, and it told a major story, was that fine doctors and medical people were seen to leave the public sector and go into the private sector. What is the reason for that? It must be partly due to the perception in the system that the action is in the private sector. We must get the action back into the public sector. We should favour and privilege the public sector and try to reform the current system by way of this motion, which is a set of sensible proposals that could easily be backed by any Member on the opposite side of the House if they were honest about what they were saying.