I move: "That the Bill be now read a Second Time." I am pleased to introduce the Health (Amendment) Bill 2025, by means of which it is intended to enhance the oversight and accountability of the Health Service Executive to both the Minister for Health and the Minister for Children, Disability and Equality. The Bill addresses a number of goals arising from the Sláintecare implementation plan, which highlighted the need to shift away from the previous directorate structure of the HSE towards an independent board overseeing a chief executive officer. The HSE board was established through the Health Service Executive (Governance) Act 2019 and has been in operation since then. Given the implementation of the HSE health regions and the accompanying changes to the governance and structure of the executive, this is an opportune time to introduce these amending provisions and strengthen the oversight relationship between the Department of Health and the HSE. The provisions in the Bill will ultimately enhance the governance of the HSE, the relationship between the executive and the Government and subsequently improve the standard of care offered to those who make use of its services. Since the foundation of the HSE board, the Department of Health has extensively consulted with the HSE and, more recently, with the Department of Children, Disability and Equality to develop robust and effective governance, oversight and accountability structures and processes. The structures and processes are guided by the founding legislation of the HSE, the executive's code of governance, the separate but complementary oversight agreements between the two Departments and the HSE, and the code of practice for the governance of State bodies of the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation. The Bill's provisions will build upon these structures and processes to further enhance the HSE's accountability while retaining the independence and autonomy of the HSE board. The purpose of the Bill is to ensure a more formal alignment of HSE and Government planning processes and to introduce more robust financial oversight measures, particularly in regard to any expenditure that exceeds the maximum amount allocated in the annual letters of determination issued by both the Department of Health and the Department of Children, Disability and Equality. This is achieved through the introduction of a number of new measures. The Bill introduces an obligation on the Minister for Health to prepare a strategic direction statement in respect of health service priorities to guide the HSE in the preparation of its three-year corporate plan. The statement will specify the Department's priorities for the three-year period in question and may also specify particular goals or outcomes related to those priorities. The statement will be prepared in consultation with the Minister for Children, Disability and Equality. Similarly, the latter will have an obligation to prepare a strategic direction statement in respect of specialist community-based disability service priorities. These statements will issue to the HSE simultaneously no later than three months before the expiry of the corporate plan in operation at the time. The statements can be amended at any time throughout the three-year period if and as necessary. The Bill provides for the replacement of the national service plan with a performance delivery plan. It places an obligation on the Minister for Health to issue an annual statement of health service priorities to the HSE. The statement will guide the executive in the preparation of the performance delivery plan and will contain priorities that are consistent with the contents of the strategic direction statements in operation at the time. The annual statement of health service priorities will be prepared in consultation with the Minister for Children, Disability and Equality. The latter will prepare a similar statement of priorities for specialist community-based disability services, to issue simultaneously and at a date no later than the issuing of the annual letter of determination from each Minister. The statements can be amended by either Minister in consultation with the other. The Bill places an obligation on the chief executive officer of the HSE to notify in writing the executive's board, the Minister for Health and the Minister for Children, Disability and Equality if the CEO forms the opinion that the HSE is likely to exceed its allocated expenditure for any given year. When doing so, the CEO will be required to submit corrective action proposals for the approval of the HSE board. These proposals must outline the reasons for the projected overspend and the actions taken to attempt to avoid it. The proposals must be in line with the strategic direction statement and statement of priorities at the time. Either Minister may request that the HSE amend the proposals if they are deemed to be inconsistent with the strategic priorities or corporate plan in operation at the time or do not have sufficient regard to Government circulars or priorities. The Bill makes a number of miscellaneous amendments that are required by outlying changes or to address practicalities arising from other provisions. These include, for example, the extension to 28 days of the 21-day deadline for the submission of the HSE performance delivery plan and the HSE capital plan to the Departments of Health and Children, Disability and Equality. A number of provisions correct references to sections of the Health Act 2004 that are being amended, removed or substituted by the Bill. The Bill also makes an unrelated amendment to the National Cancer Registry Ireland, NCRI, establishment order, which seeks to increase the membership of the board and amend the quorum arrangements accordingly. This addresses a recommendation in the Scally report to review the composition of the board of the NCRI. I will now outline the provisions of the Bill section by section to clarify its content. The Bill comprises 28 sections. Section 1 is a standard provision giving the Title of the Bill and when it will come into effect. Section 2 defines the Health Act 2004 as the principal Act referred to in the Bill. Section 3 repeals sections 10A and 10D of the principal Act, which relate to the setting of priorities for the HSE by the Ministers for Health and children. The proposed new process for the setting of priorities is outlined in sections 17 and 18 of the Bill. Section 4 inserts a definition for an approved performance delivery plan, which is to take the place of the definition for an approved service plan contained in the principal Act. Section 5 amends the object and functions of the HSE to include a specific and explicit obligation to have regard to Government circulars related to expenditure as well as other relevant documents in the performance of its functions. Section 6 updates a reference to the service plan to refer instead to the performance delivery plan being introduced in the Bill. Section 7 amends the principal Act to account for the repeal of section 10A. Specification of priorities and performance targets to the HSE by the Minister for Health, which is currently facilitated under section 10A, will instead be provided for in section 17 of the Bill. Section 8 updates a reference to the service plan to instead refer to the performance delivery plan being introduced in the Bill. Section 9 amends the principal Act to account for the repeal of section 10D. Specification of priorities and performance targets to the HSE by the Minister for Children, Disability and Equality, which is currently facilitated under section 10D, will now be provided for in section 18 of the Bill. Section 10 amends the functions of the HSE board to include an explicit obligation to ensure systems are in place to provide assurance the HSE is achieving the highest standards of budgetary management and value for money and is operating within authorised resources. It also requires the board to ensure compliance with Government circulars related to expenditure as well as Government policies, codes, guidelines and other relevant documents. Section 11 similarly amends the functions of the chief executive officer to include the same provisions as those in section 10. Section 12 inserts definitions for each of the new strategic direction statements and removes the definition of an approved service plan. Section 13 inserts a number of provisions outlining the obligations of the Minister for Health regarding the strategic direction statement in respect of health service priorities. These provisions include instructions on the content of the statement, the time of issue and the amendment process. The statement must be issued in consultation with the Minister for Children, Disability and Equality. Section 14 similarly outlines the obligations on the latter in regard to the strategic direction statement in respect of specialist community-based disability services. Section 15 outlines the new obligations of both the HSE and the Government regarding the preparation, content, submission and approval of the HSE corporate plan. The section requires the plan to be prepared within three months of receipt of the strategic direction statements and in a manner consistent with the priorities of the Departments of Health and Children, Disability and Equality. Section 16 corrects a reference to a provision that is repealed by the Bill. The section updates the reference to account for the new structure of section 29 of the principal Act. Section 17 outlines the obligations of the Ministers for Health and Children, Disability and Equality and the HSE in regard to the annual statement of health service priorities that will guide the executive in the preparation of the performance delivery plan. It also details the contents of the statement deadlines for issue, the amendment process and other relevant considerations. Section 18 similarly outlines the obligations of both Ministers and the HSE in relation to the annual statement of priorities for specialist community-based disability services.
Sentiment score: 0.16
We can do that. I might speak to the Deputy about that matter again. Section 19 details the obligations of the Minister for Health, the Minister for Children, Disability and Equality, Deputy Foley, and the HSE in relation to the performance delivery plan, which will replace the service plan. The section also outlines the requirements for the preparation, timeline for submission and content and approval of the plan. Section 20 outlines the processes for amending an approved performance delivery plan. Either Minister, after consultation with the other, can issue a direction to the HSE to amend an approved plan and can specify the manner in which it is to be amended. The amended plan must adhere to the same requirements as the initially approved plan. Section 21 deals with the implementation of an approved performance delivery plan. The HSE is required to deliver services in line with the approved plan and to ensure that the expenditure incurred for the period relating to the plan does not exceed the authorised amount. Section 22 increases the deadline for submission of the HSE capital plan to the Department of Health and the Department of Children, Disability and Equality from 21 to 28 days. Section 23 introduces corrective action proposals and outlines the obligations of the HSE, the Minister for Health and the Minister for Children, Disability and Equality in the preparation, approval and implementation of these proposals. The proposals are to be developed by the CEO and approved by the HSE board. Section 24 outlines the process for amending corrective action proposals. Either Minister, after consultation with the other, can issue a direction to the HSE to amend the proposals and can specify the manner in which they are to be amended. This direction includes a timeline for the submission of amended proposals. Sections 25 to 27, inclusive, update references to the service plan in order that it will be referred to as the performance delivery plan, as introduced under the Bill. Section 28 amends the National Cancer Registry Board (Establishment) Order 1991 by increasing the membership of the board to ten members and adjusting the quorum to account for this change. The purpose of the Bill is clear. It builds upon the foundations of the Health Act 2004 and the Health Service Executive (Governance) Act 2019 to further enhance the governance, oversight and accountability of the HSE. Through the introduction of strategic direction statements and annual statements of priorities, this Bill represents an opportunity to more formally align the planning processes of the HSE with those of the Government. The introduction of corrective action proposals means a shift towards a solutions-based approach to potential overspends and allows for early intervention with the full approval of the HSE board. Importantly, this Bill also ensures that the HSE board will retain its independence and autonomy while simultaneously ensuring sufficient oversight alignment with the priorities with the Departments of Health and Children, Disability and Equality. Ultimately, the Bill represents an improvement in governance and oversight of the executive through which an improved quality of care for the nation's citizens can be achieved. I look forward to Members' contributions and welcome the opportunity to engage in productive discussions on its provisions. I commend the Bill to the House.
Sentiment score: 0.28
I will reflect on it.
Sentiment score: 0.00
I will certainly give a copy to the Clerk. I made available copies of prepared notes last night which I expressly said I would not depend on, but they were quoted back to me. I need to reflect on how I provide information. This is a technical Bill. That is one thing. I can certainly do that. At the same time, however, this is a matter arising from what happened last night. We can manage it separately.
Sentiment score: 0.10
As long as that is done accurately.
Sentiment score: 0.00
That is a different matter, and it is the matter at hand.
Sentiment score: 0.53
There is no need. I am not required to do so.
Sentiment score: -0.15
I agree.
Sentiment score: 0.36
It is both.
Sentiment score: 0.00
We should have it.
Sentiment score: 0.00
There is a 32% increase in Mayo.
Sentiment score: 0.32
There is a 32% increase.
Sentiment score: 0.32
You are right.
Sentiment score: 0.00
It is not on my desk.
Sentiment score: 0.00
Deputy Healy-Rae has helpfully set out the difficulty with regard to hospital beds. Let us take Kerry hospital as an example. In the context of staff numbers, in the past five years, Kerry hospital has had an increase in staff of 43%. It has had a budgetary increase of 67% in the past five years also. To provide the breakdown of that staffing increase, Kerry hospital has had a 52% increase in medical staff; a 44% increase in nursing and midwifery staff; a 74% in patient and client care staff, who are the support staff; and a 43% increase in health and social care staff. Those are significant numbers. Kerry hospital is perplexing me at the moment. In May, it was one of the best performers in hospital trolley management, which is a big issue in Kerry hospital because it has been historically poor in that regard. In May, there were 13 days on which there were zero patients on trolleys in Kerry hospital. There were three days on which one patient was on a trolley. May was, therefore, a good month. It shows there was bed capacity and management of the hospital in the round. The considerable extra staff meant there was good management of the emergency department. Something happened in June, however, and the figures were the complete opposite. This is the nuance of hospital-by-hospital level experience. The Deputy set out exactly why this is so important. It is about the dignity and safety of patients who should not be waiting for 24 hours. They should not be waiting for more than six hours. Of those people who present, only 25% of them need to be admitted and managed in other pathways. This is only one particular example that happens to relate to Kerry because Deputy Healy-Rae was the last speaker. I could equally speak about Cork and the figures for that area. Although Deputy Healy-Rae was not in the Chamber when I was pulling the information together, with regard to Wexford, the constituency of the Ceann Comhairle, staffing numbers have increased by 21% over the past five years. There has been a 22% increase in medical staff and a 33% increase in nursing and midwifery staff. Wexford hospital is performing extraordinarily well with a much smaller increase in resources. It has low hospital trolley figures. Its culture is one of whole-of-hospital management. It is doing really well. It certainly needs more investment and support, but it is performing extremely well. I pulled the figures out for Waterford as Deputy Cullinane was present a minute ago. Waterford hospital has an average of zero people on hospital trolleys in 2024 and 2025. It has also had a 44% increase in staff, but with a different outcome compared to Kerry hospital. If I take St. Vincent’s University Hospital, which is the closest model 4 hospital to me, it has had a 35% increase in staff and a 59% increase in budget. Yet, it has an inconsistent performance in its accident and emergency department and its management of delayed transfers of care. All of these particular local nuances matter. The Mater hospital, which I visited last week, has been good enough on its accident and emergency management. It is the rest of the hospital’s responsibility to support the accident and emergency department. A couple of weeks ago, however, it was one of the hospitals on a list of hospitals that were in considerable difficulties. It had closed the Smithfield injury unit for the bank holiday weekend, which it has been paid to operate under the service level agreement. These are inconsistencies which are not acceptable and which we cannot stand over but they speak to the level of detail and nuance that is necessary to understand the complexity of health budgeting and how that is being translated to patient care on an individual basis. While I appreciate this Bill does not transform the world, it does a couple of really important things that we need to happen. That includes in particular the corrective action plans, CAPs, that are necessary. The CEOs are now required to notify me or the Minister for Health of the overspend and to identify the detail of what caused the overspend and how it is proposed to avoid the overspend. The board can then review that, amend or approve proposals, agree on the cause, and agree on the actions that will eliminate or reduce overspend which it believes are practicable. None of that applies at present. There is a different level of detail in managing spend and overspend. It should not be the case that there are threats or assertions that a body cannot pay its pharmaceutical bill or its revenue bill and must close beds because all of those things are completely unacceptable, outrageous responses to a failure to manage a budget. In circumstances where bills for external consultants or legal advices outside of the State structure are still being paid or where, for example, there has not been evidence of non-pay savings over a three-year period, it is a bit like taking a dead cat and saying "Now, Minister, give me a big pile of money or else." We have to be serious about hospital management and about money being spent in a consistent and predictable way. We have to do that collectively and identify the instances where that is not happening. There is unfortunately too much variance between hospitals and in how we think money should be spent. The budget has increased. In 2013, the health budget was €13.5 billion. It is now €25.8 billion. In a ten-year period, we have essentially doubled the health spend. We as a State cannot do that again. There was significant and necessary investment. We historically underinvested in health, particularly on the capital side. I thank every Deputy who has made the case for a large envelope to be given to the Department of Health and the HSE in the review framework, recognising the difficulty of managing that process overall, because of course all hospitals need water and energy security. Those things are also important but there needs to be significant capital investment. I appreciate the recognition of that. We cannot continue to grow the current budget the way it has been growing. We have invested in people and hospitals. We must get the return for that investment. It is not acceptable for a hospital to make the case for an additional CT machine or any other diagnostic equipment in circumstances where that CT machine is not being used for all of the hours that Deputies and I expect it to be used. It is not acceptable to have CT machines or other diagnostic equipment which is not being used beyond 4.30 p.m., as is the case in some hospitals. I go in and ask what time the CT machine runs until and I am told it is maybe 8 p.m., maybe 5 p.m. or maybe 4.30 p.m. That is not okay and it is not okay for the State to be required, or have pressure placed on it, to put additional CT machines somewhere that one is not being used to the optimum capacity. Those are the savings and productivity necessary to deal with the sort of service we want to deliver to patients. We have, together, a significant issue to manage, and which Deputies identified, with regard to insourcing. I believe it is not correct or moral for the State to continue a system which it knows is creating a barrier to achieving productivity in the public system. I am completely committed to a public health system funded by the State and delivered for public capacity, and to having that public work done in public hospitals. I recognise that there are historical contracts that enable consultants under certain contracts to do private activity in certain spheres. I recognise that that is so. On the other hand, I also see that 65% of consultants are now on the public-only consultant contract. We want public activity. It was the correct set of decisions to take every step possible to reduce the waiting lists because that results in people getting pain relief, elective procedures and diagnostic tests that they need. Over the next 12 or 24 months, as we decide to do this, we have a real challenge in making sure that capacity is delivered in the hospital system. I would welcome the support and help of the health committee in particular in analysing the performance of hospitals in this way and making sure that we are winding down a structure we know is legitimate and lawful but is not what we want and not what we believe is the correct thing to do. I do not want to do it in a way that will cause waiting lists to spike, not because Deputies are going to correctly hold me to account for the waiting lists but because I do not want people to be in difficulties. We will have to find the right way to bring down the activity that we do not believe serves the public interest in the medium to long term, that is, third-party insourcing and so on, and to increase productivity. Both are granular challenges which will be difficult and are complex. I need Deputies' insight, help and analysis and to use all of the tools of the Oireachtas to help to analyse the nuanced performance of hospitals that I have spoken of today. Deputy Conway-Walsh referred to Mayo in particular and I am interested in Mayo because it was one of the first hospitals I visited. It had very poor hospital trolley performance over the bank holiday weekend in early February, but it has been consistently difficult. It had a significant uplift both in resources and staff, but I am concerned about its weekend management. Not to be too unfair to Mayo, but the point is that there are different nuances in every hospital and we need to be honest about this. This Bill is important because it helps to do one thing, that is, to be focused on corrective action. That is the sort of granular detail that we will need to improve financial performance in the health system.
Sentiment score: 0.13