SEANAD REPORT:THE BILL to provide a new governance structure for the Health Service Executive seemed little more than a relabelling of the existing edifice, albeit with the potential for more control by the Minister, Marc MacSharry (FF) said. His party would support it with reservation, as he saw nothing in it that would provide the kind of confidence the public were entitled to in the management of our health services.

Mr MacSharry observed that among the Minister’s difficulties was the open flouting of his authority by a Minister of State. “If I was the captain of a football team and the vice captain did not express confidence in me, they’d be gone,” he said. Asking what budget had been earmarked for the changes, he said he dreaded to think of the cost of changing the names of various personnel on office doors.

Minister James Reilly said a directorate would replace the HSE board structure established eight years ago. The HSE would continue to have operational responsibility for the running of the health service, but new parameters were being set out for it. The directorate would be accountable to the Minister for the performance of the HSE’s functions.

The Minister said those who failed to keep outpatient appointments could face a charge of up to €20 to make a new appointment.

John Crown (Ind) said the Minister continued to enjoy his confidence in doing the difficult job he had inherited, but he was worried Dr Reilly might be “captured by the bureaucracy. Twenty years ago, I came back to work in a system that was bureaucratised, centralised, undemocratic and corporatised. Regretfully, I still do.”

Marie Moloney (Lab) said she was greatly worried about the remarks of Prof Crown, that people in the system were muzzled when they tried to highlight deficiencies and inefficiencies in the system. Dr Reilly said he did not want to preside over a system where anyone was afraid to speak out. He would encourage health personnel to do so.