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The Dáil is currently on its summer break, but its committees will be back meeting from the first week of September. On their return, health, unlike other areas of policy, will have not one, but two committees meeting to discuss the challenges facing the sector.
The long-established Joint Oireachtas Committee on Health has been joined by the recently-formed Committee on the Future of Healthcare, which is an all-party body charged with the considerable task of agreeing a 10-year vision for the country’s health service.
However, some observers have raised concerns over the possibility of duplication in the work of these committees. Others have been critical that the Committee on the Future of Healthcare has only TDs in its membership, and thus risks becoming merely a political ‘talking shop’.
It may be a reflection of the tumultuous few months in Irish politics since the February election, that one week prior to the recess last month, Seanad members for the Committee on Health had still to be named.
Because of this late addition of Senators to the Committee, members did not have much opportunity before the Dáil summer recess to set out a detailed work agenda for when it returns in September.
“But there are a number of set pieces that the Committee engages in,” the new Chair of the Committee Dr Michael Harty told the Medical Independent (MI).
The Co Clare GP was elected as an Independent TD at the last election, and he believes that the Committee can have a real impact on health debates in the coming months and years.
“The HSE and the Department of Health are invited in every quarter to review the situation in relation to the health service. So there are set pieces like that, as well as other ones such as the bills that come before the committee for discussion.”
The Misuse of Drugs Amendment Bill was the first piece of legislation that the Dáil members of the Committee discussed on 14 July.
“We then have the freedom to choose projects or topics that we will then examine in detail,” says Dr Harty.
“If you look at the work of the previous Committee, which went on for five years, they went through a substantial number of topics.”
Fine Gael Senator Jerry Buttimer, who was the last Chair of the Joint Oireachtas Committee on Health under the previous Government, says that the Committee should continue to play an important role, even with the formation of the new Committee on the Future of Healthcare.
“I think the central Committee had a very critical role,” he told MI.
“I think the important point is that this Committee [continues] in its on-going work in health and that should not be diluted or undermined. “
Dr Michael Harty TD (Independent)
As one of the few members of the current Oireachtas who is a doctor, does Dr Harty believe that his medical background will provide him with any unique perspective as Committee Chair?
“Yes, I think having a knowledge of medicine, and how the health service works, can have an influence on the type of topics and depths to which we can look into it,” says Dr Harty.
“So yes, it can have an influence. At the same time, the Chairman does need to be impartial and not to take one side or the other. But I do think we can try and examine areas that are most critical to the health service and choose those as needs arise.
“We don’t want to just be a reactionary committee, which is reacting to day-to-day crises in the health service, although obviously we do have to do that as well. But I think we have to take a broader approach and examine areas of development in the health service.”
Although a detailed description of the upcoming work schedule has not been finalised, Sinn Féin Spokesperson on Health Deputy Louise O’Reilly told MI that she believes the issue of abortion will be to the forefront of the work the Committee will do in the coming months.
“We will have to deal with the issues raised by the UN Judgment in the Mellet case,” said Deputy O’Reilly, who is a first-time TD and a member of the Joint Oireachtas Committee on Health. Recently, the UN Human Rights Committee (UNHRC) made a ruling in the case taken against Ireland by Ms Amanda Mellet.
However, Deputy O’Reilly said that the focus of the Committee would also go beyond this and into other public health topics.
“We will also need to address the public health issues of alcohol and to provide for a ‘plan B’ in the event that minimum unit pricing is challenged or delayed for any reason. The need to legislate for this serious public health issue is pressing,” she added.
“The Health (Miscellaneous Provisions) Bill 2016 will also come before us and this is likely to be a wide-ranging, comprehensive piece of legislation which will require detailed scrutiny at the committee.”
Two’s a crowd? The need to avoid duplication
The Committee on the Future of Healthcare is the ‘new kid on the block’ and Minister Harris has emphasised his belief that it has an important role to play in the long-term formation of health policy. However, there have been concerns voiced over the new Committee, as to whether it will needlessly duplicate the work of the already existing Committee on Health, or perhaps become a political ‘talking-shop’.
When the Committee on the Future of Healthcare held its first meeting on 23 June, the Chair, Deputy Shortall, spoke to these concerns.
“We must be careful not to overlap with the Oireachtas Joint Committee on Health, of which Deputy Harty is Chairperson,” said Deputy Shortall.
“As many of us know from past experience, that Committee, which deals with legislation and day-to-day activities in the health service, has a clear oversight role in respect of the different agencies in the health service and receives many representations.
“The work of our Committee is to take a step back, examine the system and take a more strategic approach to the current model and the type of model we wish to achieve for the delivery of a modern, reformed and inclusive universal health service.
“We must be mindful of that to ensure there is no overlap with the joint committee.”
Sinn Fein’s Deputy Louise O’Reilly, who is a member of the Committee on Health, told MI that she is also hopeful that members of both committees can prevent any duplication in the work that they do.
“All members of both committees need to be careful that this does not happen — I think that the focus of the committees will be different and we should be able to keep them separate,” she said.
Dr Harty said that he is conscious of the possibility of the two committees having some crossover in their work. However, he believes that the membership of the committees should prevent this from becoming a problem.
“Yes, there is a second committee sitting, where the 10-year vision is being discussed. I am a member of that [as well],” said Dr Harty.
“That is looking at the broader picture. So perhaps we can look at some areas that feed into that.
“That is a possible conflict. But there are members of the 10-year vision for change committee who are also members of the Health Committee. So I think we will have sufficient numbers there to alert us to any duplication.
“But yes, it is something that we would like to avoid and I think we will, given that there is some dual membership of both committees.”
Senator Buttimer also thinks that the committees “can keep it separate” in terms of their work.
*The Committee on the Future of Healthcare has a closing date for its formal submission process on 26 August, to be followed by a number of public hearings, including evidence from health experts. The Committee’s interim report was published on 4 August. Log on to www.oireachtas.ie/parliament to find out more about the process.
This Government will be different for the Committee on Health because it has been joined by a committee tasked with drawing up a long-term plan for health.
In early June, the Dáil agreed to establish the Committee on the Future of Healthcare (see panel on p14) to achieve cross-party consensus on a single long-term vision for healthcare and the direction of health policy in Ireland, and to make recommendations to the Dáil in that regard.
The Committee is required by legislation to present a final report to the Dáil within six months of its initial meeting. The Committee is wholly comprised of TDs and this is built into the motion that created it.
“The Committee membership shall be made up of three members appointed by Fine Gael, three members by Fianna Fáil, two members by Sinn Féin, one member by the Labour Party and five members representing the Independent deputies and members from other political parties,” reads the motion.
The move to establish this new Committee was one of Minister for Health Simon Harris’s first acts as Minister.
“One of the key proposals in the Programme for Government is the establishment of an Oireachtas Committee to develop cross-party consensus on the future of the health service,” he said in May when the Cabinet approved the establishment of the Committee.
“I believe the health service would benefit enormously from a single unifying vision that we can all get behind, and that can help to drive reform and development of the system over the next 10 years.”
Some opposition and Government politicians are concerned that the new Committee is too political and could duplicate the work of the established Health Committee.
“The first thing is that we need to plan for the future of health,” said Senator Buttimer, adding that his party colleague Minister Harris is right to look towards creating a 10-year plan for health.
However, he thinks that the Committee would be more effective if it had been established on less political lines, with an independent Chair and health stakeholders sitting around the table, rather than just political party representatives. This is what he called a more “social partnership model”.
“I would mean something where we bring everybody into the table as co-equals and build a social partnership consensus approach to the emerging needs and putting together a vision and ambition for the future health needs of the country,” he said.
“The thing I feel most strongly about is that I think the model that should have been employed is the social partnership model.
“I think emerging from that then, you have got a road map, rather than people coming in or invited in to make submissions. I would rather have had that sort of model.”
The Committee on the Future of Healthcare met on Wednesday, 20 July, and heard from representatives of Health Reform Alliance, the Irish Heart Foundation, Age Action and the Irish Cancer Society.
On making a public call for submissions to the new Committee last month, Committee Chair Deputy Roisin Shortall (Social Democrats) did not underestimate the significant challenge in finding some type of political consensus on health.
“We understand that there are differing perspectives on how best to address the complex issue of devising a long-term strategy for healthcare in this country and for that reason, we wish to hear from and engage with the public on the matter,” she said.
“To assist in preparing its report, the Committee is seeking written evidence from interested representative bodies, individuals and groupings. The remit of the Committee is to achieve cross-party consensus on a 10-year strategy for healthcare and health policy in Ireland, and to make recommendations on a changed model of healthcare, with the objective of a universal, single-tier health service.”
The scale of this challenge is made all the clearer when one looks at the membership of the Committee. For instance, will TDs from the political left such as Deputy Mick Barry (AAA-PBP), Deputy Pat Buckley (Sinn Féin) and Deputy Joan Collins (Independents4Change), be able to agree a long-term strategy for the health service with representatives of Fianna Fáil and Fine Gael?
Concerns over the lack of Senators on the Committee have been raised by some, including members of Fine Gael. The party’s Seanad Spokesperson on Health Senator Colm Burke has called for Seanad representation on the Committee, while Deputy Buttimer agrees.
“It is critically important,” Senator Buttimer told MI.
“I think it sets the wrong precedent, not to have Senators on it. It is a committee about future health that should encompass all parties in the house, of both Houses of the Oireachtas.
“I think the 10-year strategy needs to have a senatorial appointment to it.”
Fianna Fáil Senator and Mayo GP Dr Keith Swanick agrees. “I think it’s regrettable,” he told MI.
“I think it would be nice to be more inclusive.”
Dr Swanick is one of Fianna Fáil’s Seanad picks for the Committee on Health.
But Dr Swanick said someone like himself with a background in medicine and also with his work as former Secretary of the NAGP “would have something to offer that Committee [Committee on the Future of Healthcare]”.
MI understands there are no plans to bring Senators onto the Committee but it will have “structured engagement” with Senators.
Senator Buttimer also expressed some wider concerns about how the new Committee on the Future of Healthcare would fulfill its role.
“But who is going to monitor the implementation of the 10-year plan?” he asked.
“Is it going to the strategic committee or is it going to be the central committee of the House of the Oireachtas? I would have thought that perhaps the 10-year strategy should possibly have been chaired by someone not involved in politics.
“But in saying that, there is a need for a 10-year strategy; the Minister is right to have that.
“What we can’t have is a talking shop. But who monitors the result and the output? Who monitors the key aims of a 10-year strategy?”
Deputy Louise O’Reilly, Sinn Fein
Looking back at his time as Chair of the Committee on Health during the last Dáil, Senator Buttimer says he thinks the work that they did showed the potential positive role the Committee under Dr Harty can continue to fulfill.
“I think the last Health Committee pioneered the whole issue around pre-legislative scrutiny of legislation, be it plain packaging, be it the Public Health Alcohol Bill,” he said.
“Secondly, I think we showed we could handle in a sensitive and mature way sensitive social issues, and thirdly we were able to bring in witnesses and people and hold them to account, but not in an excessively adversarial manner. So I think we had a lot of success.”
In terms of future work for both health committees, Senator Buttimer says that a more collaborative approach is needed.
“I think what we need now is a collaborative approach around budgeting and more accountability perhaps around the HSE, in terms of how they interact with the different sectors of health,” he said.
“And I would just be worried that we do not create a talking shop, where nothing is achieved as a consequence of putting together this committee [Committee on the Future of Healthcare].”
Dr Harty is convinced that the unique make-up of the new Dáil should mean that its committees in general will have a greater role to play.
“I think the role of committees is going to be more important and the reason for that is, in the previous Dáil, the Government had a majority in every committee and there was little or no all-party debate,” said Dr Harty.
“But in the new Dáil, because of the way it has been set up with Dáil reform, each committee is reflective of the proportionality within the Dáil. So if something is discussed and agreed at committee, it is probably going to take that little longer, because there will be more discussion.
“But when it is agreed in the committee, it should most likely be agreed on the floor of the Dáil because the committee will reflect the proportionality that is in the Dáil.
“So meetings may go on for longer and take a little longer to agree on matters but once agreed, I think they will be on a much stronger footing.”
Committee on Health — membership
Chair: Dr Michael Harty
Bernard Durkan (Fine Gael)
Michael Harty (Rural Independent Group)
Billy Kelleher & (Fianna Fáil)
Alan Kelly (Labour)
Kate O’Connell (Fine Gael)
O’Mahony (Fianna Fáil)
Louise O’Reilly (Sinn Féin)
Colm Burke (Fine Gael)
John Dolan (Civil Engagement Technical Group)
Rónán Mullen (Independent)
Dr Keith Swanick (Fianna Fáil)
Committee on the Future of Healthcare — membership
Chair: Roisin Shortall
Mick Barry & (Anti-Austerity Alliance —
& & People Before Profit)
John Brassil (Fianna Fáil)
James Browne & (Fianna Fáil)
Pat Buckley (Sinn Féin)
Joan Collins & (Independents 4 Change)
Jim Daly (Fine Gael)
Dr Michael Harty (Rural Independent Group)
Billy Kelleher (Fianna Fáil)
Alan Kelly Labour)
Josepha Madigan (Fine Gael)
Hildegarde Naughton (Fine Gael)
Kate O’Connell (Fine Gael)
Louise O’Reilly (Sinn Féin)
Roisin Shortall (Social Democrats/Green
Party Technical Group)