Legislation to replace health boards with a new Health Service Executive will provide the "most comprehensive reorganisation of our health services since 1970", the Tánaiste and Minister for Health, Ms Harney, told the Dáil.
The Health Bill was a "historic piece of legislation", and such reform was a "once-in-a-generation event". She said it was "our generation's chance to put patients first in the design of the management of health services". However, Fine Gael's spokesman, Dr Liam Twomey, warned that the new HSE could turn into "an unaccountable statutory agency like the National Roads Authority".
He said there could be less accountability from January 1st for the people who used the service. "There is nothing that specifically shows that the HSE is really answerable to anybody other than itself."
Labour's spokeswoman, Ms Liz McManus, condemned the speed with which the Bill was being pushed through, and said the Minister was "trampling on every safeguard" expected of a parliament. She said it was a "major legal instrument that will result in a new configuration of administration of our health service" and worthy of "full public scrutiny", but by forcing through a debate without any period for reflection or consultation, Ms Harney was "treating this House with disdain and the people that we represent with contempt".
Sinn Féin's health spokesman, Mr CaoimhghíÓ Caoláin, described the Bill as "the wrong remedy for the wrong illness". It removed "democratic accountability and concentrated energy on bureaucratic change rather than on delivering for patients and real reform".
Introducing the Bill, Ms Harney said that Government policy should be judged on better outcomes for patients and better value for taxpayers' money.
She warned that there was "no going back" and "we have to bring sense to the patchwork of amendments we have made to health legislation over the years and to the growth of separate health agencies".
She added: "We do not need 273 people on separate health boards, in addition to 166 members of the Dáil and 60 senators, to manage and account for public health spending. We do not need over 58 separate health agencies."
She stressed there would be "many more reforms ahead" in the delivery of and payment for health services, in the payment for and use of drugs and with the response to people's needs.
To achieve the Government's policy of better outcomes and better value "we badly need clarity of roles and accountability" - political responsibility for the Minister and management responsibility for the management. She said the lines of responsibility and accountability were clear in the new legislation.
She added: "And I believe that will make a real difference to the quality of health services provided for our people."
The legislation aimed to "implement a single unified health service" and to "use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public".
She said the chief executive would be accountable for the appropriation account and for the vote of the executive. She said "this is a very strong form of accountability for public funds and will give much greater clarity than before, as to where responsibility for the management of public funds lies".
The debate continues today.
