James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank the Chairman and other members of the joint committee for their invitation to attend this meeting. I am accompanied by the Minister of State, Deputy White. As the Chairman has pointed out, the Minister of State, Deputy Kathleen Lynch, could not attend because of a personal bereavement. Our sympathies are with her and also with Deputy Ciarán Lynch.

I will give my opening statement and then we can deal with any questions the committee may have. I will address the issue of the rare diseases centre, as members have requested. They have also asked for an update on the current position regarding section 38 and 39 agencies. Mr. O’Brien will address this issue is his opening statement.

As the committee is aware, I launched the White Paper on Universal Health Insurance yesterday. The White Paper underpins the Government’s resolve to deliver on the programme for Government's commitment to end the current unaffordable and unfair two-tier system and establish a single-tier health service under which access to services is based on medical need and not on ability to pay.

The Government is keen to engage with the public and stakeholders on this major policy reform of the health service. This gets to the heart of what we want from a reformed health service - accountability and transparency.

Yesterday’s launch of the White Paper is the beginning of a national conversation about UHI and the future of our health services. The Government is keen that this committee will be instrumental in enabling that national conversation to take place. I noted certain concerns in this regard in the Chairman's opening remarks. I want to make it quite clear that the Government would like to invite the committee to partake in this debate. The Government is equally clear, however, that this committee makes its own decisions and if it chooses not to partake in that conversation, that is entirely a matter for the committee. Personally, I think that would be a sad outcome because, under the Chairman's stewardship, this committee has proven to be extremely helpful and informative. The committee has also been calming in its tone previously concerning sensitive national issues, particularly with regard to the Protection of Life during Pregnancy Bill.

At the launch yesterday, we started a formal public consultation process. I would encourage everyone to engage in that consultation, and the easiest way to do so is through our website. The process is open for the next eight weeks to the end of May.

We will also be consulting separately on the future health basket, including the services to be covered under UHI. As important as it is to decide what will be in the basket, it is the value framework that underpins those decisions. Under UHI, everyone will be insured and will have equal access to a standard package of services, based on need and not on ability to pay. If that goal is to be achieved, we need to involve the people in the process. This committee will be invited to conduct hearings on the values which should underpin decisions on the future health basket. I must re-emphasise, however, that it is a matter for the committee itself as to how, or whether, it will be involved in this.

In relation to the basket of services, I will be establishing an expert commission in the coming weeks. The expert commission will advise on the basket of services and will take account of the values framework. This committee may consider those costed options and the Government will then make a decision on what goes into the basket. It is important to note that the commission will be consulting with the public; it will not work in isolation. This deals with the values of transparency and accountability.

The core value of UHI is equity: no preferential access based on ability to pay, and a system of financial support to pay for or subsidise the cost of standard UHI policy premiums for those who cannot afford them. People will still be able to pay privately for services not included in the standard UHI package, or purchase supplemental health insurance cover for these. However, insurers will not be allowed to sell insurance that provides faster access to services covered in the UHI standard package of care.

I will not go into all the details of the White Paper but I do want to talk about costs. Obviously, costs are a concern for this Government, stakeholders, families and communities. As Minister for Health, I want a health service that meets people’s needs but does so efficiently. Over the last few years, we have delivered significant savings to the Exchequer in our health services and we have managed to maintain - and, indeed, improve - services. For that I wish to thank the people who work in our health service, particularly those working on the front line.

UHI is part of the overall plan to ensure we can continue to deliver efficiencies over the medium to long-term. We have generational challenges to face, such as chronic diseases, obesity, tobacco and alcohol misuse – as well as continuing to provide acute and primary care today and tomorrow for our citizens. That is why UHI is so important, not just as an end in itself but as part of a series of interlinked reforms that will deliver a health service fit for the 21st century.

That is why, along with delivering on UHI, we are delivering on the money-follows-the-patient model, which is a more cost-effective way of paying for vital health services. It is why we launched Healthy Ireland, our strategy for improving the health and well-being of people in Ireland. It is why I am so deeply committed to making Ireland tobacco-free by 2025, as set out in Tobacco Free Ireland. I want to thank the committee for its great support in this regard.

At a practical level, along with these strategic plans, the White Paper sets out a cost control framework that will ensure affordability and keep costs to a minimum. The cost control measures included range from price-monitoring of insurers and setting maximum prices for health care providers to more aggressive measures such as capping insurer overheads and profit margins.

We have a job of work to do in estimating the costs before we implement the reforms inherent in UHI. This is only right and sensible. We must take into account not just the basket of services but the demand for and utilisation of health care, service delivery models, payment systems and regulatory and administrative costs. My Department will progress work in this area during 2014 for completion in January 2015. Only then will we proceed on foot of the approval of Government to draft legislation to give effect to the reforms set out in the White Paper. The goal is to introduce UHI by 2019.

If UHI is our final destination, the term "structural reform" describes the road we must follow to that destination. We have already made good progress with new HSE governance and management structures, establishing hospital groups on an administrative basis and establishing the Child and Family Agency. The Health Service Executive (Financial Matters) Bill, which I published in December 2013, provides for the HSE to be funded through the Vote of the Office of the Minister for Health and Children from January 2015. The Bill is on Second Stage in the Dáil and I expect enactment to take place before the summer recess. We will also be establishing new and revised structures for primary, social and mental health care. This will follow on from the recent integrated service area review carried out by the HSE. The next stage is the establishment on an administrative basis of the entities that will bring in the purchaser-provider split. We already have the Healthcare Pricing Office, which is attached to the HSE, while a new shared services division is up and running also. We will be working further on the health care commissioning agency, a patient safety agency and a national entity to promote health and well-being as well as the evolution of hospital groups into trusts. We will also be putting the revised primary and social care delivery system on a statutory footing.

To reassure the committee, I note that the Healthcare Pricing Office will be independent. While it is currently operating on an administrative basis, legislation will be brought forward to underpin its absolute independence. It must be seen as independent if it is to be able to do its work. My Department is preparing legislation to set up the new structures on a statutory basis and I have put in place a high-level steering group led by the Secretary General to oversee the process. The third and final phase of structural reform will see a move to a combination of universal health insurance funding for acute hospital and certain primary care services, with general taxation funding for other services including social care services such as disability and long-term care. At that point, the Healthcare Commissioning Agency will divest some of its purchasing functions to health insurers under UHI.

I have mentioned the importance of health and well-being and, in particular, tobacco control. We are ten years on from the implementation of the workplace smoking ban, which research has found has resulted in over 3,700 fewer smoking-related deaths. This is indisputable evidence that tobacco control measures are saving lives and improving our overall health as a nation. The measures which have been put in place have worked. There has been a decline of 7.5% in the number of Irish adults smoking since the last large-scale study in 2007. Our work will continue. We are aiming for a smoking prevalence rate of less than 5% by 2025. We propose to introduce a tobacco licensing Bill to provide for a licensing system and other measures in relation to the sale of tobacco products. I was very pleased that we received approval from Government last November to proceed with a public health (standardised packaging of tobacco) Bill. I thank the committee again for its valuable contribution in that area and in advance for the assistance it will provide to me and my officials in introducing the legislation. We will not be complacent, however. We cannot afford to be in any sense. We are saving money but, more importantly, we are saving lives. We know we face the mother of all battles with the tobacco industry, which has enormous resources at its disposal. We will not be intimidated by any external entity when it comes to public health issues and, in particular, the well-being of our children.

The committee has asked that I address the issue of a national office for rare diseases. Rare diseases place a significant burden on patients and their families. The important work of developing the national plan for rare diseases continues, and the plan is close to being finalised. The policy framework relates to the prevention, detection and treatment of rare diseases based on the principles of high-quality care and equity. It will be patient-centred. The plan we implement will deal with the prevention, diagnosis and care of people with rare diseases, enhancing access to orphan drugs and technologies, responding to the needs of patients with rare diseases and their carers and research into the area of rare diseases. My Department's steering group is also considering for its report the development of a national office for rare diseases, the purpose of which would be to facilitate and support the HSE in the coordination of centres of expertise for rare diseases nationally and internationally. Such an office could act as a national point of reference on services, diagnostics, care pathways and information relating to rare diseases.

The report by my Department on recommendations for dealing with rare diseases, including the establishment of a national office, is being finalised. Departmental officials have met with the Health Service Executive to discuss the implementation of the report. In the meantime, the HSE is developing a business case on the establishment of such an office. The HSE has established a national clinical programme for rare diseases. A national clinical lead has been appointed and a programme manager is in place. The programme aims to improve and standardise patient care for individuals affected by rare diseases in Ireland by increasing detection and prevention, facilitating early and timely diagnosis, intervention and coordination of care and increasing awareness, information and support. The programme has already started to map out current services and develop care pathways for patients with rare diseases.

Many of the reforms we have introduced to date represent the building blocks for universal health insurance, which is our ultimate goal. The underlying principle will always remain that of better outcomes for patients. That is our business.