James Reilly (Dublin North, Fine Gael)

The plan reflects the commitments for health in the programme for Government and the savings targets set out in the comprehensive expenditure report 2012-2014. I already acknowledged that the scale of the financial challenge facing the HSE means there will be an inevitable and unavoidable reduction in services but this will not be a straight line reduction. Approval of the plan followed extensive work undertaken by my Department and the HSE, including a rigorous examination of budget allocations across the services aimed at minimising the impact on front-line services and identifying where efficiencies can be driven.

It is clear that the targets for service delivery set out in the plan are very demanding and will not be deliverable on a business as usual basis. The plans commit the HSE to minimising the impact on services by fast-tracking new, innovative and more efficient ways of using reduced resources. It reflects the need to move to new models of care across all service areas which will treat patients at the lowest level of complexity and provide quality services at the least possible cost.

Reform initiatives set out in the plan include development of proposals to protect the viability of community nursing units and to increase the immediate care capacity for older people. I will continue to work with the Minister of State, Deputy Kathleen Lynch, on this issue.

There will be a significant strengthening of primary care services including issuing GP visit cards to long-term illness claimants. Along with the Minister of State, Deputy Shortall, I will ensure the delivery of this significant step on the road to universal health insurance, UHI, and free GP care for all. An additional €35 million will be targeted at improving child, adolescent and adult community mental health teams, as well as suicide prevention and counselling services. There will be a more tailored approach to disability services. The roll-out of the colorectal screening programme will commence. Funding for the HPV vaccine programme and an MMR catch-up programme will be prioritised. I am happy to inform the House that there has been a 80% take-up of the HPV vaccine programme, one of the best recorded. There will be a progression of the clinical care programmes including the roll-out of a national chronic disease management programme for diabetes.

The service plan will be implemented in the context of a further reduction in the number of staff available to provide services. The Government has determined that in line with its commitment to reduce the size of the public service, health sector employment numbers must be reduced to 102,100 whole-time equivalents by the end of 2012. From September 2011 to the end of February this year, some 3,700 staff members will have retired from the health service. Approximately 1,500 of these have already retired during the four months to the end of December last while the most recent data indicates that a further 2,200 will depart by the end of February. I intend to review the plan once the full impact of the staff leaving at the end of the 29 February grace period is known. As this is a dynamic plan, it will be reviewed regularly.

While the numbers leaving are indeed significant and represent a significant challenge for the health system in delivering services, we will still have in excess of 100,000 staff. We must focus our attention on how to make the most effective use of this most important resource. The priority must be to reform how health services are delivered to ensure a more productive and cost-effective system. This requires greater flexibility in work practices and rosters, as well as maximising the use of redeployment so as to facilitate the best possible organisation of services. The service plan includes a commitment to addressing these issues in the context of the public service agreement which provides the framework for delivering significant change.

This agreement, if used to its full potential, can provide the health sector with the tools to transform, modernise and minimise reductions in health services. It will allow us to reduce staff numbers, to become more efficient and productive, reduce our costs and improve quality. It is essential we achieve these goals.

The service plan represents a key signpost for how our health and social services will be delivered in the coming year. In addition to the plan, the Government has set out a major agenda of reform of our health care system which will lead to universal health insurance as promised in the programme for Government.

Last week, I hosted a national forum attended by key stakeholders from the HSE where I identified four key reform priorities for 2012. These include delivering on the special delivery unit's agenda; further overhaul of health system governance; changing the model of care, which my ministerial colleague, Deputy Shortall, will further discuss with particular reference to primary care; reforming the health insurance sector including introducing full risk equalisation; and working with the insurance companies to reduce cost. The special delivery unit, SDU, has already had a significant impact on hospital performance and is improving patient experiences in a tangible way. Last year, I identified two key priorities for the SDU and I am happy to report it has delivered on both objectives.

In the area of unscheduled care delivered in emergency departments, ED, the cumulative number of patients waiting on trolleys at 8.00 a.m. across the country for the first 16 days of January 2012 reduced by 27% when compared with the same period last year. I directed that all public hospitals ensure they had no patients waiting more than 12 months for scheduled care by the end of 2011. The National Treatment Purchase Fund reported that at the end of 2011, 41 hospitals, 95% of the total, met the target to eliminate over 12 month waiters from their active list. The only hospital that did not succeed was University College Hospital Galway. This compares to 28 hospitals at the end of 2010 that had patients waiting over 12 months for treatment on the active list.

The work of the past six months has shown that it is possible to exert control and deliver improvements even during a time of budgetary cuts. However, the improvements already won have to be secured and improved upon while simultaneously pushing forward with further initiatives. I recently announced new and ambitious targets for the SDU to deliver by the end of 2012 or earlier. The first target is that no one should wait longer than nine months for elective treatment, down from last year's target of 12 months. As would be expected there has been an uptake in waiting lists in the first few weeks of January after the Christmas break. Measures are being put in place by the SDU to ensure the 12-month limit is maintained and reduced to nine months by 31 December 2012. The other target is no one should be longer than nine hours in an ED with 95% waiting no longer than six hours. This will be a real challenge but will be meaningful for the patient. From the time a patient registers at the front desk to when he or she is discharged from the department or sent on to a ward, no one should be longer than nine hours in an ED with 95% waiting no longer than six hours. The SDU will also set and implement targets for improved access to outpatient and diagnostic services in the first quarter of 2012. Work is under way measuring the outpatient waiting list, an exercise never done before.

Notwithstanding the gains achieved so far, there is no room for complacency and delivering on these new targets will be extremely challenging. However, I have witnessed the dedication and skill of health sector employees and their satisfaction when their hard work is translated into a better service for the patient. As such, I have every confidence they can continue to push forward in the coming year. I commend them on their work to date.

In reforming health system governance, I recently announced my intention to establish seven new directorates - hospitals, primary care, social care, mental health, children, public health and shared services. Other organisational reform priorities for the year include the relocation of the national clinical care programmes and the national cancer control programme to my Department. This will help ensure even closer working with the SDU in improving performance across the system. A new programme management office will be established in the Department to drive the implementation of this wide ranging process of reform.

I will provide the House with further details of two important building blocks towards UHI which we are developing immediately. The first is my decision to organise every acute hospital into a set of hospital groups so they are managed efficiently in well co-ordinated units. Each group will have a consolidated management team headed by a group chief executive with responsibility for performance and outcomes, operating in clearly defined budgets and employment limits. This initiative will build on the groups that I have already announced in Galway and Limerick.

The second building block is the framework for the development of smaller hospitals which I announced last year and will be published shortly. The hospital groups and the framework are closely linked.

The initiative I am taking to set up hospital groups is an important one. For too long, some hospitals have tended to see themselves as operating in isolation from one another without much regard to how a co-ordinated effort between hospitals could produce better outcomes for patients. I am pleased many hospitals are now working much more closely together, recognising they need to pool skills and resources to the benefit of all patients.

Having a designated group of hospitals in each area with a group chief executive and consolidated management team will help us ensure a more efficient service which uses our limited resources to best effect. The group chief executive and management team will work closely to run the group of hospitals efficiently within the requirements of a specified budget and number of staff employed. This will help hospitals plan their services, and most importantly, it will benefit patients who are offered a more integrated service. I will make a further announcement regarding the establishment and composition of the hospital groups in the near future.

Last year, I announced the Government would publish a framework for the development of smaller hospitals. I intend to honour that commitment shortly. The purpose of the framework is to offer clear information about the role of our smaller hospitals in the future. It will demonstrate in a practical way that smaller hospitals can and will provide more services for more patients in their local community. Far from being downgraded or closed, smaller hospitals will be developed over time to provide day surgery, ambulatory care, a range of medical services and diagnostic services to their local communities. I have often made the point that much of this work is already done in larger hospitals even though it could be provided for many people closer to home in their local community. This transfer of services from larger to smaller hospitals makes sense. It brings services closer to patients and it frees up the larger hospitals to provide the more complex work that only they can provide.

The framework will be an initial blueprint setting out the main type of service change that we see happening over the coming years. It will not be a master plan drawn up centrally and delivered or imposed locally. It will form the basis for local consultation based on the principles it sets out. As we fully recognise that the best solutions will almost certainly vary between regions, there can be no question of a one size fits all approach.

Implementation of the framework will focus on nine smaller hospitals, namely, Navan, Dundalk, Loughlinstown, Mallow, Bantry, Ennis, Nenagh, St. John's Limerick and Roscommon. We have been working on draft plans for the development of each of these hospitals and these plans will form the basis for the consultation process that will take place in each area.

My Department is also working on a high level policy framework for health and well-being to cover the period from 2012 to 2020. The policy framework will be Ireland's vision for a healthier population that is protected from public health threats and lives in a healthier and more sustainable environment with increased social and economic productivity and greater social inclusion.

The theme that runs through the entire HSE service plan is reform, innovation and efficiency. The reforms that I am proposing are different from those tried before in a number of ways. I intend to oversee a reform programme that is comprehensive rather than incremental, led by innovation as opposed to dictated by resources and, most important, patient focused instead of system focused.

Last week the special delivery unit announced improvements in the number of people waiting on trolleys. Since the middle of December 27% fewer people were on trolleys compared with the same period in the previous year. Before the SDU became fully operational last September there were on average 50 more people on trolleys every day than during the previous year. We started last year with the number of people on trolleys at about 30% above the level of the previous year and we are now 30% below the previous year. That represents a considerable improvement against a backdrop of ever diminishing budgets. In improving service while reducing budgets, we are doing something that has not been done in any other western health service.

The change that I am driving is not for its own sake. It is a prerequisite to giving people a fairer health system that is more efficient and of higher quality. The reforms are working and we are now beginning to see real evidence of progress. The progress that has been made proves it is possible to drive service improvements, even during these times of financial difficulty, through flexibility, innovation and new ways of working. The improvement is real and measurable, and it is what our citizens deserve.

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