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

I will be as quick as I can. Deputy Kelleher raised several issues which others have raised. Perhaps the committees will accept a composite reply which will save a great deal of time.

I agree, paraphrasing the old saying, that justice must not alone be done but must be seen to be done. The same can be said of this inquiry. Not only must it be independent; it must be seen to be independent, and there can be no perception of a lack of independence. It is worth spending a little time on this issue because others also raised it. This is a difficult and traumatic time for the family of the late Mrs. Savita Halappanavar. This procedure will be very difficult for them. In so far as I can, I want to accommodate their wishes. Equally, we have a duty of care to the women who use the services in this country to expedite this as quickly as possible to ensure that there are not any unsafe practices at that hospital so that there is no risk. Members have spoken about a public inquiry. A number of persons have called for that. The problem with a public inquiry is that it will certainly take much longer and the answers will be much slower to come. The changes that have taken place, as Mr. O'Brien outlined, allow for a real sense of independence here. Hopefully, we will be able to expedite this as quickly as possible. People have mentioned a timescale of three months. I hope it will be completed much quicker than that. In light of that, we can review the situation.

I must point out that there will be a coroner's court hearing as well, which is also something that takes time. It is really important that we get to the truth in a clear and transparent fashion that stands up to scrutiny, not only the scrutiny of the family of the late Mrs. Halappanavar but also that of the Irish people and of the world. That is our aim. Patient safety must always be to the fore of my conscience. I want to be able to give an assurance that the service is safe, and that is not in any way to be pejorative about the service provided at the hospital. We merely need that reassurance. We need this investigation to be independent and to be seen to be independent, and we must allow the HSE to get on with its business as quickly as possible. Everybody has the height of regard and respect for Professor Sir Arulkumaran, his bona fides and the experience he brings to this.

On the more general issue of the budget and the cost of services, I made it clear that I do not want to cut services to patients or clients who need them and who have been assessed as needing them, but I am determined to cut the cost of services. That is something we must consider, and there are many ways of approaching it. We have examined many efficiencies and we have achieved them through measures such as the clinical programmes, but there comes a point at which we must examine how things are organised in terms of rosters. I believe the new consultant agreement at the LRC is a key part of this, as consultants will now be available any five days out of seven, including in the evenings and at night. This will ensure that senior decision-makers are there so that decisions will be made more quickly and with less regard to and reliance upon tests. The leadership that is shown in this regard will continue throughout the service in other areas where rosters are concerned.

Deputy Kelleher also raised the issue of full cost recoupment for all private patients in public beds. We were quite cognisant of the fact that if we were to introduce this across the board immediately, the system would fall over. One could be looking at a €250 million cost to the insurance sector, and it just could not bear it. The figure of €75 million was always in the budget under this heading. We have more than achieved that, which allows us bring in this measure on an incremental basis.

I want to talk about why private health insurance is so costly in this country. I have instructed the new leadership of VHI, through its new chairman and CEO, to address this under four separate headings. The first of these is more robust auditing. Everybody in this room has heard anecdotal evidence of subscribers looking at the bill paid by the insurer and declaring that he or she did not have this or that done although it has been paid for. We need more robust auditing. Something that has never happened - which in my view is astonishing - is clinical auditing, in which the treating physician is challenged as to whether the treatments given and the tests carried out were necessary. That must be done. Then we must look at how the VHI is billed per day, even by the public sector. I want to change that to billing per procedure so that hospitals that are effective and efficient get their patients in on the day of procedures and home as soon as possible, as long as there is no co-morbidity that needs to be taken into consideration. Those are the hospitals that will thrive. Those which are inefficient and do not do so will not thrive. As a form of quality control, we also will be watching readmission rates. The last area to consider is what we pay consultants for the procedures they carry out. Why are we paying at the same sort of rate for procedures that used take two hours to do but with new technology now only take 20 minutes?

There are a host of areas in which we can save money and reduce costs to the consumer. It is about getting back to that principle of reducing the cost as opposed to reducing the service and focusing on the outcomes for patients, not the inputs. We are always talking about inputs; it is time to talk about outputs for the patient. It is a question of whether the outcome for the patient has improved rather than how many doctors were at the bedside at the time. From memory - I was trying to see if I could get the figures for this - private health insurance costs increased at a much greater rate over the period 2008 to 2011 than they have since.

The Deputy mentioned home help and home care services. He is quite correct. I was concerned about that last week. I had taken soundings from many TDs and Senators who hear about people's problems and there were number of issues arising. When we took the decision that this had to be done, there were certain issues with regard to the process that had to be fulfilled and I was not happy when I heard from many backbenchers that this was the case. I have made it clear to the HSE, which has taken this on board and is redoubling its efforts, that no one's hours should be taken away without a full assessment - not a desktop assessment - of his or her case. No one should be informed of a decision by voicemail; direct contact is vital. Only in exceptional situations should this be carried out by letter. It was suggested that a clear mechanism should be put in place for reviewing individual decisions. This is something that many backbenchers felt they could not get around.

How does one appeal a decision that was seen as absolutely unfair? A designated individual is to be appointed in each integrated service area with responsibility for ensuring such reviews are carried out in as timely a manner as possible and an escalation process to a senior manager will be put in place in order that cases can be properly reviewed. We have already put in place a weekly reporting arrangement to monitor reductions in home help hours and I have directed the HSE to provide more comprehensive reports every Monday. Each integrated service area will nominate a senior official to deal with Oireachtas Members' inquiries about home help and home care packages because Members were experiencing difficulties in contacting an identified person in the HSE to make their case and organise an appeal. Standardised guidelines for the provision of home help and home care packages are to be applied throughout the country. It became clear during the course of our investigation that in some areas of the country home help was, in fact, home care, whereas in others home care is clearly related to more needy cases in terms of assisting people to get dressed, wash or go to the toilet. A standard definition of what constitutes home help and home care will be agreed. Just as we faced difficulties with the fair deal scheme because people were receiving long-term care under differing criteria, even though they were supposed to be using the same assessment tools, we have to introduce uniformity across the system. That is the benefit of having a national organisation. It will slow the process down, but I am more concerned with ensuring people receive the services for which they have been assessed than with meeting our targets for budgetary savings.