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

There has been no consultation with any of those groups. I pointed out that this is a temporary arrangement for two years. A report will come to me and it will have to be checked by my Department from the point of view of patient safety, patient services and financial implications. There will be ample opportunity for all those groups to be consulted on the working of the groups as they apply over the period of two years for which they will be in trial before we go to the permanent situation of hospital trusts.

In response to Deputy Ó Caoláin, the €900 million savings that must be made next year are a combination of programme for Government commitments, increased pressure through demographics and the carry forward of the deficit. It is a challenge but it is one we will meet. Regarding the 3,200 staff, or 6,400 over two years, these are proposals from the Department of Public Expenditure and Reform. We are still in negotiation with that Department with regard to how they will impact on health. As I said earlier, I am focused on cutting the cost of service, not cutting the service to people who need it. I wish to maintain as much service as possible so I am looking at how to cut the cost of service.

Senator MacSharry asked about home help and increases in emergency department activity and admissions. That is highly unlikely. The figures we have are up to September-October. The issues surrounding home help and home care have only come to pass since about October, so they could not have any impact. Basically, it is due to demographics. As people get older they tend to get more illnesses and cancer. That is the reality of life. However, we hope to address that through more emphasis on prevention and well-being and more care of chronic illness in the community.

I agree with Senator Crown's comments about the rarity of maternal death in this country. However, that is no argument for delay in addressing the ABC case. This is a tragic incident that occurred in one of our hospitals and it must be investigated expeditiously for the reasons outlined, not just to remove any uncertainty for Mrs. Halappanavar's family but also to assure women, who are expecting a child and will have to use services at a hospital, that the service there is safe. The ABC case is a separate issue. The Government has commissioned a report on it from the expert group.

I will be bringing it to Government next Tuesday and I hope the Cabinet will agree to its immediate publication. There will be time for a long discussion in Dáil Éireann and Seanad Éireann, with no time limits so that everyone has the opportunity to express themselves. In the past, some of the discussions and debates were limited, with two or three minutes per contributor. This issue is too serious to allow that format but we are not holding the debate to delay proceedings. We have Friday sittings so we should use them. We should make sure everyone gets to speak on this, that all political parties have the opportunity to digest it and that the broader public has the opportunity to become engaged through access to the report.

Deputy Catherine Byrne asked about Hollybrook, which was built for the specific purpose of looking after the people from the area of Inchicore. Earlier this year, the HSE proposed to relocate current services, including staff and patients, from St. Brigid's Hospital in Crooksling as it was not compliant with the HIQA standards. This would enable the closure of St. Brigid's Hospital in Crooksling. However, having regard to the wishes of patients at St. Brigid's Hospital and the need to maximise the level of service provision in the region, the services at Crooksling will be maintained and an alternative avenue of opening the Inchicore unit is being explored. Crooksling has been modified in terms of the model of care possible after the reduction from four to three units. In light of the public sector moratorium and the significant additional reduction in staff numbers required over the coming two years, it is essential all possible approaches are considered in respect of how the unit may be opened. One option is through use of a public private partnership agreement. The model has been used successfully by the HSE to open a 100-bed unit for older persons in Ballincollig, Cork. The unit delivers real cost benefits and value to the system, which would not be possible through direct employment. I visited the unit and the patients are happy. There is a great range of services and the Chairman of this committee knows it well. It is operating at a cost of €5.2 million when the estimated cost of the HSE operating it was €7 million. The HSE is also considering the Inchicore unit in light of the recent decision to locate the new children's hospital on the St. James's Hospital site. In these circumstances, the future of the long-term care unit on the St. James's Hospital site must be considered. Many of the people in the unit are from the area and its environs. Any decision on either unit will be taken in the best interests of the existing patients in the local area. I hope that clarifies the situation.

Deputy Peter Fitzpatrick asked about private health insurance and generic drugs. The Minister of State, Deputy Alex White, apologises as he had to go to the Seanad to reply to an Adjournment matter because another Minister of State, Deputy Michael Ring, had to leave and was unable to reply to it. The generic drugs market is quite small in comparison with what it might be. Reference was made to the producers of the drugs and decreasing prices by way of agreement. Generic prescribing legislation and drug reference pricing legislation will allow us to make more savings in this regard. The more generic drugs, rather than branded drugs, that are prescribed, the greater the opportunity for cuts to occur. What saves most money is doctors not prescribing when there is little indication to do so and something is more likely to be a viral illness than a bacterial illness. On Northern Ireland television, there was a great advertisement years ago suggesting one does not need a pill for every ill. People sometimes feel they have wasted their money when they go to a doctor unless they get a prescription. People should remember one has paid for a professional opinion on health and the reassurance that brings. In any event, when free GP care comes in - and it will despite what many people believe - that issue will be easier to address. We now have a new prescribing advisory council, with six new pharmacists gone into the payment board to examine GPs prescribing, to help them be more cost-effective and to advise them if they are out of kilter with their colleagues in various areas of prescribing.

Reference was made to private health insurers and the outstanding moneys. Mr. O'Brien can respond to that. Some of it is insurance money but more of it refers to other fees due to hospitals or overnight stays. Deputy Peter Fitzpatrick also referred to reducing the attendance fee at the Louth County Hospital. Perhaps we can discuss that in a different forum. We do not want people to start heading to Louth County Hospital because it is cost free instead of going to their GPs. Some reduction may be in order but we will have to discuss the technicalities at a later date. Deputy Ó Caoláin referred to mental health.