Ciara Conway (Waterford, Labour) | Oireachtas source

I welcome the Minister and his officials. I thank him for taking the time to address the committee this morning.

The Minister mentioned that pay racks up the health bill. That is to be expected as it is a labour intensive service and I welcome that the Minister intends to protect that but he stated also that the price of inputs must be reduced. We published a document, Future Health: A Strategic Framework for the Reform of the Health Service 2012-2015. Have we provided for the way that will appear in the Estimates in terms of how services will be removed from acute hospital sectors? We know they become less expensive when they can be delivered in the community. We know also that when patients can be treated closer to their home it is more efficient but also has better health outcomes for people. How do we intend to do that because while the document is welcome, I am not sure how the Estimates will reflect the reality of that strategic document?

My second question is on the Ogden report. I welcome the Minister's statement that the Department is starting to implement some of the reforms outlined in that report because that is integral. An issue I raised previously is that the lack of an accounting system in the Health Service Executive, HSE, that differentiates between different budgets is part of the problem we are facing in terms of the overrun. We know that acute hospitals suck up services from other places yet we see that savings are being examined at the ninth hour in community services. That has been mentioned by a number of speakers.

I am sure other Deputies around the table could instance this also but regarding financial controls and accounting, local area health managers have told me they could have found the savings if they had been given adequate time but they were not given adequate time and, therefore, they had to make snap decisions, and we know that hard cases make bad law. That is evidenced in respect of the home help service in particular in which savings were sought very late in the day. People have given testimony about that. My grandmother who is 93 years of age and lives alone has lost one and a half home help hours. We know first hand what is happening in that area. We are to have a strategic approach to health and we cannot expect local area health managers to make cuts before the end of the year.