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

There ought to be a quid pro quo and mutual respect on the part of the system and patient. The patient should be respected by the system delivering the care, but the patient should respect the fact that the system must deliver to others also and that if one abuses it, others suffer.

With regard to the average cost of the GP service, €51, one should note that it is €22 in France. This is somewhat a case of apples and oranges because there are many other supports in France that do not exist here. We will address this. I take on board fully the idea that we can address the issue of primary care and make it affordable for people by not having them worry about whether they can pay their electricity bill or take a sick child to the doctor.

A number of members, including Deputy Healy, asked me when the Supplementary Estimate will appear. The bottom line is that we have not finalised the figure we will require, but I believe it will come in under 2%. That would be a pretty good achievement given that there have been quite large supplementary budgets in the area of health at times when budgets were increasing. I do not want to become overly political about this. We are operating in a time in which budgets and staff numbers have been diminishing, yet we have managed. I compliment the men and women of the health service on managing to improve it through reducing inpatient waiting times and the number of people who must lie on trolleys.

In a general way, I wish to emphasise again to Deputy Ó Caoláin something I believe to be of critical importance, namely, this continual overemphasis on inputs, that is, on how much money or how many doctors or nurses. The focus and entire discussion must be on outcomes for patients and I have made the point to all doctors, nurses, administrators and others that if one keeps one's focus on the patient and the outcome for the patient, one will not go too far wrong. It does not matter how eloquently delivered or elegantly designed something is, as unless it improves patient outcomes, it is for nothing and is useless to us.

I always am happy to listen and I acknowledge members have concerns. As for the home help and home care situation, I am aware there always are individual hard cases that fall through the net and which we must try to address through this sort of forum and through other fora. In this instance, so many Oireachtas Members approached me with so many cases that on investigation, I found the process we had envisaged was not being followed and people were not being assessed fully before having had a service taken away. Moreover, people were having messages left on their voicemail, which is utterly unacceptable. I sent a letter to the HSE in which I agreed with the executive that from henceforth, no hours would be taken away without full assessment and there would be no voicemails. Moreover, there will be a clear mechanism for reviews and a senior manager to review monitoring arrangements, as well as a senior official for each integrated service area, ISA, to deal with Oireachtas inquiries and I hope this has happened. The letter also provided for standardised guidelines for the provision of home help, as well as clear definition of what constitutes home help versus home care because in one area, home help may be the same as home care, while in another home help and home care are two separate things. I accept this was not done in the manner in which it should have been done. Moreover, I accept that what I now have asked to be done will slow down the process considerably and the type of money that was envisaged to be saved may not be saved. However, I am more interested in ensuring that people who have been assessed as needing a service have that service than in saving money, even though I have an obligation to do that.