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

In my view, there is no single biggest reform as what we are doing is reforming the entire system. This is a valid and important point to make. I keep using John Donne's line, "No man is an island, entire of itself" and no part of the health system is an island entirely unto itself. If one hopes to fix the emergency department problem, one must fix what is happening elsewhere in the hospital and in respect of long-term care and home care in the community. Moreover, one must sort out primary care in the community in order that people do not end up in hospital in the first instance. This is what we are doing and we are going at it across the entire system. While it is a massive amount of reform, it is the only way to do it. In the past, it has been done incrementally but that has not worked. Moreover, if money could have solved it, it would have been solved a long time ago. I hope people get a flavour of the direction in which we are going. It really has been a huge challenge and I again thank the men and women working in the service who have taken on this challenge and who now are growing in confidence. As I have stated previously, I am more convinced than ever that we will succeed because of the new leadership that is growing, both within the service itself and at managerial level, as well as within the Department and the HSE. Consequently, I believe the budget plan this year will stack up and that is the way it is going to be done. I intend to bring the service plan to the Cabinet for its approval and to go through it in order that everyone knows precisely what it is we are talking about and what are the implications.

The changes to the HSE obviously are very important. The Deputy has mentioned directories and I note the Health Service Executive (Governance) Bill is going through the Chamber at present and will be through before the end of the session. Even if Members are obliged to sit on Fridays and Saturdays, I want to get that Bill through. Several people have mentioned core pay and that the Croke Park agreement protects this and so it does. However, there are many other aspects of creating increased productivity. One does one or two things, in that one can cut the cost of service either by cutting pay or by getting more service for that pay and I prefer the latter. However, I wish to debunk one point that is in the mind of many people. I acknowledge it also was in my mind for many years, until Dr. Martin Connor did the analysis, which is that the hospitals soak up all the money. The first point is the non-hospital budget is twice that of the hospitals in the health service and the second point is that since 2009, the non-hospital budget has fallen by 11%, while the hospital budget has fallen by 21%. Consequently, we are reaching the point in the hospital sector at which we cannot continue to cut because we are on the bone.