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

You energise us all.

I thank the Chairman and members of the Oireachtas Joint Committee on Health and Children for the invitation to discuss health service issues. I am accompanied by the Ministers of State, Deputies Kathleen Lynch and Alex White, and together with my senior officials we will provide as much information and clarification as possible. I welcome Dr. Fergal Lynch, the deputy Secretary General at the Department, and Mr. Tony O'Brien, the director general-designate at the HSE.

At the outset, I thank the Chairman and committee for their hard work, dedication and commitment to progressing the protection of life during pregnancy Bill 2013. The committee has just completed its oral hearings and will now submit its report to the Government on the content of the Bill. This new legislation takes account of our obligations under the judgment of the European Court of Human Rights, with due regard to our Constitution and to the Supreme Court ruling in the X case. It is still the hope of the Government that the protection of life during pregnancy Bill 2013 will be enacted before the Dáil rises for the summer.

I take this opportunity to update the committee on significant developments in the health services since I last attended in November 2012. Members may recall that I briefed the committee on the publication of Future Health - A Strategic Framework for Health Reform 2012-2015, which sets out the major health care reforms that will be introduced by 2015 as the key building blocks for the launch of universal health insurance in 2016. The new structures are already being established and the actions being delivered in 2013 involve governance changes, the establishment of hospital groups, reforms of the private health insurance market, establishment of a health and well-being framework and the development of a money-follows-the-patient funding model. Newly enacted legislation underpins a permanent risk equalisation scheme which commenced from 1 January 2013. The scheme protects our system of community rating, whereby older and sicker people can buy health insurance for the same price as younger and healthier customers.

Despite significant challenges, especially in scheduled care - primarily, the extended flu season, leading to increased admissions - the implementation of programmes by the special delivery unit resulted in significant progress in improving hospital access targets. By December 2012 there were 20,352 fewer patients on trolleys, with a reduction of 23.6% since 2011; 3,620 fewer adults waiting more than nine months for inpatient and day surgery, a reduction of 98% since 2011; 1,670 fewer children waiting over 20 weeks, a reduction of 95% since 2011; and 4,554 fewer patients waiting over 13 weeks for routine endoscopy procedures, a reduction of 99% since 2011. There has been some rebound because of the extraordinary and prolonged winter. That has seen not so much an increase in attendance at accident and emergency departments but rather an increase in admission rates, up to 17% among the older person demographic. These people were really sick, as intensive care units were full, with all ventilators in use. This was not an experience that was unique to the Republic of Ireland, as it was also evident in the North and in Manchester in the north of England. In order to address this, an allocation of €18 million has been approved by the Department and the HSE to create an intervention fund to aid hospitals in reaching Government targets in scheduled and unscheduled care. The priority is to unblock access and improve the flow of patients through the health system. The Department of Health is preparing a White Paper on universal health insurance, UHI, which will set out details of the UHI model in addition to the estimated costs and financing mechanisms associated with its introduction. A preliminary document on UHI was published last February, setting out progress to date and the major tasks and projects that stand to be addressed throughout 2013 and beyond.

A hospital financing sub-group, established under the auspices of the UHI implementation group, has developed policy proposals on the money-follows-the-patient model. Stakeholder consultation will now be undertaken, followed by the implementation of money-follows-the-patient shadow funding during 2013 in advance of phased implementation of the new arrangements from 2014. The objectives of the new funding model are to achieve a fairer system of resource allocation, drive efficiency in the provision of high-quality hospital services, increase transparency in the provision of hospital services, and ultimately support the move to an equitable single-tier system.

Earlier this month I announced a reorganisation of public hospitals into more efficient and accountable hospital groups that will deliver improved outcomes for patients. This Government decision was informed by two reports, The Establishment of Hospital Groups as a Transition to Independent Hospital Trusts, or the Higgins report, and The Framework for Development - Securing the Future of Smaller Hospitals. The establishment of hospital groups signals a fundamental modernisation of our health system organisation in line with best international practice.

The new hospital groups, each with its own governance and management, have been designed to provide the optimum configuration for hospitals to deliver high quality, safe patient care which is cost effective and guarantees better outcomes for patients. I take this opportunity to thank Professor John Higgins again for all the work he did. I also thank the group that supported him. The framework for hospitals outlines the need for smaller and larger hospitals to operate together, which is intrinsically linked to the formation of sustainable groups. Better co-operation between hospitals will help to maximise the amount of care delivered locally. Hospital groups will secure the future of our smaller hospitals. When the new groups are established, services can be exchanged between sites. This will result in the maintenance of activity in smaller hospitals and will allow them to focus on the provision of care that is safe and appropriate.

Work on the roll-out of hospital groups will begin immediately and will be overseen by a national strategic advisory group and driven by the HSE. Following a rigorous evaluation of each group to ensure it is fit for purpose to function as a hospital trust, legislation will be put in place in 2015 to enable independent hospital trusts to be established, taking account of any changes to groups which may emerge from the review process.

I acknowledge that the Minister of State, Deputy Alex White, and he will expand on this, has successfully put the drug reference pricing legislation through the Dáil. It completed its passage yesterday.

Equally, I wish to mention the Croke Park II agreement. I will not speak in great detail but it is obviously important that a ballot by health care workers is to take place regarding new arrangements that will yield real savings and, we hope, more services for patients. Mr. Barry O'Brien is present and he will address that in a fuller fashion. However, I take this opportunity to thank Mr. Barry O'Brien, Frances Spillane and Fergal Goodman, who were the health team that attended those negotiations on our behalf, on doing such a good job.

Turning to legislation, the legislation to abolish the HSE is complex but will be done sequentially. As a transitional measure, the Health Service Executive (Governance) Bill 2012 abolishes the current board and chief executive officer structure and provides for the establishment of a new governance structure. The Bill is intended to bring greater focus on service delivery and ensure more accountability to the Minister for Health. The national directors will be responsible at national level for the delivery of services in their relevant service areas, such as hospitals, primary care, mental health, social care and health and well-being. They will lead the development of national service plans associated with their sector, manage performance and, in time, develop strategic commissioning frameworks for their areas, as appropriate. The chief financial officer will be accountable for the financial management and performance and for ensuring that the HSE operates within its annual allocation as well as achieving the stipulated income targets. Indeed, due to calendar scheduling, we were due to take that Bill today but could not because this committee was meeting. It has been put back to later in June.

The preparations are proceeding for the development of the new national children's hospital on the campus of St. James's Hospital. New governance arrangements have been put in place to advance the new phase of the project. The National Paediatric Hospital Development Board has been restructured to focus on the core functions of planning, designing, building and equipping the new hospital. A strategic advisory group is being established to provide external advice and expertise to the project. This project will be progressed as speedily as possible, recognising the urgency and priority attached to it together with its scale and complexity.

It is important to reflect on certain key trends within the health sector. Given the continuing severe economic constraints facing the country, increasing numbers of the population are eligible for medical cards and decreasing numbers are opting for private health insurance. Key challenges will be to continue to ensure that resources secured are carefully and appropriately targeted to deliver more efficient and effective ways of providing services. This can be seen in the acute hospital sector where a gradual decline in inpatient admissions is being more than offset by a rapid rise in day cases. Further improved treatment models are leading to better outcomes, as evidenced by continuing improvements in cancer survival. In the case of stroke, the new stroke programme has resulted in saving one life every week and pre-empting the need for three people per week to go into long-term care.

Over the last decade Ireland has achieved a rapid improvement in life expectancy, increasing from nearly one year below the EU average to just above it. Much of this increase is due to significant reductions in major causes of death, such as circulatory system disease. The number of people in older age groups is beginning to increase significantly. Approximately 20,000 more people are being added to the over 65 year old age group each year. The numbers will double in the next 25 years to over 1 million people, with the largest proportional increase in the over 85 year old category. This is good news. However, it will have implications for our health service.

In the area of health determinants, lifestyle factors such as smoking, drinking, obesity and lack of exercise continue to be issues which have the potential to jeopardise many of the health gains achieved in recent years. The type and volume of services that must be delivered by the HSE across all health areas and through a variety of demand-led schemes and preventative services will increase in cost and complexity in tandem with the factors that affect the health of the population and the performance of the health system.

Healthy Ireland, a new Government framework for action to improve the health and well-being of people living in Ireland over the coming generation, was launched in March 2013. This framework sets out a broad range of actions that will be undertaken by Government Departments, public sector organisations, businesses, communities and individuals to improve health and well-being and reduce the risks posed to future generations. Healthy Ireland has been developed in response to rising levels of chronic illness, lifestyle trends that threaten health and persistent health inequalities. The framework is based on evidence and experience from around the world which shows that in order to create positive change in population health and well-being a whole of government approach and the involvement of local communities as well as all of society are required. The Department of Health will be leading across the Government on this national agenda.

I will bring regular progress reports to the Cabinet committee on social policy and I will also keep the Oireachtas Joint Committee on Health and Children fully informed. The Cabinet committee on social policy will oversee progress on Healthy Ireland and provide leadership and accountability for its implementation. Implementation of the framework's 64 actions will be subject to rigorous planning, reporting and evaluation. Healthy Ireland is designed to bring about real, measurable change and is based on an understanding of the determinants of health and well-being in a person's life - economic status, education, housing, transport and their physical environment. It is about each individual sector helping to improve health and well-being, multiplying all efforts and delivering better results. It will result in people living in Ireland being supported to make healthier choices in their daily lives in health promotion and sustainable environments.

The core of everything we are doing is evidence-based to improve outcomes for patients. As long as that remains to the fore of our minds in all we do I believe we will do right by patients. If we veer from that, we will lose our way. I and my ministerial colleagues will be happy to answer the committee's questions on these and other issues.