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

I thank Mary for her kindness and great service over the years and wish her well in her new position. I thank the Chairman and members of the committee for their invitation to meet them. I am accompanied by the Ministers of State at the Department of Health, Deputy Kathleen Lynch and Deputy Alex White, and we look forward to providing the committee with as much information as possible.

To save committee members the effort of continuing to refer to Mr. Tony O'Brien as DG designate, I am pleased to announce that he is now the director general. The health service is embarking on an important step on the road to reform. I know Mr. O'Brien will be all that he promises in terms of being the leader of a new way of doing business and ensuring better outcomes for our patients and citizens.

A number of notable developments have taken place in the health service since I last addressed the committee on 23 May. It has been my great pleasure to announce the Government's intention to relocate the National Maternity Hospital from Holles Street to the St. Vincent's University Hospital campus at Elm Park. An indicative sum of €150 million has been approved in the HSE's capital plan to allow this to proceed. This project heralds a new and exciting chapter in maternity care for women and infants in Ireland. The proposed relocation addresses a key recommendation in the 2008 KPMG independent review of maternity and gynaecology services in the greater Dublin area, namely, that Dublin maternity hospitals should be located alongside adult acute services. Co-location of maternity hospitals with adult acute services is the optimal solution for the provision of hospital based maternity services because it can provide access to the full range of medical and surgical specialties and clinical support services in sufficient volume and complexity to provide added value. This is particularly important for high-risk mothers and babies. This commitment by the Government underpins a determination to provide strong maternity services for Ireland. It will also strengthen the successful relationship with University College Dublin as part of the Dublin east hospital group.

When I addressed the Committee in May I reported that the INMO had recorded 20,352 fewer trolleys in 2012 compared to 2011, which is a reduction of 23.6%. As of 12 July 2013 the INMO reported a further 10.6% reduction in trolleys compared to the same period in 2012. This is equivalent to 4,244 fewer emergency patients waiting for an inpatient bed. At the same time, however, the severe pressures experienced in emergency departments had a knock-on effect on waiting times for elective care. As shown by the June figures for inpatient and day case waiting times, which are now on the National Treatment Purchase Fund website, this resulted in a rise in waiting times since the very significant achievements at the end of 2012. The special delivery unit, together with the NTPF and the HSE, is engaged in a national intervention strategy to address the recent rise and to work towards the 2013 maximum wait times.

I have recently received Government approval to begin the process of introducing standardised or plain packaging of tobacco products in Ireland. Smoking places an enormous burden of illness and mortality on our health services, with over 5,200 people dying every year from tobacco related diseases. One in two of all smokers will die from a tobacco related illness. Standardised packaging of tobacco products will remove all forms of branding, trademarks, logos, colours and graphics. Plain packaging is one of a number of measures that are required to denormalise smoking in our society. Education and awareness, cessation services and extending the smoking ban to other areas are just some of the other measures which I am currently progressing.

A landmark political agreement was reached by Ministers at the Health Council in Luxembourg last month. This agreement brings the EU a step closer to revamping rules on how tobacco products are produced, packaged and presented in member states and improving health protection for EU citizens. I had the honour of chairing that Health Council, which reached agreement just six months after the original proposal was published by the Commission. It will enable the incoming Lithuanian Presidency to open up final negotiations on the tobacco products directive with the European Parliament. Reaching a Council agreement on the revision of the tobacco products directive was the main priority of the Irish Presidency in the field of public health. This is only right and proper given that 700,000 Europeans die every year from tobacco related illnesses. This has caused a reaction in the tobacco industry globally but our determination and conviction will not change. I thank members for their support for this initiative.

The Health (Pricing and Supply of Medical Goods) Act 2013 commenced on 24 June. The Act provides the Irish Medicines Board and the HSE with a robust statutory framework for the introduction of generic substitution and reference pricing on a phased basis. It will provide much greater access to generic medicines in Ireland and reduce medicine costs for patients and for the State. Generic substitution will be introduced incrementally, with the Irish Medicines Board prioritising those medicines which will achieve the greatest savings. The legislation will promote price competition and greater use of generics and deliver lower medicine prices for the taxpayer and the patients.

Another key step in the health reform programme was achieved when the President signed the Health Service Executive (Governance) Act 2013 on 3 July. This Act is designed to prepare the health system for the changes ahead while also making the HSE more directly accountable to the Minister for Health, who in turn is accountable to the people through the Oireachtas. The Act provides, inter alia, for the abolition of the board structure of the HSE and for a directorate headed by a director general to be the new governing body for the HSE. As is currently the case with the CEO, the Act provides that the director general will be the Accounting Officer for the HSE. This is a temporary arrangement as it is the intention to return the Vote to the Department of Health from 1 January 2014. At that point the director general will no longer be the Accounting Officer. This will require further legislation to disestablish the HSE Vote and fund the HSE through the Vote of the Office of the Minister for Health.

During the consideration by the Dáil of the Health (Amendment) Bill 2013, I announced new rates for all private in-patients in public hospitals, which will take effect on 1 January 2014. The Bill has subsequently been passed by both Houses of the Oireachtas. As a result of discussions with private health insurers, I decided to phase in the charges for private patients over a number of years. The rates included in the legislation are set at the level to raise an additional €30 million in hospital revenue in 2014. This phasing is intended to enable the insurance market to adjust to the new charges without destabilising impacts and it will also allow for assurances to be provided to the insurers that the additional revenues raised in 2014 will amount to €30 million in the calendar year.

As a result of this legislation, the hospital charges for a private day-case patient will be reduced from a total of €828 to €407 in a category 1 hospital. The daily charge for a private patient accommodated overnight in a multi-occupancy room in a category 1 hospital will be €813. Currently, the equivalent charge applied to a patient in a semi-private bed is €1,008. In support of this phased approach, the private health insurers have confirmed their commitment to participating in the initiative, to be chaired by Mr. Pat McLoughlin, that will address costs in the private health insurance industry to support the ongoing sustainability of the market. I am sure the members have all read the newspapers today and acknowledge the VHI's success in reinsuring in the market. While that is very welcome, it is no substitute for cost control, and that initiative will continue unabated. Costs are far too high in our private health care system.

Reform of our health service is essential. Modern medicine is helping people to live longer, healthier lives but we are still trying to deliver 21st century medicine in health systems that owe more to the 19th century than to the new millennium. Future health is specifically designed to dismantle the failed centralised command and control system of management, and return power to patients and professionals. To help re-direct this power the Government has decided to re-organise all of Ireland’s adult public hospitals into six groups which will, over time, become self-governing trusts. The objective is to create networks of hospitals which are big enough to offer patients a full range of high quality services safely, yet small enough to be flexible and adaptive.

The response from health-care professionals to date has been very encouraging. People working in the system know better than anyone that change is required, and importantly, they want to be involved in that change. We must continue to develop a system that allows more empowerment of the people who work on the front line and, most importantly, of the patients. The informed patient is the safest patient.

The Department is currently working with key stakeholders to develop a number of quality and patient-safety outcome indicators, with the intention of publishing the results. The HSE has also developed an Irish hospital mortality index which will also be published. Once the HSE is abolished, a new healthcare commissioning agency, HCA, will be established. It will be called the new healthcare agency. The contracts it commissions will be used to achieve improvements in patient outcomes. Outcome measures will be developed for both primary and community care. I am sure the Chairman and his committee are tired of hearing me say we need better outcome measurements. Outcomes for patients is what our health services should be all about. As long as we continue to focus on patient outcomes, all we do will be right.

I welcome the passage through both Houses of the Oireachtas of the Protection of Life During Pregnancy Bill. No Bill has been so fully debated, nor so long awaited. It is 21 years since the X case. Oral hearings took place before the heads of the Bill were published which informed those heads of Bill. Oral hearings took place after the heads of Bill were published which informed the Bill itself. Second Stage debate, to which virtually all Deputies contributed, resulted in more amendments. An extended Report Stage debate took place in the Dáil and after that the Seanad debated various Stages over several days.

This Bill is about protecting lives, those of the mother and her unborn child. It is to clarify for women what they are legally entitled to by way of medical services and how to access those services. It is to clarify for the medical and nursing professions what is legally permissible and what services they are legally obliged to provide. I have a deep respect for life. I have spent my entire professional life, spanning three decades, helping protect and save life. This Bill will do both. I thank the Members of both Houses for their contributions, and this committee in particular. I thank members of the Opposition for their support. All have deep conviction in their beliefs. I thank my ministerial colleagues, Deputies White and Kathleen Lynch. I thank the Chairman of this committee for his tremendous support and the manner in which he chaired the committees and kept the conversation at a civil level so that people could speak, listen and hear. This has been a very difficult journey for many people, but the right thing is rarely the easy thing to do. We have collectively done the right thing.

The Ministers of State, Deputies White and Kathleen Lynch, and I will continue to strive to give the Irish people the kind of patient-centred health service they need and deserve. Recognising the scale of the challenge involved, we will oversee the development of a health service that provides timely access to patients, high-quality, safe care, and provides an example of best practice in health care provision internationally. Both my ministerial colleagues and I will be very happy to answer members' questions on these and other issues during the meeting.