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

I wish everybody a happy and healthy new year.
I thank the joint committee for giving me the opportunity to make this presentation on the 2014 national service plan. I am joined by my colleagues from the Department of Health, Ms. Bairbre Nic Aongusa, assistant secretary, and Ms Fiona Prendergast and Mr. John Keegan, principal officers. I am also joined by the director general of the HSE, Mr. Tony O'Brien, and his directors Ms Laverne McGuinness, Mr. Thomas Byrne, Mr. John Hennessy, Mr. Philip Crowley, Ms Stephanie O'Keeffe and Mr. Barry O'Brien.
This year's service plan has been prepared at a time of unprecedented challenges for the health system which arise as a direct consequence of the emergency financial situation in recent years. It is important to acknowledge the significant improvements in productivity and the increasing range of services delivered during this period against a backdrop of significantly reduced budgets and workforce numbers. The health system has also had to support increasing demand for its services during this time, with the population of the State increasing by 8% and the proportion of persons aged 65 years and over increasing by one fifth.
Managing the impact of these significant financial, resource and demographic pressures on the health system in the years ahead, while delivering safe, quality health and social care services to the public, will only be possible by way of a reformed health system that provides access according to need rather than ability to pay, for best health outcomes from the available resources and treats patients at the lowest level of complexity that is safe, timely, effective and efficient and as close to home as possible. A 20% budget reduction and a 10% reduction in staff numbers form the backdrop to the service plan.
I will continue to deliver the Government's programme of health reform – the most comprehensive programme of reform since the foundation of the State – throughout the year. I am pleased that the HSE has placed the advancement and implementation of these reforms at the centre of its planning for 2014.
The following key elements of the health reform programme are built into the fabric of the 2014 service plan: phased implementation of a money follows the patient funding system in hospitals, with payments to be made to participating public hospitals on the basis of the level of inpatient and day case activity that they complete - in other words, if no patients have been treated, no funding will be available to the hospital; the transition to hospital groups, including the appointment of new group chief executive officers, CEOs, where required, the development of a memorandum of understanding between the HSE and each group and the development of a programme for implementation of hospital groups; the establishment of new community areas, with associated governance and organisational arrangements, following the completion of the review of integrated service areas - I refer to Mr. Pat Healy who has done great work with his team in this regard; implementation of new internal management structures, with specific programmes relating to shared services, procurement, human resources and information; establishment of an interim patient safety agency, initially on an administrative basis, within the HSE structure; development of commissioning functions, with the aim of achieving the greatest progress on a commissioner-provider split, prior to the introduction of statutory functions; and formation of a cross-divisional working group for health and well-being aimed at identifying the most effective model for the delivery of health improvement gains for the population in the context of a health care commissioning environment.
My overriding priority in delivering these key health reforms across the health sector this year is patient safety. I very much welcome the fact that patient safety and improving the quality of services to the people of Ireland are at the core of the service plan and that all health staff, individually and collectively, have a responsibility under the plan for the safety and quality of services they deliver to patients and service users in their care and must integrate this commitment to safety and quality into their core work practices. The service plan provides for the development and use of a comprehensive set of quality and safety indicators to measure the quality and safety of services, with a particular focus this year on the priority areas of medication safety, health care associated infections, HCAI, and the national early warning score, NEWS. It also looks to implement the recommendations made in the reports of the HSE and the Health Information and Quality Authority, HIQA, on the maternal death at Galway University Hospital by targeting necessary patient centred improvements in maternity care. These health reform and patient safety priorities set out in the service plan are critical in order to maintain sustainable levels of service delivery to the population into the future and build on the progress made in recent years.
The 2013 edition of Health at a Glancepublished by the OECD shows that Ireland continues to make substantive headway in improving health outcomes. Mortality due to cancer fell by 21%, ischemic heart disease by 59% and cerebrovascular disease by 54% between 1990 and 2012 and in all three instances the rates of improvement in Ireland were above the OECD average. Since 200 life expectancy in Ireland has increased by four years to reach 80.6 today, again above the OECD average. I thank the men and women who deliver our health and social care services for maintaining and, in many cases, improving the ever expanding range of services provided for the general public, despite reducing resources in recent years. Their efforts have been highly commendable in these most challenging of times. The reform process is well under way and gathering momentum.
Chronic diseases such as cancer, cardiovascular and chronic respiratory disease and diabetes are the leading causes of mortality and account for more than three quarters of all deaths in Ireland. The risk factors associated with the increased prevalence of chronic diseases such as obesity, lack of exercise, unhealthy eating patterns, over-consumption of alcohol and use of tobacco products are generally preventable.

To address these areas of concern, Healthy Ireland, the Government’s national framework for improved health and well-being published in 2013, sets out a whole-of-government and cross-sectoral approach to address the demands placed on health and social care services from the growing incidence of chronic illnesses, together with the challenges of an ageing population. The commitment in the 2014 service plan to the health and well-being reform agenda set out in Healthy Ireland is critical in enabling the required shift in emphasis towards health prevention, promotion and improvement in the years ahead.

The revised gross expenditure health ceiling is €12.584 billion for 2014. This figure does not precisely correlate with the funding set out in the national service plan owing to the transfer of the children and families budget, €537 million, to the Department of Children and Youth Affairs. Child and family services are encompassed within the national service plan, but funding for these services will be channelled through the newly established Child and Family Agency. In addition to this adjustment, the revised Estimate for the HSE includes additional health funding of €47 million over and above the budget provision and €22 million in funding transferred to the HSE Vote from the Vote of the Department of Health for the drugs programme. The HSE is required to achieve savings measures of €619 million next year to remain within the 2014 health expenditure ceiling. The savings target has reduced from €666 million announced in the budget to €619 million as a consequence of the additional €47 million in funding allocated to the HSE Vote in the Revised Estimates Volume.

I have agreement at Government level that the medical card probity savings target this year will be €23 million, not €133 million previously pencilled in for this measure. That €133 million comprised €20 million already identified for probity measures and a further target of €113 million included in the budgetary arithmetic. It is now accepted, as a result of the objective verification process carried out on this €113 million probity target at my request since budget day, that this figure did not sufficiently take into account the extent to which medical card centralisation and already implemented probity measures in the past few years had already achieved much of what could be achieved in that regard, given, in particular, the Government’s affirmation that no changes whatsoever were to be made to general medical card eligibility criteria. The Government has made it very clear that there will be no change to the current guidelines for general medical cards and is committed to ensuring those entitled to a medical card receive and retain one.

The medical card scheme is demand-led. We have to ensure those entitled to medical cards continue to hold them. At the same time, we have an obligation, under the legislation, to ensure those whose situation has improved and, therefore, are not entitled to a medical card are not incurring a cost to the health service. I am aware that there has been public concern that, under the probity measures, medical cards may be indiscriminately withdrawn or cancelled. Nothing could be further from the truth. It is important to note that no person who meets the eligibility conditions for a medical card will be affected by this measure. To this end, the service plan provides €35 million to meet the cost of new applications for medical and general practitioner visit cards in 2014.

The implementation of the Haddington Road agreement, commenced on 1 July 2013, is now well advanced in most sectors and already delivering on its objectives. The Government is satisfied that the measures negotiated across all sectors, including the health sector, will deliver the targeted savings of €1 billion over the lifetime of the agreement. The agreement involves a demanding set of targets for the health service which accounts for approximately one third of the overall public service workforce. Naturally, the resultant savings to be realised in that sector form a significant part of the overall €1 billion target.

Throughout the talks process which resulted in the Haddington Road agreement senior officials from my Department and the HSE played a key role in supporting the Department of Public Expenditure and Reform in the negotiations at both central and sectoral level in agreeing the finalised planned measures for the health sector. They have continued to work closely with officials in the Department of Public Expenditure and Reform since the agreement came into force. The realisation of these savings in the health sector will, of course, be challenging and the focus and responsibility of management are on the delivery of these savings through the implementation of the various measures and other flexibilities for which the agreement provides. A HSE national assurance and support team is working with managers to ensure measures to deliver the necessary savings are implemented.

The amount of €108 million is an integral part of the overall savings target for the health sector. The €108 million pay-related savings target will be subject to a separate process and, of necessity, remain unspecified and be held centrally by HSE management until a procedure is in place setting out how these savings are to be achieved. These measures are to be determined with the assistance and support of the Departments of the Taoiseach and Public Expenditure and Reform. There is no question of health employees being required to take additional payroll reductions other than those required under the Haddington Road agreement.

There are significant service developments included in the 2014 service plan. In line with the programme for Government commitment to universal health insurance, a GP service, without fees at the point of use, will be provided for the estimated 240,000 children aged five years and under in 2014. Additional funding of €37 million was provided in the budget to meet the cost of this measure. In addition, €20 million has been earmarked this year to meet programme for Government commitments for mental health services. This funding will allow for continued strengthening of community teams, increased suicide prevention resources and clinical programme development and implementation and support an additional 250 to 280 posts. These posts are in addition to the approximately 900 posts approved to date under the programme for Government commitment to mental health service development.

The 2014 HSE service plan includes an additional €178 million for vital service developments, including the €35 million for additional medical cards to which I have referred and €30 million in acute service areas across emergency department, inpatient, day care and outpatient services which continue to experience increased service demand. Other priority service areas addressed in the plan at my specific request include the continued roll-out of diabetic retinopathy screening and treatment, involving additional funding of €4.5 million in 2014; funding to provide a service to undertake bilateral cochlear implants, with a particular focus on five-six year olds in 2014, involving additional funding of €3.2 million in 2014; in the area of disability, there is additional funding of €10 million for young people with a disability leaving school or training and needing emergency and residential placements; there will be additional organ donation and transplantation resources of €2.92 million in 2014 to benefit patients and their families; and funding of €1.2 million in 2014 to allow discharge from hospital and provide required care in the community for special care children who have had to undergo tracheotomies to allow such children to grow up at home, not in hospital. On the point of funding for young people with a disability leaving school, everyone agrees that the parents of such children leaving school should not face a summer of uncertainty as to whether their children would have a placement. This funding will alleviate the concerns of these parents.

On publication of the service plan on Wednesday, 18 December 2013, I welcomed the support of my colleagues in the Government in dealing with some of the concerns that arose following budget day. These concerns were addressed by way of the additional €47 million in health funding provided by the Government in the Revised Estimates Volume, the reduced medical card probity target of €23 million, also agreed to by the Government, and the further process, now in place, in regard to the €108 million in pay-related savings. The HSE has confirmed that its primary focus throughout the year will be to continue to deliver the same level of front-line services with a reduced budget, while ensuring quality and safety is paramount.

In the context of a reduced overall budget, the director general has also highlighted that the Haddington Road agreement provides an important mechanism by which the service plan can be delivered, and I fully endorse these comments.

I would like to conclude by again expressing my deep appreciation for the hard work and commitment of staff across the health and social care services. Given the reduced human and financial resources available over recent years, the achievement of the health service in terms of maintaining quality services and implementing reform during these most difficult of times is deserving of the highest praise. I am confident we can continue to build on these achievements throughout 2014.