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

I apologise for the responses to members' questions being delivered so soon in advance of this meeting. We will certainly endeavour to ensure this does not happen again. The members of this important committee should have time to consider the responses they get.

I am grateful to the Chairman and the committee for inviting me to discuss health services here today. As the Chairman pointed out, I am accompanied by the Minister of State, Deputy Kathleen Lynch, and by senior officials from my Department, including Mr. Fergal Goodman and Dr. Siobhán O'Halloran, who is the chief nursing officer. This is the first time a chief nursing officer has been appointed at the level of assistant secretary in the Department. It is important for the health services that the voice of nursing can be heard at the highest level in the Department. I am also accompanied by Mr. Tony O'Brien and his team, including Ms Laverne McGuinness, Dr. Áine Carroll, who is the clinical director, Mr. Ian Carter, who is the director of hospitals, Mr. Stephen Mulvany, who is the director of mental health, and Mr. Pat Healy, who is the director of social care.

Earlier this week - less than 48 hours ago - we discussed the 2014 Health Service Executive service plan. It is clear that 2014 will be a very challenging year. Perhaps it will be the most challenging year for the health services we have yet had to deal with. Despite the many challenges we have faced up to now and will continue to face in the future, it is important to reflect on the considerable progress that has been made, especially in the essential task of reforming our health services. I remind the committee that just over a year has passed since I launched Future Health, which is our blueprint for the reform of our health services. As members will know, the Government's policy is to end the unfair and inefficient two tier health system and to introduce a single tier system supported by universal health insurance. Future Health provides the blueprint for the steps on the road to universal health insurance.

Among the many measures in Future Health, we stated we would establish hospital groups. This has been done and last year we published the reports which set out how the groups would be organised. Considerable work was done to ensure agreement on the composition of the hospitals groups. I thank all those involved in the process, including officials of the Department and of the Health Service Executive and Members of the Oireachtas. We have appointed chairpersons for each group and we are recruiting chief executive officers, with interviews taking place as we speak. Work will continue in 2014 to fully establish the groups on an administrative basis.

The creation of hospital groups is a critical step in improving hospital performance and, ultimately, patient outcomes. In the short term the groups will harvest the benefits of increased independence and move away from the traditional command and control style of the HSE. We want to devolve as much independence as possible to those who best understand local needs and conditions.

In 2013, we published Healthy Ireland, our strategy for improving the health of people and enhancing our health and well-being. This is an ambitious strategy which aims to embed health and well-being across public policy and services. In 2013, as part of the Healthy Ireland framework, we published Tobacco Free Ireland, our strategy for making Ireland tobacco free by 2025. A general scheme for the Public Health (Standardised Packaging of Tobacco) Bill 2013 was approved by Government on 19 November last. I was particularly pleased that at European Union level, the tobacco products directive was agreed during the Irish Presidency. This is a significant development and was a priority for me during our successful Presidency. The directive is a crucial step in protecting public health and harmonising the marketing of tobacco products at EU level. I am aware of the joint committee's close involvement in this issue and members will be aware of my particular interest in making progress on it. I note also that the committee will hold further hearings on the legislation later this month.

In 2014, we will establish a Healthy Ireland council, for which we have invited expressions of interest for membership. We will also establish a research and data plan, an outcomes framework, a positive ageing implementation plan and a national physical activity plan.

In July 2013, we established the directorate of the health services under the Health Service Executive (Governance) Act, which also abolished the HSE board. We started the process of bringing the HSE Vote back to the Department with the publication of the Health Service Executive (Financial Matters) Bill. A finance reform board is in place and a chief financial officer has been appointed in the HSE. The individual in question attended a meeting of the joint committee two days ago. A new financial and cost management system has been identified and is being costed. We will progress the legislation and continue to work on the management system during 2014.

In 2013, we published the phase 1 report of the chair of the consultative forum on health insurance. The chair is proceeding with phase 2 and will report back to me in three months. As members are aware, we must continue to address issues in the private health insurance market as a basis for the introduction of universal health insurance. They will also be aware of my concern about the high cost of private health care. I have received a draft of the White Paper on universal health insurance which I hope to publish shortly. Universal health insurance is fundamental to the reform of our health services and goes to the core of Future Health.

At the same time as focusing on the future of the health services, we are focused on making a real difference to people today and tomorrow. We have made good progress in addressing the costs of drugs and medicines. With the passing of the Health (Pricing and Supply of Medical Goods) Act 2013, we have a robust system of reference pricing and generic substitution. We have reduced the cost of atorvastatins by approximately 70%, with more reductions set to follow in 2014. This saves patients and taxpayers money and allows us to focus on maintaining front-line services. I read a newspaper report this morning which indicates that pharmacists are taking this matter into their own hands and becoming much more competitive in terms of the mark-up being applied in their businesses. This is a welcome development.

Another key element of Future Health is the concept that money follows the patient. The introduction of the new funding system on a phased basis lays the foundation for universal health insurance. Following a pilot study in 2013, the system is being introduced across the health services on a phased basis in 2014. The money follows the patient principle will provide the funding framework for improved and enhanced outcomes for patients as well as the professionals who serve them. Put simply, if there is no patient, there will be no payment.

Despite the challenging financial circumstances, as part of budget 2014 we will introduce free general practitioner care for children aged five years and under. In 2014, work will continue on the development of options for the provision of a GP service without fees to the entire population by early 2016. Those who query the wisdom of providing free general practitioner care for children while there are wider difficulties with the medical card system fail to see the overarching importance of the move. The Government is committed to a major enhancement of primary care services as part of the move to universal health insurance. This step of a phased introduction of free GP care must be seen in that context.

We must move away from the current over-reliance on hospital care and make proper use of primary care given that all available evidence shows the latter can meet 90% of medical needs. The true significance of providing GP care without fees to children under six years is the commitment it represents to enhancing primary care services in general. We will develop more dynamic and efficient health services with better outcomes through universal health insurance. The Minister of State, Deputy Alex White, is unable to attend because he is chairing a major conference in Dublin Castle.

In December, we published the Health Identifiers Bill and launched our e-health strategy. Technology can enhance health care, improve outcomes and drive efficiency. To implement the strategy, e-health Ireland will be established, initially in the Health Service Executive, and will be headed by a chief information officer for the health service who will be recruited through an open competition. Priority areas for initial development include e-prescribing, online referrals and scheduling, telehealth and the development of summary patient records. Again, on a day-to-day basis, the judicious use of technology brings greater efficiencies. In the long term, the use of technology gives us more information and enables us to make better health care decisions, thus saving lives and money.

Health service staff are high quality, dedicated people. The Chairman, members and I are always at pains to point out the great work done daily by the women and men working in the health service. They deserve high quality, dedicated facilities to support them in their work. Despite the significant financial challenges we face, the Government has, since 2011, progressed 34 primary care centres and a further 12 have been approved for building. As resources permit, this network will be expanded.

Our aim in respect of the national children’s hospital remains to secure planning permission by December 2014. As to the relocation of the National Maternity Hospital, Holles Street, to the St. Vincent’s University Hospital campus at Elm Park, a project team has been appointed and we expect a design team to be appointed shortly. We are also making progress with the relocation of the Central Mental Hospital from Dundrum to Portrane. I am sure the Minister of State, Deputy Kathleen Lynch, wishes to say a few words on that issue.

The Minister of State also published a national positive ageing strategy in April 2013. This is being implemented. Regulations to allow for the registration and inspection of residential services for older people with disabilities were signed on 30 October 2013. The Health Information and Quality Authority is now empowered to register, inspect and monitor such services.

As well as looking to the future, we sought to address legacy issues. In particular, the State Claims Agency is implementing a redress scheme for women who had been excluded from the 2007 Lourdes scheme on age grounds alone. I commissioned a research report on symphysiotomy and Judge Murphy has been appointed as mediator. When she reports, I will consider her report and bring proposals to Government for approval. I thank all members from all parties for their support and role in helping to address these issues, which have caused so much pain to so many.

Since taking up office, I have been driving improvements in unscheduled care targets and hospital outpatient performance. While these winter months bring an increase in demand in emergency departments, it is clear that we have made significant progress in reducing the numbers of people on trolleys and waiting lists for appointments. In 2014, we will continue to reduce maximum waiting times and develop better information systems, including the unscheduled care information system for hospitals. As I noted, we are joined today by the director of hospital services, Mr. Ian Carter, who can discuss these issues in much greater detail. Linked to this, the patient safety agency will be established on an administrative basis and a licensing system for public and private health service providers will also be developed. I thank the Chairman and members for their attention. We will be pleased to take questions.