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

Births, marriages and deaths, or hatches, matches and dispatches, as they are referred to, are in a different section. Consequently, it is up to the GPs, who must play ball in this regard. The Deputy should not get me wrong, as in the main they are. I believe this is working well and this is the reason much of the work on the issue of probity etc. already has been done on this. This is the reason the idea that €113 million could be saved from that process left me highly unconvinced and is the reason I requested and secured agreement from the Departments of the Taoiseach and Public Expenditure and Reform to carry out the validation process, which proved us to be correct.

Deputy Fitzpatrick raised a number of issues. The plans for universal health insurance are on course. The White Paper will be published, there will be an opportunity for everyone to be consulted and for a constructive conversation to take place across this for all stakeholders, including the public. The Deputy mentioned that 34 primary care centres have been progressed. They have actually been completed and 12 more are in the pipeline, as well as others that might enter the pipeline if we can get more interest from GPs to develop them themselves.

Whether we develop them or they develop them, whether they are done through direct build or through lease, there is no point in putting a brick in the ground if the GPs are not signed up. That is why, of the 35, only so many went ahead. One does not get GP interest. The last thing we want to do is build a primary care centre and have the GPs sitting outside asking how much they will be paid to be included because that is what would happen.

On staffing, I am not aware that there is any issue about staffing once the agreements have been reached, but Mr. O'Brien can go into that. The Deputy mentioned mental health issues, which I will let the Minister of State, Deputy Kathleen Lynch, deal with.

On the €30 million intervention fund, Mr. Ian Carter who is here might give the committee a flavour of how that might be spent. It is used to support innovation to improve the patient experience, both in emergency departments, inpatient and outpatient waiting times.

The issues around the care of the elderly are issues that are common to both myself and the Minister of State, Deputy Kathleen Lynch, in terms of the acute sector having facilities in place to allow the frail elderly commence rehabilitation immediately they are fit to do so. Often what happens is somebody goes into hospital with pneumonia, ends up with the medical problems resolved after 48 or 72 hours, but is clearly not well enough to go home and needs physiotherapy and occupational therapy. Sometimes such a person does not get this in the hospital and is left lie in the bed so that he or she becomes unable to go home ever, and that is what we are trying to address through the frail elderly programme. Dr. Áine Carroll who is present can talk through many of the clinical care programmes. There has been astonishing progress made on stroke, which I mentioned already and which Dr. Carroll can go into in more detail, and in congestive heart failure which has been raised by members as well.

On private health insurance, PHI, the cost of insurance has gone up and I am most concerned about that. As I have stated before and will say again, I do not accept that this 9% medical inflation should be taken as a given when the rest of the country was in deflation. It is utterly unacceptable. We are still paying for procedures that used take two hours at the same rate when now they only take 20 minutes. There is a host of work to be done here - it will be done - in terms of clinical audit, audit and benchmarking what we are paying and why we are paying what we are paying. Clinical audit is critically important. One needs a similar professional to challenge the professional concerned as to why tests are done or why treatments are carried out because there has been much anecdotal evidence of patients having procedures carried out that were not strictly necessary.

The Deputy referred to the national ambulance service. We dealt with that earlier through HIQA, which will be addressing that urgently. I will refer to the Minister of State, Deputy Kathleen Lynch.