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

Deputy Ó Caoláin referred to the nursing home support scheme and the reduction in the budget for long-term inpatient care. It is true we took €23 million out of that budget but it was to create new and more innovative home care packages which will benefit a far greater number of people and keep them at home, which is where most people wish to be.

I am hugely grateful to the tremendous work done which has led to the remarkable progress in our health services. That is down to the men and women who work in our health services. It is one of the few services that is 24-7 and is demand-led. No health professional worth her or his salt would turn away a patient in need or acute distress.

While we have had an 8% growth in population over the past six years, there has been a 20% reduction in the health budget and a 10% reduction in health staff. It has been said elsewhere that the only place that has had greater cuts than this country has been Greece. Our health service has not fallen over but, in fact, has improved. It has not improved to where we would all like it to be but it has improved as evidenced by a 34% reduction in the number of people who had to endure long stays on hospital trolleys. Up to 99% of inpatient treatments are carried out within eight months, which I accept is still too long.

That 95% of outpatient appointments are now within a year is still far too long, but given that up to last year they were not even measured we can certainly thank the men and women working in our health service for extraordinary progress.

I have spoken about reforming our health service and we all know about the black hole which is supposed to be in health. In opposition, I stated not another bob would be given until we found the black hole, and we have done so. A total of €4 billion is gone and there is no more black hole. I would love somebody to show me where it is because it is not there, and the men and women who work in our health service also know it is not there. We can only go so far and we stated that our reform plan has a number of stages. We must make what we have as efficient as we can, after which we will continue the reform to break up the HSE from being a provider and procurer and create a split between procurer and provider.

An integral part of ensuring we get the right outcomes is to have a national pricing office for health. I met the German Minister in Greece last week to organise help from our German colleagues and we are very fortunate that a gentleman from there, who has Irish connections, is willing to come over because we need someone independent to set the price for procedures. Otherwise, hospitals will accuse the Department of paying too little, the Department will accuse the hospitals of charging too much, the professionals will accuse both and each will accuse the other. We need an honest broker and evidence-based pricing. There is no doubt or question in my mind that we pay far too much for certain procedures. Committee members will have heard me state this previously and I will not go into it all over again.

I am inclined to state enough is enough and that the health service can take no more. It now needs time to continue its reform so it can become more efficient. We have achieved a huge amount despite all of the challenges we faced and it is not fair to our staff to ask them to take even more cuts. I stated in the HSE service plan that the priority of all priorities is patient safety and I will not preside over an unsafe system or health service as a Minister for Health, as a doctor or as a parent, and nobody in this room would either.

The moratorium was necessary to make certain achievements and it is not being implemented in an inflexible way. It is being implemented in a manner which allows us to get the skill mix right. Committee members will have heard me ask why in one hospital there are nine nurses per health care assistant and in another similar sized hospital there are 2.8 nurses per health care assistant. There is clear room for change. Other reforms which need to be introduced include expanding the roles of the various people who work in the health service. In the Chairman's constituency of Cork, physiotherapists screen all of the orthopaedic referrals and can deal with 50% of the cases without the patient having to see the surgeon. There is a host of measures we can take and we are taking them.

Deputy Dowds mentioned the scope to cut back on administration but I believe we are very near the end of this and there is not much scope left. To be quite frank, we have cut approximately 16% centrally. When people speak about administrators, they must remember it includes those who work on wards. If there is no ward clerk, it will be far more expensive to pay nurses and doctors and it will not be cost-effective. We will keep examining the model of care and refining it, which is what any good system should do as it should be dynamic. The clinical programmes have led the way in this, supported by the special delivery unit. The problem with the HSE in the past was that we never managed to transpose excellence from one part of the system throughout the entire system. The new hospital groups will be a huge part of addressing this because instead of dealing with 49 different hospitals, we will have six hospital groups for adults and the paediatric hospital group. It will be much easier to get a message across and exchange information. There is only so far we can go before we start to compromise patient safety and we are coming to this point. I send a loud warning to those who would have us go further.

Last year, the Supplementary Estimate was relatively small at €200 million out of a budget of €13 billion. To put this in context, and Mr. Smith will correct me if I am wrong, the daily spend is €35 million so it was only four or five days' expenditure. This is in a demand-led scheme. This year alone, we have had a 33% rise in attendances with a huge rise in admissions. These are sick people who need to be admitted. Everybody knows how hard it is to get into hospital and those who are in hospital are ill. We want to reduce the average length of stay and we have much more work to do in this regard. We can certainly make much more progress.

Deputy Ó Caoláin was concerned about the section itself. Section 10 is a critical control mechanism to replace the vote control in place at present. There will be a charge against the HSE budget and it will be a matter for the HSE to allocate resources according to priorities. I set the priorities in terms of the broad outline of the HSE service plan, but I am not involved in the day to day workings of the system or in operational matters as these must be left to those on the coalface. I am very pleased the special delivery unit has managed to give a voice to those at the coalface and takes on board some of what they have to say. They do not agree with all of them but what they do agree with, which make sense and is priced appropriately, is done. Many more incentives will come into the system to help people on the front line shape the way they work because they deal with the problems day in day out and have the best understanding of them.