Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I am pleased to have the opportunity to address the select sub-committee today on the revised Estimates for 2015 for my Department - Vote 38.

I very much welcome the new emphasis on performance in these discussions. The briefing provided to the Deputies this year concentrates on the three particular service areas in which the committee has expressed a particular interest - primary care services, acute hospital services and long-term residential care.

On my appointment as Minister for Health, I said on more than one occasion that my first priority was to achieve a realistic budget for the health service. We have achieved that in the revised health Estimate for 2015. Before looking at the Estimates in detail, I wish to make a few general observations on the overall budgetary situation, as there are a number of complicating factors this year.

The disestablishment of the HSE Vote is, we all appreciate, a complicating factor when comparing year on year.

Since the beginning of this year, the HSE is funded by grants provided under Vote 38. The revised Vote structure has resulted in income of €1 billion, previously accounted for as appropriations-in-aid under the Vote of the HSE, being accounted for as income in the annual financial statements of the HSE rather than the Vote for the Department of Health. This income comprises hospital maintenance receipts, superannuation, the pension levy and other miscellaneous income such as car parks, restaurants and the primary care reimbursement service. Restating the Health Vote for 2014 on a like-for-like basis consistent with the new Vote structure, the gross Revised Estimates provision for the Health Vote for 2014 is €12.113 billion, while the post-Supplementary position is €12.793 billion. In other words, the gross Vote for 2015 is €564 million more than the original provision in 2014.

In addition to the increased Exchequer funding, additional non-Vote income collected by the HSE of €131 million and at least €130 million through cost reductions and other savings have also been identified and will be retained within the HSE to support services providing, in effect, €825 millionin additional resources, as compared with the original position in 2014 or, more accurately, €145 million compared with the post-Supplementary position. This funding increase is part of a two-year process to stabilise and improve health funding. The spending ceiling for health in 2016 has been increased by a further €174 million. Given the demographic pressures facing the sector, there is no question that the budgetary situation remains challenging. I am confident, however, that we are in a much more stable financial position than we have been for some time.

The budget parameters for 2015 have allowed the HSE service plan to include a number of targeted enhancements to health and social care services, while providing generally for the delivery of existing levels of services. The service plan also progresses key elements of thehealth service reform programme. In addition, the Minister of State, Deputy Kathleen Lynch, and I recently published our 25 health priorities for the year ahead. These measures include legislation to reduce alcohol consumption, proposals to extend the remit of the Health Information and Quality Authority and the range of services available in primary care, moves to increase the number of people with health insurance and the first national survey in eight years of Ireland’s health. These priorities provide a clear direction for the development of health services and policy in 2015 and align with and support many of the developments provided for in the service plan.

There is, undoubtedly, a strong case for increased funding in health in the years ahead. However, it is also important to acknowledge that, with growing demand, increasing health funding without reform will not resolve the difficulties in our health services. Our experience during the boom Celtic tiger years, when considerably increased year-on-year funding was spent on health without a satisfactory return, is a stark testimony to this. Providing more resources without reform simply will not work, which is why the continuation of the programme of health service reform is of critical importance.

With this in mind, the HSE’s 2015 service plan gives priority to progressing the Government’s reform agenda. This plan provides for the establishment ofcommunity health care organisations,which will improve the way in which primary care in the community is delivered. Likewise, the reorganisation of public hospitals into hospital groups is designed to deliver improved outcomes for patients. Each group of hospitals will work together to provide acute care for patients in their area, integrating with community and primary care. The objective is to maximise the amount of care delivered locally while ensuring that specialist and complex care is safely provided in larger specialist centres. One of my priorities for 2015 is to get the community health care organisations and the hospital groups up and running. As part of the reform agenda, I also expect to see the issuing of the first individual health identifiers, which is the equivalent of an identification or PPS number for health, increased investment in ICT and e-health and the embedding of the activity-based funding model in the health service in 2015. This year’s Estimate provides for an almost 40% increase in ICT funding, from €40 million to €55 million. This needs to be sustained in the years ahead.

The HSE has put in place a considerably enhanced governance and accountability framework for 2015. This is set out in detail in the service plan. The framework provides the means by which the HSE, hospital groups and community health organisations and other units will be held to account throughout the year for their efficiency and control across the balanced scorecard of access to services, patient safety, finance and human resources.

A suite of performance indicators for 2015 is set out in the HSE’s 2015 service plan. Having clear and achievable targets is important both in terms of driving performance and activity forward and in measuring past performance. Performance indicators are particularly useful when it comes to measuring volume and throughput. However, they are not always sufficient in themselves when it comes to evaluating the more qualitative aspects of service delivery. For example, an existing performance indicator for ambulance response times measures the extent to which a target time of 19 minutes is achieved. This is an important measure but what it cannot do is consider or take into account the actual outcome for the patient. For example, an ambulance getting to the patient in 18 minutes but the patient dying is counted as a success whereas the ambulance getting to the patient in 21 minutes, defibrillating him or her on the scene and the patient surviving is considered a failure. That is often how targets work. HIQA now acknowledges that we need to have a different set of targets, with new ones based on clinical audit and actual patient outcomes.

As I mentioned earlier, the 2015 service plan provides for the delivery of an existing level of services, with targeted enhancements in some areas. Enhancements include the commencement of the extension to the BreastCheck programme to women aged 65 to 69 years of age, implementation of the first two phases of a universal GP service, making a GP service without fees available to all children under six and everyone over 70 years, and the provision of €30 million in funding for new hepatitis C drugs which cure the virus. An additional €35 million in ring-fenced funding is being provided for mental health services in 2015. A number of measures will be taken this year to develop primary care services further, thereby allowing more people to receive a wide range of quality services in their own community. An additional €14 million is being provided for primary care developments, including the extension of the pilot ultrasound GP access projects in the south and west and the provision of additional minor surgery services in agreed GP practices and primary care centres. There will also be an extension of the GP out-of-hours services, within existing resources, to areas currently not covered, and more spending on community orthodontic and ophthalmic services. An additional €2 million is being provided to improve maternity services.

The Minister of State, Deputy Lynch, and I are also keen to deliver real improvements in patient access and experience in our hospitals in 2015. For this reason, we have included clear targets for 2015 in relation to delayed discharges, trolley waits and waiting lists times in our recently published health priorities for this year. We want to reduce by one third to fewer than 500 the number of patients with delayed discharges, and we are seeking to reduce by one third to fewer than 70 on average the number of patients on trolleys in emergency departments waiting more than nine hours for admission. We are also committed to developing and implementing a plan to address waiting lists, with a focus on very long waiters, so that by mid-year, nobody will wait longer than 18 months for inpatient and day case treatment or an outpatient appointment, with a further reduction thereafter to no greater than 15 months by year end. These targets involve progressive and measurable improvement for patients and I expect all hospitals to meet them at a minimum and, where possible, surpass them.

As Deputies and Senators will appreciate, there are enormous demands and cost pressures on our health service. Health care demand continues to rise due to our growing and ageing population, the increasing incidence of chronic conditions, and advances in medical technologies and treatments which can be very expensive. Health services all around the world are struggling with this issue of rising costs, deficits and difficulties and getting staff. An interesting article in The Guardianin England pointed out that the NHS has spent €2.6 billion on agency staff because of the difficulties it is having in recruiting staff and that most NHS trusts are now in the red. I am aware of the limitations as to what can be achieved with the additional modest increase in funding available this year. We clearly do not have sufficient funds to address immediately all areas of concern across the health sector. However, what we have been able to do in this year’s HSE service plan is make a welcome start towards stabilising and improving the funding of our health services.

I thank the committee for its attention and I commend the Revised Estimates for the Health Vote to it. I am happy to supply any further information or clarification that Members may request.