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

I thank the Cathaoirleach and members of the committee for the invitation to attend. I am joined by Minister of State, Deputy Kathleen Lynch, Dr. Tony Holohan, chief medical officer, Ms Tracey Conroy, assistant secretary in my Department, Mr. Tony O’Brien, director general of the HSE, and members of his leadership team. Members will recall that at the start of the year, the Minister of State and I set out our work programme for 2015. It contained 25 actions under five major themes. I will touch on each of them briefly and record some of the progress being made.

The first theme is Healthy Ireland. We need to improve our health as individuals and as a nation. This is the best way to ensure we live long and healthy lives and the most effective way to prevent illness and reduce health costs in the long term.

The legislation brought forward by the Minister, Deputy James Reilly, on plain packaging on tobacco was signed into law by the President on 10 March and my Department is currently drafting regulations on the prescribed aspects of the Act. It is, as members know, subject to legal challenge.

The general scheme of the public health (alcohol) Bill was approved by Government on 10 February. I intend to publish it before the summer recess. As it has already been subject of a dedicated committee meeting, I will not say any more on it today. Provisions under the Public Health (Sunbeds) Act 2014 requiring health information, warning signs, prohibitions on certain marketing practices, health claims, notification requirements, fee and fixed penalty notices were commenced in February and March. This will discourage younger people in particular from using sunbeds, while imposing stricter regulation on providers. It will reduce skin cancer prevalence and save lives.

Recent statistics reveal that 61% of Irish adults and one in four primary school children are now overweight or obese. My Department held a major stakeholder consultation at the end of April on what we need to do collectively to address the challenge of overweight and obesity. The consultation brought together key stakeholders to prioritise the actions which Government and other sectors need to take over the next ten years to tackle overweight and obesity. A new obesity policy and action plan will be finalised this year and brought to Government for approval. While some comments and reports on the matter in recent weeks were sensationalised and not evidence-based, which serves no good, it is a real personal and public health issue and needs to be taken as seriously in the future as tobacco in the recent past and alcohol now.

The second theme is patient outcomes and patient safety. As members know, I have taken a personal interest in emergency department overcrowding. Overcrowding in our hospitals has eased since January and is trending downwards. Progress is being made but it still remains higher than at this point last year. Similarly, the number of delayed discharges has fallen from a peak of 850, but remains at about 680. At the beginning of April the Government approved additional funds of €74 million to reduce delayed discharges by providing €44 million to the fair deal scheme resulting in an additional 1,600 places, and €30 million to provide an extra 250 convalescent and rehabilitation beds in community and district hospitals. The implementation of these measures has now begun but will take about eight weeks to fully implement.

As of 30 April there were 575 people on the fair deal waiting list with an average wait time of four weeks from the date of approval, down from 11 weeks at the start of the year. More than half of the additional community and district hospital beds are now open. The emergency department task force report needs to be fully implemented and I will personally drive this. There will always be surges in demand, and all health services have patients on trolleys from time to time, but trolley waits of nine, 12 and 24 hours represent a real patient safety risk and need to be reduced considerably. I have mandated the HSE to ensure than nobody is waiting more than 18 months for a surgical procedure or outpatient appointment by July, and no more than 15 months by the end of the year. I know that may not seem very ambitious, and it is not, but within current resources it is realistic and achievable in all but a small number of sub-specialties. While the numbers on waiting lists are likely to continue to rise as demand rises, I want to make sure that those who are waiting are not waiting as long.

On patient safety, we are continuing to develop and monitor the implementation of the national clinical effectiveness guidelines, of which there are six to date with a further two currently in development, namely, the national paediatric early warning system and the clinical handover for acute services, and we are continuing to develop better implementation of HIQA recommendations. The HSE's joint open disclosure policy with the State Claims Agency is now being used in 47 acute hospitals and five PCCC areas, up from 15 hospitals and one PCCC area in 2013.

The third theme is universal health. Agreement was reached with the IMO in April on GP care without fees for the under-sixes and over-70s and on the introduction of an asthma cycle of care for children and a diabetes cycle of care for medical card or GP visit card holders who have type 2 diabetes. This represents the first step in the phased introduction of a universal GP service and will benefit over 300,000 senior citizens and children this summer. On universal health insurance, I firmly believe that we need to make health insurance more affordable before we can make it universal. At the end of 2014 I announced a number of actions to achieve this. These include a reduction in risk equalisation stamp duty, a reduction in the HIA levy, no further diminution of tax relief, discounts for young adults and, last month, the introduction of lifetime community rating. As a result some premiums have been reduced, others frozen and new affordable products are on offer. The number of people with health insurance is rising again and initial indications suggest that a very large number of people signed up in the past few weeks to beat the LCR deadline. I have learned this morning, in fact, that 74,000 additional people signed up in the past few weeks and the figure for the year so far is 80,000.

The fourth theme is reform, including greater investment in IT, which saw a 30% increase in budget this year to €55 million in capital. Key IT projects include e-referral, so that GPs can make referrals to hospitals online; electronic patient records, a move from paper to electronic records which we hope will be fully in place by the end of the decade, so that the moment a person gets into the back of an ambulance a paramedic can access their medical records on an i-Pad; and the issuing of the first individual health identifiers later this year - a sort of PPS number for health. I would encourage the committee to invite Mr. Richard Corbridge, chief information officer for the HSE, to come in to brief you on these very exciting plans.

The fifth theme is investment in modern infrastructure and facilities. The most important of these is the new children's hospital, the biggest single health infrastructure project ever in the history of the State. The planning application for the hospital will be lodged this summer and, subject to An Bord Pleanála’s decision, we could have planning permission by Christmas or early in the new year with construction commencing soon after. I visited Great Ormond Street Hospital in London this week and I can assure the committee that the new children's hospital we have planned will be more modern and have more beds and operating theatres than any children's hospital in the United Kingdom.

On the overall financial position of the health service, the latest figures from the HSE demonstrate the significant challenge facing us as a result of the changing demographics in Ireland. Over the next few years, the population aged 65 and over will increase by approximately 20,000 per year, placing increased pressure on our acute hospital, community, and social care sectors. We will continue to work to develop safe quality services for patients, while at the same time looking for ways to reduce costs. While it is difficult at this stage to draw conclusions as to the year-end position based on data from January and February, due to a number of factors including the exceptionally high level of delayed discharges during these two months, the new measures recommended by the ED task force and agreed by Government, along with the ongoing reform of practices and processes in hospitals, are beginning to show results. Current expenditure projections are preliminary in nature, and my Department and the HSE are working together to understand the deficit to date and the likely full year impact of this variance and emerging and known funding pressures. The HSE is moving to reduce overspending and is working closely with the Department to mitigate the projected deficit to the greatest degree possible. Mr. Tony O'Brien will speak on this further if members wish.

I want to turn now to maternity services and, in particular, to the recently published HIQA report on Portlaoise hospital. Many aspects of the HIQA report disturb me, as I am sure they do committee members. I am ashamed at the manner in which patients were treated without respect, care and compassion when they most needed it by members of my own profession and other professions. Many did not receive the quality of care we should expect from a modern health service in the developed world. Patients and their families were treated dreadfully and at times inhumanely. As I have said previously, it is not all about resources and we should challenge those who seek to make resources the excuse for all failings. If we allow it to be an excuse it will always be the default excuse. That in itself is a threat to patient safety. It costs nothing to care. Honesty costs nothing - and in fact it probably saves money - and neither does compassion. Adherence to professional standards and being properly trained and accredited to do one's job should be a given. Too often, it is not.

The report highlights the urgent need to embed a patient safety culture right throughout the health service. I intend that this should not just be another report. It should be a watershed report. Patient safety, outcomes and quality must never come second to institutional, corporate, staff or local political interests. Decisions made on resource allocation and service location must be made on the basis of what is best for patients in terms of safety or outcomes, not financial savings or votes. Having met some former patients and there families last night, I am more convinced than ever that a patient advocacy service should be established and it will be fully independent of the Health Service Executive.

All mistakes are not medical negligence and mistakes and misjudgments will always happen - that is the nature of medicine. All complaints will not be valid or upheld. But we need to move to a new culture when complaints are welcomed and seen as a tool to guide us in improving services and patient satisfaction. Too often and for too long the health service has been defensive in dealing with complaints and fails to deal with them in a timely manner and therefore adds insult to injury and hurt on hurt. An independent patient advocacy service will be crucial in supporting patients and changing that culture. I accept the HIQA report in full and thank the investigation team for its work. The four recommendations made to my Department will be implemented. The HSE has confirmed that it too will implement the four recommendations made to it. I expect the HSE to implement an action plan to address the findings of the report without delay, and certainly by the end of the year.

Improvements have been, and will continue to be made at Portlaoise hospital, which I had the opportunity to visit yesterday. New management and governance structures, both clinical and operational, are in place, including a new hospital manager and a director of midwifery for the first time, as well as an on-site risk manager.

Appointments have been made to key posts of concern in both the maternity and general services. This includes additional consultants in anaesthetics, surgery, emergency medicine, paediatrics and obstetrics. Sixteen additional midwives have been appointed and approval has been given for further midwifery posts to include shift leaders and posts in diabetics and ultra-sonography. An ambulance by-pass protocol is in place for serious paediatric and trauma cases. For the record, it is important to point out that since the Government came to office the number of midwives employed in the public health service has increased from 1,100 to 1,400 and the number of consultant obstetricians is at an all-time high. It is certainly nowhere near where it needs to be and it is not up to international standards but it does show that during a period of cutbacks the Government did prioritise front-line services in particular in this area.

Structural change has begun, with Portlaoise hospital now forming part of the Dublin-Midlands hospital group. Governance of the maternity service will transfer to the Coombe in line with a memorandum of understanding agreed already. At the end of April, I appointed a steering group chaired by Ms Sylda Langford, former director general of the Office of the Minister for Children and Youth Affairs, to prepare a new maternity strategy for Ireland. In doing so, I am implementing one of the recommendations of the HIQA report into the care of Ms Savita Halappanavar.

The new maternity strategy will put the needs of mothers, babies and their families at its centre. The focus will be on maximising patient safety, quality of care, and clinical outcomes as well as the desirability of greater patient choice, the move towards more services in the community, and a renewed focus on prevention and well-being. I have asked the group to report to me by the end of the year. As committee members are aware, ten years ago cancer care in Ireland was below standard and fragmented, and we did not collect data properly. Today, it is well organised and survival rates are improving all the time. I want to adopt the same programmatic approach that was adopted to cancer to women's and infant health in the next decade.

There are a number of other initiatives and developments on which I would be happy to update the committee but I know my time is limited and committee members will also want to hear from the director general and to ask questions, so I will conclude at this point. I will be happy to respond to queries that arise.