Simon Harris (Wicklow, Fine Gael) | Oireachtas source

We have concluded a very good drug agreement and I thank all the State agencies which worked very hard on it. We got such an agreement because of the decision taken by this Oireachtas in 2013 to put legislation in place which enabled the HSE to set the reimbursement price, were the Government of the day not satisfied that it was getting the savings that were needed. When Government was informed by the HSE that it intended to use this legislation, which received cross-party support and was recommended by the previous health committee, it got people back to the table and achieved substantially larger savings than we would otherwise have achieved. This is an example of the good work that can be done by Oireachtas committees which then feeds into legislation and into a real benefit for the taxpayer. The Senator is right, however, in that we need to do much more. There is a medicines management group within the HSE and it has a number of ongoing projects. There is a potential saving with regard to oral nutritional supplements of €5 million per year and there is ongoing monitoring of preferred drugs and prescribing trends. It is continuing to review high-tech medicines used in assisted reproductive technologies and is developing EU authorisation processes for these medicines. It continues to look at ideas suggested by Deputy Kelleher in his legislation on biosimilars, on which I hope we can have a good engagement in this committee at a future date, and at enhancing evidence-based prescribing and optimising patient safety through a reduction in medication-related adverse events. We are continuing to strengthen the audit function in respect of making sure we are paying the right prices in the case of dispensing fees. There are a number of things we need to continue to do in this area.

The Senator's point about beds and operating theatres echoes complaints I hear from consultants and surgeons on a regular basis. I visited Cappagh Hospital recently, where four of its six theatres are closed not because they did not have the consultants but because, under activity-based funding, they had run out of parts. They had run out of the replacement hips and knees they needed to carry out procedures. That creates huge frustration among patients who are waiting and creates huge issues in regard to retaining skilled professionals in this country. I do not refer to this particular hospital but people are turning up for work and are not able to work to their optimum, meaning patients suffer. For this reason I have made a decision to allocate additional resources to Cappagh in the budget for my Department and within the HSE service plan for 2017. We have allocated €3 million to Cappagh for 570 orthopaedic patients to receive funding through the winter initiative which will eliminate the hospital's 18-month target. We have done the same for scoliosis and orthopaedics.

The Senator asked whether I would be open to considering other arrangements and I want to be careful how I answer that, on account of the contractual positions that exist. I hear what he said on the need to provide our surgeons with the opportunities to carry out surgeries. The Senator will have seen that, in my five months in this job, I will not be imprisoned by ideology on this and I want whatever it takes for patients to be seen more quickly. My preference would be to strengthen the public system so that doctors and surgeons have the necessary facilities but I will keep his suggestion in mind.

There was a question on NCHDs and this was a point made to me when I first engaged with junior doctors on taking up this role. While there are pay issues across the public service that are dealt with centrally through our colleagues in the Department of Public Expenditure and Reform, there are issues above and beyond pay that can have a real impact on recruitment and retention of our health care professionals. I hear, loudly and clearly, the point on the need to provide the same training opportunities and career advancement as exist in other jurisdictions not too far away from here. This also follows the report which we are working our way through at the moment. This is a priority area.

We have not listened to NCHDs often enough in the health service and their voice has not been heard enough outside of the normal industrial relations mechanisms. In terms of policy engagement it is important we do not just hear the voice of certain grades within our health service but that of everybody. A very good initiative undertaken by the HSE is the creation of the lead NCHD role. In every hospital I visit, junior doctors and NCHDs are making me aware of their presence. The lead NCHD tells me what his or her team can do in the hospital to improve practice and process. All lead NCHDs are brought together by the HSE senior management on a regular basis to have an input and this is something I want to see more of. It is about issues other than pay, such as recognition, listening and the opportunity to feed in to decisions as well as training opportunities.