Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the Minister and his officials. The Minister made an informed contribution. It is important that we interact with him and policymakers from all sides to ensure value for money and policies are brought forward that will underpin our basic commitment, collectively, to improve health services. I do not expect detailed answers, but I would like some insight.

On the National Treatment Purchase Fund, NTPF, the Minister has said he is not ideologically driven in how health care is accessed as long it is accessible and affordable and the waiting lists for inpatients, outpatients, day cases and so on can be addressed. Have comparisons been made, for example, of the cost to the public purse of performing orthopaedic surgery in various public hospitals and between public hospitals and the private sector? Very often, we simplify comparisons and do not compare apples with applies, but we need to do so in this case to ensure the public system is providing value for money and, equally, the private system is providing value for money and that NTPF money is not being eaten up in a manner that was unintended. Is that information available?

Senator Colm Burke has referred to an issue that has arisen in orthopaedics in Cork and elsewhere in recent years - hospitals running out of implants. The South Infirmary Hospital was told at the end of September 2013, for example, that that was it for the year. That is exceptionally frustrating for patients on waiting lists and senior, experienced, professional clinicians who want to get on with their job but who have to park surgical procedures, which is unacceptable. There are huge funding difficulties, but there has to be a more imaginative way to ensure a pipeline of implants for knee, hip and other replacements. Can the Minister be more definitive? The issue of clinical staff being unable to perform their duties in expensive operating theatres has to be examined.

There is a reward for management in keeping hospitals full of healthy patients or patients who need low level medical support because if they admit high dependency patients or patients who need surgery, it will eat into their budgets. We, therefore, need to be imaginative in how we address that issue. Senior managers have told me that if beds are full of patients who do not need major surgery or interventions, they can stay within budget, but if they fill them with patients who should be in the hospital, it eats into their budget. That is a perverse way of doing business, but it is happening in all the hospitals in the public system. They are penalised if they ramp up activity and do what they are meant to be doing. We have to examine this issue.

As I am ranting a little, I will move on to the drug pricing agreement, which I welcome. It was a confident move by the HSE and the Minister to say they would activate the legislation if more flexibility was not displayed by the pharmaceutical industry. However, in the next few years, there will be major challenges in funding health care generally and drugs specifically. High tech drugs are coming on stream and more novel, innovative medicines are available. That will continue to happen. Is there a robust enough system in place to negotiate with powerful and influential organisations? I do not cast aspersions, but is the system robust enough to enter into negotiations with these organisations, collectively and individually, and assess whether the State should fund these medicines? Private Members' Bills have been introduced which would have put the onus on the Minister of the day to play God. I do not accept that should be the case. The issue should be depoliticised to the point where there will be a system in place under which, at the end of the day, an entity or a group of people will still have to make a call on whether a medicine should be made available that, unfortunately, could have life or death implications. If all the funding is spent on medicines, that will have life or death implications in other areas of the health service. The pharmacoeconomics group does its job, but I wonder whether we should revisit this system to ascertain what is best practice outside the country. The Minister has said he will visit Bratislava, for example. There were be a significant increase in the number of medicines coming on stream in the next five to seven years. They will be expensive and almost tailor made to individuals through genetic profiling and so on.

On the emergency department task force, I criticise and compliment in equal measure; therefore, I am reasonably fair. The Minister has said €40 million is available for the winter initiative and to ensure the numbers of home care packages and home help hours will increase, which means that more patients will be moved out of hospitals. However, after almost every initiative that has been implemented during the years, 700 and 800 patients remained in hospitals who should not have been there. They are referred to as delayed discharges. We were at a figure of 1,000 at one stage, but it has been pared back to 660 or 680. Is there a systemic failing or is there insufficient capacity in the community care, social care and primary care systems? We have had this problem consistently.

We have siloed budgets. I have dealt with two cases in recent years in which high dependency home care packages were required for two children. They were in Crumlin hospital and could not be transferred because they were from the country. One cannot transfer budgets. One manager in the midlands told us that they could not bring in the child because they did not have funding for the high dependency home care package, yet management in Crumlin hospital wanted to move the child out, while the parents wanted to bring the child home. One has to wonder if there is any ability to cross-manage budgets in a way that would make sense for everybody. Clearly, that would have been in the interests of the hospital, the patient and the parents and it should have been done. Reference was made to the HSE, various directors and so on. Could we end up siloing everything again under the various headings such as community care, social care, mental health and so on? When the Minister examines this issue, he should ensure there is flexibility at directorate level, otherwise we will end up with these difficulties.

On e-health, Deputy Louise O'Reilly referred to the challenge in large organisations in introducing new technologies - whether they have the capacity to implement and develop them. There is major resistance to them, but sometimes they just do not have the capacity. Have the HSE, the Department and the hospital groups the capacity to embrace these new technologies and ensure staff will be able to use them?