Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Deputy. He has made many points and I will try to go through them as quickly as I can.

With regard to the National Treatment Purchase Fund, NTPF, the Committee of Public Accounts did some work on this a while back and found there was value for money from the fund, although there is a case to do more. The activity-based funding model we are moving towards will enable us to have a much quicker look at value for money. It will create data on, for example, how many procedures were done in a certain public hospital for a certain amount of money, which will provide us with a level of data in regard to public hospital costs which, to be frank, we do not have to the quantity we need.

I want to be clear in regard to the NTPF that I am very eager it does not just do outsourcing but also does insourcing. This is not all about private hospitals or private health. It is about accepting we have too many people waiting too long and we need to come up with a pragmatic solution. I believe the Deputy and I share a view on this. Some of our public hospitals have spare capacity. We should be funding them to do the procedures. The job of the NTPF is not simply to come in and outsource everything to the private sector. It will have a dedicated fund to get through the waiting lists in the most efficient and pragmatic manner for patients, be that in a public or a private hospital. However, I make the point that there is spare capacity, and Cappagh hospital is an example of spare capacity within the public service that we have tried to ramp up through winter initiative funding.

The other part of the value for money question we have to consider is where there is not capacity. There are parts of the public sector where, even if it is more efficient to carry out procedures there than somewhere else, there may not be the capacity there today, whether in terms of theatre nurses, whom we are having a difficulty attracting, or in terms of the infrastructure of the building. These are all issues we have to address but they are not going to be addressed today or tomorrow. The patient is waiting and, therefore, the value for money question becomes less relevant and it becomes a question of where we can get the patient seen now.

The Deputy made a point about running out of money for implants. This is a huge challenge and we have to do much better. I believe the NTPF will provide a pipeline of work that will enable us to better predict what we actually need to do. When I met NTPF representatives recently, I was very encouraged that they were able to say that if I provided them with X million euro, they could do a certain number of procedures, and if I provided Y million euro, they could do a certain other number of procedures. This will provide a degree of certainty to the Irish patient that X number of tens of thousands of operations will be done in certain specialties under the NTPF and this will bring down waiting times for those procedures. That is something we badly need.

The Deputy referred to the group structure, which is something we need to stress-test much further. The whole idea of the group structure is using each hospital within it in the most effective way. There will be the acute hospital, the level 2 hospital and the level 3 hospital. Moving patients between hospitals to get them to the most appropriate setting for their needs is happening very well in some hospital groups. I note the links between Beaumont Hospital and hospitals in County Louth, such as Louth County Hospital and Our Lady of Lourdes Hospital, and in Cavan. We see patients being moved from Beaumont Hospital and getting a procedure done very quickly in Cavan Hospital. To be frank, that is not happening enough in every hospital group and it is something we need to do more on. I agree with the Deputy on that.

With regard to the drug pricing agreement, the Deputy is correct that we are facing a huge challenge, not just in this country but globally in terms of the availability of drugs. We have a very good and proud record in this country of providing our patients with access to new drugs and we bear up very well in terms of international comparisons. The drug pricing agreement is not going to see us, in any way, shape or form, spend less on drugs but it will see us have some degree of headroom to purchase new drugs for our patients. The robustness question is a fair one but I am satisfied that the State showed its robustness this time. The industry certainly found this in the sense that it had thought it would be able to put in place a deal that would achieve a certain amount of savings and it ended up delivering a deal with the State that has brought a significantly larger amount of savings.

The point both the Deputy and I are grappling with, and it is a point on which I would appreciate the committee's help, is how we can do this better and what is best international practice. I am talking to other European health Ministers in this regard. I have heard ideas from the Deputy's own party in regard to the creation of a fund. I am not against that and I believe there is a logic to it. However, there is still a difficulty as to how it can be funded enough, how we know how much is enough, who accesses the fund and what are the criteria. As an Oireachtas, or as a committee, we can do a very useful body of work. I would certainly appreciate the views of the committee in terms of best international practice in this regard.

Another point I would make in regard to the drug pricing agreement, which I believe shows the robustness of the State's side, is the frequency of the price realignment. We do not have a static deal that states we are paying so much for every drug for the next number of years. There is an annual pricing realignment built in that can see us benefiting on a year-on-year basis from price reductions, obviously with reference to a larger basket of countries, including a number of lower-priced countries that were not included previously.

In regard to the winter initiative, I am convinced the key to making progress in our emergency departments lies with delayed discharges. The figure I was given yesterday in regard to delayed discharges is 629, which is still far too high, and while it has been higher and has been lower, it needs to be much lower. As I have tried to delve into this, I have found a number of reasons as to why there are 629 patients in hospitals today who medically do not need to be there. For example, there is a degree of capacity in the private sector in certain geographic areas to provide home help. If one goes to certain hospital on the north side of Dublin and goes into its bed management room and looks at the people listed on the whiteboards, they will have funded home care packages but they do not have anyone to provide them. It is an issue the HSE is working on. While we are making some progress on that, it is partially to blame for that large figure.

There is the issue of nursing homes. This is a very big decision for any patient to make and the State should not be imposing a decision on what nursing home an older citizen wants to go to, or if the person is not in a position to make the decision, where their family wants them to go. The person might want to go to nursing home X but there might not be a place in that nursing home today or tomorrow. We have to grapple with the fact that it is fine that the person gets to wait for a nursing home as it is their decision, their dignity, their life. However, is there not somewhere better for the person to be, other than the acute hospital bed? This brings in the whole question of transitional beds and we see in the winter initiative the commitment to opening more transitional beds.

Let us not ignore the elephant in the room. The Deputy makes a significant point that the silo mentality is something we have to look at. I have resisted saying too much on this because I know the Committee on the Future of Healthcare, of which a number of members of this committee are members, is looking at structures. I want to try to get to this cross-party agreement on the ten-year plan, as we all do, which is a huge body of work. I personally believe there is significant merit in looking at how hospital groups and CHOs operate. If people are protecting budgets, with the hospital protecting its budget and the community protecting its budget, and the person in the hospital who needs to send a patient home today does not actually control the budget for home care, that is a problem. I intend to act on it but I would like to see if we can arrive at a conclusion as part of the work that is ongoing in that committee and I do not want to wrongly interfere. However, I accept the silo piece is a legitimate point of criticism and something we need to deliver on.

I am glad the Deputy raised the point about children. There is a view at present that we are just building a national children's hospital, which we are, but we are doing so much more than that. We are building a hospital in Dublin and we are building satellite units in Dublin but we are also putting in place a paediatric model of care so any child, anywhere in this country, will be under the umbrella of a children's hospital group. Therefore, we will not have silly situations which have an adverse impact on our children because they are stuck in one hospital because someone else will not talk. I intend to bring that paediatric model of care to Government shortly. I am also engaging with the boards of the existing children's hospitals. I have met two of them and am meeting the final one in the morning. I intend to bring the heads of a Bill to Government to move on with that new integrated model.

With regard to e-health, I am now satisfied that we have the capacity which we clearly did not have on the State side and the HSE side for a long number of years. Excellent work is being done by the chief information officer and the e-health group. As a GP himself, the Chairman will know GPs are streets ahead of the acute hospital sector in terms of technology. When a person goes into a GP, they are not tripping over paper files. The Chairman should see the pictures I get sent of the paper files being stored in hospitals - there are warehouses full of paper files. GPs have proven they can grapple with the e-health agenda and they are doing it. We now have e-referrals in place where many GPs, at the click of a button, are able to refer a patient onto an outpatient waiting list. The analysis my officials have done is that before that happened, the referral would have passed through 16 pairs of hands before the referral was made. We will very shortly have e-discharge so the GP hears back that the patient is out of hospital and also receives the patient's notes. We will have the individual health identifier and, ultimately, we will have the electronic health record by 2020. There is a huge body of work going on and I am satisfied it is going well.