Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am very pleased to have the opportunity to appear before the committee again.

I am joined today by my ministerial colleagues, the Minister of State with special responsibility for disabilities, Deputy Finian McGrath, the Minister with responsibility for mental health and older people, Deputy Helen McEntee, and the Minister with responsibility for communities and the national drugs strategy, Deputy Catherine Byrne. The Minister of State with responsibility for health promotion, Deputy Marcella Corcoran Kennedy, sends her apologies as she is in Brussels. I am also accompanied by officials from my Department, Mr. Jim Breslin, Secretary General, Ms Frances Spillane, assistant secretary with responsibility for disability services and older people and Dr. Siobhan O’Halloran, chief nursing officer and assistant secretary with responsibility for mental health and drugs and social inclusion. I also welcome Mr. Tony O'Brien, director general of the HSE, and his officials. At our last meeting we had a frank and positive exchange. I look forward to an equally interesting discussion today.

One thing that was clear during my last meeting was that health should not be a party political issue. At any one time we all know someone who is accessing services, a family member, a friend, a colleague. We all share the same goal. Each of us wants a health service where people feel valued, respected and well cared for. Since I was appointed six months ago, I have visited more than 20 hospitals and other primary care health facilities throughout the country. It is vital and has been very beneficial for me to see for myself what professionals, front-line health service staff, patients and families experience. There are positives and negatives to report. Do I feel heartened when I witness the levels of professional commitment? Yes. Do I feel encouraged when patients tell me that their lives have greatly improved since they had their surgical procedure or obtained treatment in an Irish hospital? Yes.

Equally, I am not blind to the fact that we face significant challenges. We face increased demand from a growing and ageing population and the increasing incidence of chronic conditions. I know that patients and families and, indeed, clinicians are frustrated by waiting times. To address these challenges I, as Minister for Health, and this Government accept that significant investment is required. In recent years the health Vote has typically required an annual supplementary budget to cover deficits. In July of this year, in an effort to properly fund health and break the cycle of Supplementary Estimates, the Government provided an additional €500 million funding to the health service to bring the total gross funding to €13.695 billion.

When we last met we were in the last phase of budget 2017 negotiations. I am pleased to report that budget 2017 delivered the highest health budget ever at €14.6 billion. Of this amount, just over €14 billion is for current funding and just over €450 million for capital funding. This unprecedented investment will serve to make a real difference in the services we can deliver. Budget 2017 includes €18.5 million to support the development of primary care services; €10 million in new development funding for home care supports like home help and home care packages; €20 million to enable people with a disability to move to more appropriate accommodation in the community. The budget also provided for automatic medical cards for an additional 10,000 very sick children, whose parents are in receipt of domiciliary care allowance. These increased resources will also allow the health services to plan for the challenge of increased demand from a growing and ageing population, and begin some significant new developments which will over time deliver real improvements for patients.

Before going on to talk about the services which will be delivered in 2017, I want to refer to industrial relations matters, which is a topical issue at the moment. Members will all know that the INMO executive council has decided to ballot on industrial action. I respect their decision but industrial action is not the way to address the medium-term or long-term needs of the public health system. This Government is committed to a collective approach to industrial relations and public sector pay policy as the most effective means of delivering economic security and stability. Any approach to pay restoration must be within the terms of what is available and affordable. I am pleased, therefore, that the INMO has once again confirmed its commitment to the Lansdowne Road agreement. Through that agreement we have been able to deliver benefits for our front-line nurses such as the restoration of the increment for nurses who graduated between 2011 and 2015, amounting to some 4,000 nurses working in the Irish health service today who will see pay restoration of over €1,000 from January 2017. The public service pay commission has started its work and the Government will continue to work with ICTU over the coming weeks to ensure the continuation of a collective pay policy framework that meets the needs of public servants and society. I am well aware of the pressures felt by nurses and that is why budget 2017 provides funding for an additional 1,000 nurses to join the payroll. This is a very important role and I want to work with the INMO on recruitment and retention issues.

I want to see how we can improve and enhance the Bring Them Home campaign we have in place through the HSE to bring our nurses back home from abroad. I will be meeting the Irish Nurses and Midwives Organisation, INMO, next week as part of my ongoing engagement with key stakeholders on important issues relating to the health service.

The health services to be provided within the available funding will be set out in the HSE’s 2017 national service plan which is being finalised. I take the opportunity to outline key priorities for the year. One of my priorities when I was appointed Minister for Health was to reactivate the National Treatment Purchase Fund, NTPF. This year I secured an investment of €1 million specifically to treat approximately 3,000 additional people who had been waiting for an endoscopy treatment. As a direct result of this initiative, as at the end of October, the number of patients awaiting a gastrointestinal endoscopy had fallen dramatically, from 5,700 to 1,200. The NTPF is confident that by the end of the year there will be no patient waiting longer than 12 months for an endoscopy. Budget 2017 provides an additional €50 million to be allocated to the NTPF in 2017 and 2018 to treat patients who have been waiting the longest. It is important that we focus on those who have been waiting the longest. I am not sure that was always the way the NTPF worked in the past, but it must work that way now. In August the HSE developed a waiting list action plan focused on reducing the number of patients who had been waiting the longest. Throughout 2017 my Department will continue to work with the HSE to reduce waiting times through driving efficiencies and process improvements, with a particular focus on adherence to chronological scheduling and validating waiting lists.

I am delighted that the €40 million allocated as part of the additional €500 million secured in July has been provided on a recurring basis for the winter initiative. Winter comes every year and it is important that funding be provided on a recurring basis. I am pleased that has happened. As part of the winter initiative, €7 million has been allocated to fund a targeted waiting list programme for orthopaedics, spinal surgery and, importantly, those with scoliosis. The initiative had provided resources to treat patients on orthopaedics and scoliosis waiting lists, with over 600 patients benefiting. Since the initiative was announced recently, 354 patients have either been treated or given an appointment to receive treatment within the next six weeks. This funding is crucial in enabling winter preparedness measures to be introduced across the health service and reducing overcrowding pressures in hospitals.

I very much welcome the additional funding in the budget of over €90 million for acute and emergency services. The increased allocation demonstrates the Government’s commitment to driving key policy and strategic initiatives to improve and expand acute care and emergency services for patients.

Patient safety and the delivery of quality services to patients will remain priorities for me, my Department and the HSE. Provision is made for costs associated with the new primary care centres and the extension of medical cards to all children in receipt of the domiciliary care allowance. Work will continue on the development of appropriate primary care services through primary care teams.

Of course, improving health services is not only about resources, but I hope the additional resources demonstrate our commitment to investing the gains from a recovering economy in a better health service. With increased resources we can at least plan for the challenge presented by increased demands. While we need to consider the challenges facing us, we should also recognise where progress is being made.

At a previous committee meeting Deputy Catherine O'Connell and I spoke about maternity services. This is one area, in particular, where we are beginning to make a difference. This has been a landmark year for maternity services with the publication of the country's first ever national maternity strategy, Creating A Better Future Together, 2016 to 2026. The publication of the strategy demonstrates a new and enhanced focus on maternity care, both at policy and service delivery level. It provides a roadmap for how we can improve maternity and neonatal care in the years ahead. The Health Information and Quality Authority will publish in the coming weeks new national standards for safer and better maternity services. They will provide a framework for maternity service providers to ensure they are meeting the needs of women, their babies and partners and that a consistent service is being delivered across the country. These developments represent the necessary building blocks to provide a consistently safe and high quality maternity service.

The HSE’s national standards for bereavement care following pregnancy loss and perinatal death guidelines are also a positive step in the right direction, recognising that in the midst of devastation there are practical ways by which we can and must help bereaved parents.

I am aware that recently the committee was briefed by the National Paediatric Hospital Development Board and the Connolly for Kids Hospital group on the development of the new children’s hospital. The committee has asked me to address the issue and I am more than happy to do so. I want to be clear about this, as I read the transcript and watched much of the debate at the last meeting of the committee. It is very important that we all accept that every single person involved in, and every single doctor working in, the health service shares a common desire to try to put in place a national paediatric children's hospital. Some of the language used at the last meeting of the committee in terms of there being a suggestion anybody involved in the project, from a policy or medical point of view, would want to see anything but the best outcomes for the children was, frankly, offensive.

We are all united in a desire to build a national children's hospital. We can have disagreements but let us not get into the gutter. Let us not attack the bona fidesof the people involved in this project. I have seen the people work and I have talked to the clinicians, who were working so hard on delivering this landmark project for Ireland. It is really important that the legitimate issue people want addressed, explained and discussed be addressed. Accountability is important. Please do not doubt the bona fides and intentions of any of the people in my Department or the HSE, or those on the National Paediatric Hospital Development Board. They are working tirelessly to deliver this landmark project.

Independent reviews since 2006 have reaffirmed the importance of colocation with a major adult academic teaching hospital. St. James's Hospital has the broadest range of national specialties of all our acute hospitals, in addition to a strong and well-established research and education infrastructure, making it the hospital that best meets the criteria to be the adult colocation partner.

Importantly, enabling works began this summer on the campus of St. James's Hospital and they are under way as we speak. The National Paediatric Hospital Development Board is currently reviewing tenders for the main works contractor and specialist sub-contractors for the new children's hospital.

I will now address some of the issues raised at the Oireachtas committee meeting on 27 October. The issue of access to the children's hospital is of great importance to everyone associated with this project. The design of the hospital has recognised the need of most parents to access the hospital by car, and parking has been provided for families based not only on current demand but also on projected future demand. The parking system will also allow families to reserve spaces ahead of arriving at the hospital, and emergency drop-off spaces will also be provided. St. James's Hospital campus is better served by public transport than any other hospital in the country. I acknowledge, however, that most people will arrive by car. That is why it is essential to provide adequate parking.

The question of transporting neonates quickly and safely was raised during the hearing. This is very important for any parent, and it is important to raise it. The national neonatal transport programme serves the whole neonatal population across all 19 maternity centres and three paediatric hospitals and retrieves patients from anywhere in Ireland and abroad. In the programme's 14-year history, it has transported over 5,000 sick babies and, thankfully, there has not been one single fatality in transport. Let us acknowledge the work of the programme over 14 years. It has resulted in the safe transport of over 5,000 of our sickest babies.

It was suggested a children's hospital could be more easily, cheaply and quickly built on another site, such as that at Connolly Hospital. People have suggested it is not too late to change the site. I want to make clear that the cost of transitioning the new children's hospital to another site has not been assessed in any detail as no such project exists. We do know, however, that the transition of the new children's hospital from the current site at St James's would require the abandonment of all the work undertaken to date and a whole new design and planning process. At best, this would lead to a delay in developing this hospital, and it would also mean that construction inflation would be likely to have a significant impact on project costs. Together with lost expenditure on the project to date, that could offset much, if not all, of any savings to be obtained from building on a greenfield site. That is the best-case scenario. The truth is that such an application would have no guarantee of success.

Let us not forget that An Bord Pleanála's report ruling on the planning permission for the hospital rightly referred to congestion on the M50 and seriously called into question the view that unfettered access to the Connolly site and to on-site car parking can be accommodated. Let us also remember when we are having these conversations that the National Children's Hospital at St. James's will be supported by satellite units at both the Connolly and Tallaght hospital sites. I have visited Connolly Hospital to discuss that exciting development with management, staff and patients there.

We all know at this stage, being truthful, that further debate will not create consensus on this issue. The debate has been running for a seriously long time. There are children whose parents could, understandably, have expected to have benefited from this hospital who are now no longer children. My priority is now to make progress on the new hospital as soon as possible. The decision on the location was made in 2012 and it was reaffirmed by my most immediate predecessor. My priority is now to get on with building the hospital so we can ensure children, young people and their families have the facilities they deserve.

I want to see continued engagement from the National Children's Hospital and the new National Paediatric Hospital Development Board with parents who have legitimate concerns. This is a hospital for the children and parents of Ireland. The voice of children has to be at the centre of this, and ongoing engagement with parents and children is essential although we will not agree on every issue. The commitment I give to this committee is that we should continue to engage on all the issues.

The hospital will be built on the St. James's site. Let us continue to engage on all the issues and provide assurances, information and exchanges of ideas. That is absolutely vital and I am happy to commit to this happening.

Another topic which came up during our discussion at the committee the last time was the opportunity e-health offers. Deputy Louise O'Reilly asked me several questions on this. Projects under development in this area include the implementation of a new individual health identifier, a new national laboratory information system and a new maternal and newborn information system.

I also want to refer to some key initiatives being progressed by my ministerial colleagues. Several members are interested in disability services, an area in which I too have an interest. My colleague, the Minister of State with responsibility for disability issues, Deputy Finian McGrath, has been driving specific measures in this area. While he will be happy to discuss this in greater detail, I will highlight some positive developments. The task force on personalised budgets for people with disabilities was established by the Minister of State, Deputy Finian McGrath, in September.

The terms of reference of the commission of investigation into a former foster home in the south east are being advanced, informed by the recent Dignam report. The registration of designated centres for the Health Information and Quality Authority, HIQA, inspections was successfully extended through legislation, while HIQA's excellent work through its inspections continues to be carried out. Children with disabilities continue to be a priority and in 2016 the health sector worked closely with our colleagues in the Department of Children and Youth Affairs to launch the new access and inclusion model for children with disabilities to avail of the free preschool year. There is a renewed commitment to continue to move people with disabilities out of congregated settings to enable them to live independently and to be included in the community. This is being supported by €100 million in capital funding from the Department of Health from 2016 to 2021. This will also be supported through the service reform fund which represents a combined investment of €45 million between the Department of Health and Atlantic Philanthropies. An additional €31 million of the overall health budget was secured in additional funding for disability services in 2016 and included in the 2017 Estimates.

In the area of mental health, my colleague, the Minister of State with responsibility for mental health and older people, Deputy Helen McEntee, established a youth mental health task force. This is a community-led group with representatives of the public, private, community and voluntary sectors, which is mandated to act as a galvanising force to improve the mental health and well-being of our young people. An important project advanced at budget time by the Minister of State, Deputy Helen McEntee, is the national forensic mental health facility at Portrane, County Dublin. This project was spoken about for years and now will be developed as a result of the additional funding secured by her.

It has long been government policy to help older people and others to stay in their own homes and communities for as long as possible, with long-term nursing care being seen as a last resort only after home care and other community-based supports have fully utilised. Under this Government that emphasis is being strengthened. Overall funding for services for older people has increased to €765 million in 2017, an increase of €82 million since the HSE's 2016 service plan. This has focused on additional funding for home care in particular and is aimed at allowing people to continue to live in their own homes and at facilitating discharge of older people from acute hospitals.

Since her appointment as Minister of State with responsibility for communities and the national drugs strategy, Deputy Catherine Byrne, has launched a national public consultation process and published an expert review to guide which will inform the development of a new national drugs strategy. This will be published in early 2017.

The Minister of State with responsibility for health promotion, Deputy Marcella Corcoran Kennedy, launched the A Healthy Weight for Ireland - Obesity Policy and Action Plan 2016-2025, with 60 actions to improve Ireland's health and to reduce the burden of obesity across society. This policy and action plan aims to reverse obesity trends, to prevent health complications and reduce the overall burden for individuals, families, the health system and the wider society and economy. We are on track to be the fattest nation in Europe if we do not get this right. This is an important initiative.

These, of course, are just a sample of the many initiatives being progressed by my colleagues. The development of primary care is central to the Government's objective to deliver a high-quality, integrated and cost-effective health care system. The programme for Government commits to a decisive shift in the health service towards primary care. This involves enhancing primary health care services, building up GP capacity, increasing the number of therapists and other health professionals in primary care, and continuing to expand the development of the primary care infrastructure.

The development of a new, modernised contract for the provision of general practitioner services will be key to achieving our objectives of treating more people in the community. Engagements to date have seen the Department of Health, HSE and the Irish Medical Organisation, IMO, agree a several service developments including the introduction of a diabetes cycle of care for adult patients with type 2 diabetes, an enhanced support framework for rural GPs, and a revised list of special items of service under the contract to encourage the provision of more services in the primary care setting. The next phase of discussions on other aspects of a new contract is expected to commence before the end of the year. I have made it clear I want that process to be inclusive of GP organisations and look forward to the process moving ahead over the next several months.

We see the continued enhancement of speech and language therapy services for children and adults.

This has been a particular focus in recent years and development funding of €4 million was provided this year to focus specifically on speech and language therapy waiting lists in primary care and social care for children up to 18. This investment is allowing the HSE to fill 83 new posts in primary care to address waiting lists, prioritising the longest-waiting children for speech and language therapy. When these positions are filled, the number of speech and language therapists will be close to 700 whole-time equivalents.

The development of primary care centres to accommodate primary care teams is obviously an ongoing area of importance.

Regarding medical card coverage and developments, at 1 October 2016 there were just over 1.7 million medical cards, representing 35.9% of the population, and over 460,000 GP-visit cards, representing 9.8% of the population. Over 45% of the population has free access to GP services under universal GP care and the GMS scheme. This compares with nearly 38.1% at end of 2010.

Before I finish I wish to mention an upcoming event. I will shortly establish the new patient safety office based within the Department of Health, which will lead a programme of significant patient safety measures focused on initiatives such as new legislation, the establishment of a national patient advocacy service, the introduction of a patient safety surveillance system, extending the clinical effectiveness agenda and setting up a national advisory council for patient safety.

While we have secured a significant increase in funding for the health services, I do not underestimate the challenges involved in the delivery of a safe efficient health service. We must maintain our focus on improving the way services are organised and delivered. I hope I have given the committee a good overview of the many initiatives and reforms that are under way. I thank members of the committee for the opportunity.

If I can be so cheeky, I remind people that every Member of the Oireachtas has received an invitation from me to raise awareness about blood donation. We need more blood donations. It is something I have not done to date and I will rectify that wrong today. I hope as many Members of the Oireachtas as possible will join me after this meeting in donating blood. Transport provided by the Irish Blood Transfusion Service will leave Leinster House at 1 p.m.