Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Chairman and the members and I am very happy to have this opportunity to appear before this committee once again. As the Chairman has outlined, I am joined today by my ministerial colleagues, Deputies Finian McGrath, Catherine Byrne and Jim Daly. I congratulate Deputies McGrath and Byrne on their re-appointment and I welcome Deputy Daly to his new role as part of the Department of Health's ministerial team. I am also joined by the Secretary General, Mr. Jim Breslin.

I am pleased on more than one level to be here again. I have said on a number of occasions that our health service needs stability in its political leadership and direction. I am very glad and honoured that I, as Minister for Health, will have the opportunity to continue to work with this committee and with all involved in the Irish health service with the common aim of trying to improve the health service for our patients and staff. Although the name in the ministerial chair is the same, I welcome the opportunity to take stock and take a fresh look at this Government’s priorities and, indeed, the Oireachtas' priorities and to refocus our efforts to make things better for patients. The Taoiseach has made it very clear in his speech to the Dáil Chamber that delivering real improvements in our health services is a key priority for this Government. I will not deny that we face challenges. Over the last period of time, however, I have learned some valuable lessons.

Perhaps one of the most encouraging lessons is that there is an absolute abundance of good people who are making a difference in our health service. I am talking about clinicians, patient groups, policy makers and, indeed, Oireachtas Members, all of whom share the same goal, namely, to develop a health service we can be proud of. We need to harness that commitment. While we need to acknowledge the range of issues and challenges we face we also need to look at oursuccess stories, of which there are many. Just yesterday I welcomed the publication of the third annual report of the national health care quality reporting system. It is very encouraging to see the improvements in a number of areas. Hospitalisation rates, for example, have decreased substantially for both diabetes and heart failure. During the last ten years, deaths following stroke and heart attack have decreased by 28% and 40%, respectively. Cancer screening and treatment services compare favourably against other OECD countries and rates of MRSA have fallen by 66% since 2006.

We have a range of policies and strategies in place to bring about further improvements. The Healthy Ireland strategy, the maternity strategy and the eHealth strategy provide great clarity on what is required in three important areas, as do the HSE’s national clinical programmes at a more operational level. I will shortly launch a new cancer strategy and the Minister of State, Deputy Byrne, will bring a new national drugs strategy to Government following a huge amount of work and engagement with stakeholders on her part. I also intend to shortly bring proposals to Government on the development of a human tissue Bill that will encompass opt-out arrangements for organ donation. This can actually help save more lives. All of these represent real progress in improving outcomes for patients and for service users. I have also learned the value of using the available expertise to inform solutions.Importantly, the strategies I have just outlined have all been developed with both patient and service user input. Who better to inform a strategy than those who have experience and valuable input to offer?

The value of adopting a cross-sectoral approach cannot be overstated. When I say cross-sectoral I am talking about collaboration within our health services and also across Government. This is clearly evidenced in the publication of the report of the Committee on the Future of Healthcare. The near unanimity in support for the report demonstrates that we as politicians can put aside our political differences for vital issues such as the goal of delivering a world class health service. I would again like to commend the work of all members of the committee, some of whom are also members of this committee, for the time and effort they dedicated to producing the Sláintecare report.

This is a critical milestone in the history of our health service. It provides us with a solid framework and guidance for the development of health services over the next decade.

There is no doubt that considerable change and transformation is required. That is why the ten year timeframe is a key strength of the report. If we want to introduce meaningful changes on a sustainable basis, we need to be realistic about the timelines required to plan and implement large scale system change in services as important as health care. We must also ensure sustained buy-in to these changes, independent of intervening electoral cycles and the composition of the Government of the day. We need a new model of integrated care, centred on comprehensive primary and community care services. That fact is undisputed by any member of the committee. Our hospital system will simply not cope with the likely levels of demand in the coming years if we continue with our current model of care. Our hospital services are already showing the signs of considerable strain in meeting growing demand for services. Health outcomes and patient experience can be much improved by developing greater services in the community and by bringing about deeper and more seamless integration across the health and social care system.

Since taking up the position of Minister over a year ago, I have been clear that we need more capacity, both physical and staffing. This problem is being experienced right across the health system. A capacity review is under way which will report later in the year. It will give us a definitive assessment of capacity requirements across the system and provide a platform for planning and delivering health services in the years ahead. We all know we will not address capacity constraints overnight but building on the additional capacity already introduced last winter, we can, through targeted capital investment, start to equip our health services for the growth in demand that is being experienced. Since last we met, the Government has approved two major capital investment decisions in health facilities in the form of the national children’s hospital and the national forensic mental health facility. We also saw the opening of the new state-of-the-art emergency department at University Hospital Limerick. There is also a concerted effort under way to recruit and retain staff. While this is not without its challenges, the development of a more attractive working environment will go hand in hand with the roll-out of system improvements.

The number of consultants has increased significantly. At the end of April 2017, there were 2,884 whole-time equivalents. This constitutes an increase of 298 since April 2014. The number of non-consultant hospital doctors has also increased significantly from 4,982 at the end of April 2014 to 6,092 at the end of April 2017 to support service delivery and the progression of compliance with the provisions of the European working time directive. This was very important. Nursing and midwifery numbers at the end of April 2017 stood at 36,549 whole-time equivalents, having increased by 625 whole-time equivalents in the 12 months from end April 2016 and by 1,870 in the three years from end April 2014. We intend to build on these increases through further recruitment and retention initiatives. The new public pay agreement, which is under consideration by union members, provides improvements in pay which I hope will make the salaries we can offer in this country more attractive. However, the committee members know that pay is not the only issue which influences the attractiveness of a working environment. A number of initiatives are being taken forward by my Department and the HSE, including the continued implementation of the recommendations of the MacCraith group and the task force on staffing and skill mix for nursing, which is beginning to yield real progress.

Significant work is also being undertaken by the office of the chief nursing officer in my Department to widen opportunities for nurses to develop career paths as advanced practitioners or working in the community as part of the development of primary care services. An essential part of any development of primary care will be the agreement of a new GP contract which we have discussed many times at this committee. I am very pleased that the next phase of discussions is under way with the aim of developing a new modernised contract to facilitate the shift within the health service away from hospital services towards an integrated primary care service. I want to see a new contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions. The discussions which are currently taking place are wide ranging and ambitious in their scope. While there will be challenges for all parties involved, I am hopeful that with the goodwill and co-operation of all parties, significant progress can be made in these discussions. I have always said this was a huge body of work which would take the bulk of 2017 to do. That is indeed proving to be the case.

To achieve the responsive, integrated, effective system that we all desire, significant investment in information systems is needed.This came up often during the SlainteCare report process. We were coming from a particularly low base when the e-health strategy was first put in place. This is a prime example of a challenge which might have appeared too daunting to permit systemic change but we are beginning to see what can be achieved when a clear strategy is put in place. At end of May, I signed a commencement order and made regulations under the Health Identifiers Act 2014 allowing for access to the register of individual health identifiers and also for the use of the health identifier within the health sector, both public and private, for the purposes provided for in the Act. The latest legislative provision allows for the beginning of the roll-out of individual health identifiers by the HSE. While it will take some time to embed the number in all our health systems, the recent legislative action is a timely and important step and an enabler for an improved health information system.

In addition to tasking me with preparing a response to the SlainteCare report, the Taoiseach announced upon his appointment that bringing forward legislation on alcohol is one of his priorities. Committee Stage of the Public Health (Alcohol) Bill will likely recommence in the Seanad in this session of the Oireachtas. I appeal to all members of the committee and our respective political parties to give their full support to our progression of this critical piece of public health legislation through the Oireachtas. The Taoiseach also announced that bringing forward legislation to allow for a referendum on the eighth amendment in 2018 is one of his priorities. I await the report of the Citizens Assembly which I understand is due to be published very shortly. As members know, the report will be referred to the special joint committee on the eighth amendment which is to report its conclusions and recommendations to both Houses of the Oireachtas within three months of its first public meeting.I have been clear my view is that this is an issue with which we as a nation must now deal definitively. I want to be the Minister who brings forward the legislation to allow this important referendum to take place in 2018 but I am conscious of the body or work the Oireachtas committee will do over the coming months. I am committed to making all possible resources available within my Department to ensure we can act on any proposed change.

One of my personal priorities and that of the Taoiseach is to make progress on access-related issues. While there are may good parts of our health service, access is the key issue that causes so many of our citizens' problems. Reducing waiting times for the longest waiting patients must be a key priority. It is for this reason that €20 million was allocated to the NTPF in the budget 2017, rising to €55 million in 2018. I asked the HSE to develop waiting list action plans for inpatient, day case, scoliosis and outpatient services and they are now being implemented and making a difference. The inpatient, day case and outpatient planfocuses on reducing the number of patients waiting 15 months or more for inpatient and day case treatment or for an outpatient appointment by the end of October. The scoliosis action plan aims to ensure that no patient who requires scoliosis surgery will be waiting more than four months for surgery by the end of 2017. It is an extraordinarily ambitious but important target. During 2017, my Department will continue to work with the HSE and NTPF to ensure the best use of public hospital capacity and the private hospital system to meet the needs of patients waiting for inpatient, day case and outpatient services. We will ensure work begins to get under way quickly for 2018.

In turning to emergency care, I acknowledge first the distress caused to patients, their families and front-line staff working in extremely difficult working conditions in emergency departments in hospitals throughout the country. Data from the HSE indicates that the national situation saw an improvement from January to early May. Since May, there has been an increase in trolley numbers due to a series of factors including, increased emergency department attendances and elective activity, which shows that when one tries to perform more elective procedures, it has a knock-on effect in the emergency department, showing the clear need to increase capacity. My Department and the HSE are currently engaged in a process to commence winter planning for next year and to achieve an improvement in emergency department performance. The HSE is implementing a roadmap which sets out an approach to driving reduction in the number of patients waiting on trolleys and trolley wait times over the period from March 2017 to the end of the year 2018. Achieving improvements in access times for both scheduled and emergency care is a challenge for health services against a backdrop of growing demand but it is a challenge to which everyone must rise. I will be working closely with officials and the HSE to show that we can make a positive impact in this area. It cannot be beyond our health service or our country to improve this situation. My ministerial colleagues are also progressing a number of priorities within their areas of responsibilities and I am sure they will be able to outline these during the questions which follow.

I am very happy to be returning to work with the committee with a fresh mandate from the Taoiseach to deliver real and lasting improvements in our health services. Life will never be so dull that we have unanimity on everything-----