Michael Harty (Clare, Independent) | Oireachtas source

Before I open the meeting to other members, I myself will comment.

The role of this committee is to hold the Minister, the Department of Health and the HSE to account on the urgent need for health reform as laid out in the Sláintecare report and this will be the lead committee to oversee that reform programme.

If evidence of the need for reform was needed, it was clearly illustrated on last night's "Prime Time" programme which demonstrated and exposed the damage of mixing public and private care in the public hospitals. It leads to unfairness and inequality of access. One must ask why it takes a television programme to illustrate these deficiencies in the health service. It was a shocking indictment of management and clinical governance and it illustrates the perverse incentives to doctors and hospitals to have private patients treated at the expense of public patients in the hospitals where private patients and public patients compete for the same beds.

It also illustrated the pressure on the public hospitals to treat more private patients as these hospitals depend on their income from private health insurance to fund their public services. This process is entirely wrong and denies access for public patients to the public hospitals.

The programme itemised the payments to consultants for hours not spent in public hospitals, but a far greater cost is to patients who are denied services because of failures to provide a consultant-led service in the hospitals. It leads to increasing waiting lists and an unacceptable unmet need. It means that senior decision makers are not present on the floor to make important clinical decisions and that leads to inefficiencies in the service.

To address this problem, we need to have a cultural change - the Minister himself referred to it - in the way we manage the health services and this involves accountability and sanction. The public-private mix is one of the greatest barriers to health reform and has to be tackled. It demonstrates the absolute need for legislation to hold hospital management and clinical management to account. The Minister, in his statement, states that we need to give "careful consideration" to this issue but he does not state that he is determined to definitively eliminate private practice from public hospitals. I hope the Minister will not be influenced by the powerful lobbies that will resist that change.

The Sláintecare report points to reform and gives it a proper direction. It is ambitious and radical and it has to be in that it has to bring equity of access based on need, not the ability to pay. It is about fairness and justice for all. The provision of adequate care is a human right and I believe patients are being denied human rights in the waiting lists that they have to endure, and the denial of treatment and procedures. We must have a single-tier service provided on the basis of need, not the ability to pay.

A single-tier service, as outlined in the Sláintecare report, has cross-party consensus and this should not be ignored or easily dismissed in the reform process. We do not need to have a piecemeal implementation of the Sláintecare report items which are in keeping with existing Government policy while the Minister procrastinates on the difficult but essential elements of reform which will require extraordinary political commitment if we are to develop a health service which we can trust and which can deliver quality care.

Six months have passed since this report's publication yet we still await the appointment of a lead executive and the setting up of an implementation office. We await legislation to reconstitute the HSE and the setting up of a Cabinet subcommittee in the Department of the Taoiseach to oversee the reform process. Without these essential components the reform process is not going anywhere.

The Cabinet subcommittee needs to be at a level of the Taoiseach and needs to have the power of the Taoiseach and the inter-connectivity between the Department of Finance, the Department of Public Expenditure and Reform and the Department of Health. This high-level political commitment will be needed to oversee the implementation office and give it political protection in delivering Sláintecare.

We must start drawing up legislation which will underpin the statutory basis of Sláintecare. We need legislation on a national health fund; legislation for a new Irish Sláintecare Bill and legislation for accountability in the Department of Health and the HSE; and, legislation to set up national standards in clinical governance. None of these is forthcoming to date. They are of vital importance if we are to establish a proper functioning health service which can deliver quality care. It is only then that we can start to effectively invest in health reform. If we do not have this legislation, investment in health reform will be wasted.

We should not let complacency develop. Already key deadlines have been missed. The implementation office, under the auspices of the Taoiseach, has not been set up. Recruitment of a lead executive at the level of Secretary General has not happended. Staff with expertise in implementing change have not been recruited. A detailed implementation plan has not been published six months after the publication of the Sláintecare report. We need to combat resistance to change, both in the Department and the HSE and in the wider health service.

Several members of this committee and I, as Chair, were members of the Committee on the Future of Healthcare and we know the recommendations of the Sláintecare report. The reality is that all milestones set out to date in the implementation section have been missed. This indicates that the reform programme is stalled and has gained no political momentum to date.

The Minister was quite correct in stating that the Committee on the Future of Healthcare did not sidestep its responsibility in this report. We expect the same commitment from the Minister. We need commitment at the highest political level to form the Sláintecare reform process.

It appears that the Minister was second guessing many of the recommendations of the report. Deputy Harris was calling for space and time to reflect and deliberate on and consider the report. The Minister has had six months to do so yet we have had no completion of any action recommended in the report. The programme office has not been set up, a missed deadline. A lead executive has not been appointed, a further missed deadline.

The failure to develop a draft implementation plan is also a missed deadline. A Cabinet sub-committee chaired by the Taoiseach and consisting of the Departments of the Taoiseach, Finance, Public Expenditure and Reform, and Health, has not been established to give political power to the implementation of the Sláintecare report.

Apart from the often proposed reorientation of the health service towards primary care, the disentangling of private care from public hospitals is an essential component of Sláintecare, as illustrated by the television programme broadcast last night. While a chairman to oversee the independent review has been appointed, the review group has not yet been populated, which is another missed opportunity.

The report refers to the realignment of community health organisations and hospital groups. The decision to put this proposal out for a consultative process will again delay reform. I referred to the legislation to reconstitute the board of the Health Service Executive, which has not been brought before the Dáil and is unlikely to be presented to the Houses before 2018. The timeline for this Bill is much too vague.

The Sláintecare report makes extensive reference to ehealth and information and communications technology systems and the Minister spoke of increased investment in ehealth. The HSE's chief information officer resigned from his post last week and stated the Government's failure to fund the programme was frustrating, noted that funding was in limbo and indicated that there was an absence of funding certainty coming from Government. These were some of the reasons for his resignation, which hardly engenders confidence in funding the Sláintecare reforms.

The unwinding of the financial emergency measures in the public interest for contract holders, including general practitioners, will not take place until 2019 at the earliest. Coupling the unwinding of FEMPI with contract negotiations will not encourage young graduates to take up general practitioner contracts before 2020, nor will it address the manpower crisis in and crumbling of our general practice network. These factors are already affecting the delivery of primary care and placing greater strain on hospital services. This decision will inhibit meaningful reform for several years and delay the transfer and reorientation of our health service towards primary care.

The pace of response to Sláintecare is much too slow. Implementation milestones and processes to achieve these milestones are nowhere near completion. Six months after the publication of the Sláintecare report, a draft implementation plan is several months away. Legislation must be enacted in several areas to give structure, responsibility, accountability, transparency and answerability to the health service. I expect the Minister to pick up the pace of reform. The joint committee will invite him back in the new year to give us an update on how he is progressing the Sláintecare reform programme.