Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputies Kelleher, O'Reilly and Murphy O'Mahony for their questions. Deputy Kelleher is correct in that the political system cannot wash its hands and say that all of the challenges relating to the health service have been caused somewhere else. No party, including Fine Gael and Fianna Fáil, or Government can absolve itself from the continuum of change which there has been in terms of policy and which has meant that no project - good, bad or indifferent - as ever been finished. Lots of reform agendas have been commenced but have never been concluded. The greatest strength of the Sláintecare report is the political consensus such that I, as Minister for Health, and my successors will have a roadmap for this area. In that context, I acknowledge the presence of Deputy Shortall, Chairman of that Oireachtas Committee on the Future of Healthcare.

On the enforcement of contracts, I stand over what I said. What we saw on the national airwaves in regard to a minority of consultants was immoral, brazen and unfair. Before we move to the issue of the responsibility of managers, we need to pause and consider that of personal responsibility. We have some very highly-qualified individuals in our health service who did not show up for work or do what they signed up to do. There is a managerial issue here. I refer to the need for accountability and management and for improvements in this regard on a regular basis. However, the managers turned up for work. It was the doctors who, in some cases, did not do so. It is the doctors who, in some cases, did not do what we paid them to do. Deputy Kelleher is correct that it is the job of the HSE to enforce the contracts and the job of the Department to monitor the position and ensure that they are being enforced. I did not design the contract. It is a legacy I have inherited. I do not like the current contract or the current mix of private-public care. I do not think it serves our patients or our public service well. I agree with the direction outline in the Sláintecare report. Deputy Kelleher is correct in his comments about the impact study. It is important that we check that there are no unintended consequences and that we see it through the prism of ten years. I want it to be clear that I want to see private practice removed from public hospitals, albeit on a phased basis over a number of years. That is my policy position.

Nationally, approximately 82% of the work is being done in the public system. The HSE is reaching or exceeding the 80-20 split nationally in regard to contracts. Within the statistics, however, are hidden outliers on either end. It is acknowledged that some consultants are working way more than they should be and that there is a risk of them being overworked. Equally, there are incidences of people working for only a few hours per week and being paid for hours not worked. I assure the committee that my Department has been engaging with the HSE for a number of months on the need to have a better monitoring system in place to provide assurances that the contracts are being adhered to. I want to see that system in place for 2018.

Deputy O'Reilly asked what the system will look like. I want the HSE to design but I want it to be a system which provides as much assurance as possible in respect of doctors as is the case with nurses. For example, we must know if a person has done what he or she was paid to do. I mentioned that there appeared to be a culture of deference regarding consultants in parts of our health service in that a nurse or health care worker could be asked why he or she was late for work but nobody could actually say whether a consultant had worked his or her required hours. I do not want to cast a slur on all of our doctors because many of them are doing a fine job. However, we know that those who were not doing their work were not, perhaps, pulled up in the same way that other grades in the health service would be.

I do not see this as throwing a minority under the bus. It is appropriate that the HSE would formally investigate each of the cases shown on the national airwaves last night, as would happen in any workplace. I should make the following point because the context is important. The Comptroller and Auditor General's 2015 report on the health service highlighted a problem in respect of the collection of private income such that at a committee meeting at that time we might, perhaps, have been asking different questions, including why managers were not collecting money that was duly owed to the State. It is stated on page 224 of the report that the average delay in collecting moneys due to the State was 186 days. In some hospitals, the delay was more than 300 days. When people talk about setting targets for managers regarding income, that is not in any way to be done in the context of ignoring the legal requirements of a contract. Rather, it is to ensure that moneys owed to the State are collected. That is the situation, for better or worse. Members want might to see that system or the legislation changed but managers are required to collect the money that is owed to the public health service.