Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Chairman and Deputy Durkan. On the issue of patient safety raised by Deputy Durkan and the Chairman in regard to the State Claims Agency, it is probably somewhat unusual to see the State Claims Agency as a part of the health Vote because it is an agency under the Department of Finance. I do not believe it happens for other Departments but the logic behind it is that by keeping it on the health Vote, it forces the system to continue to learn and be acutely aware of the impact of claims in regard to the overall resources available to our health service. It very much keeps it front and centre, and there is a logic in regard to that.

I am pleased to point out to the Deputy that we are making huge improvements in terms of our structures for patient safety. To give a couple of examples, when I became Minister, I had the pleasure of being able to open a new national patient safety office within my Department last December, which is almost a year old now. The idea is that we would have a dedicated unit within the Department of Health to drive patient safety initiatives. In terms of what they look like, I will bring forward legislation to Cabinet this month on the licensing of our hospitals. The best way this Oireachtas can absolutely ensure patient safety is to provide a licensing system. In other words, if a public or private hospital or a health service wants to operate in this country, they have to be licensed by a regulator, presumably the Health Information and Quality Authority, HIQAs, of this world. That gives the State a level, so to speak, that perhaps it has not had to date, which I believe will bring into sharp focus the issue of patient safety. I expect to make progress on that legislation this month, which will be important.

We also brought forward last month open disclosure provisions. Since I have become Minister, I have met many people who have had a bad experience in the health service. Thankfully, most people have a good experience but when I meet those who have had a bad experience, one of the comments they make to me time and again is that they just wanted to find out what happened, to be sure that it would never happen again and that people had learned lessons from it. They just want somebody to hold up their hands and say what went wrong, why it happened and what they are going to do to make sure it never happens again. Many of those people have found themselves with no other way of getting those answers other than going to court. Apart from the time burden of that, which is huge, it puts a huge emotional burden, strain and stress on those people in that they have to go through a very adversarial system just to find answers. The idea of the open disclosure provisions, which in fairness this committee considered at great length and for which I am grateful to the members, is to provide a safe space within the health service for clinicians or others to converse directly with people using the health service. That has been sought for a very long time and it is very welcome. Also, on the Mediation Act, the idea that we will not have an adversarial system in terms of them versus us or that the corporate entity protects itself at all costs is important.

On the idea of periodic payments referenced by Deputy Kelleher, people do not want to go to court for massive sums of money. They wish these things had never happened to them or their child. However, where they need support to address the issue is to help them care for their loved one who may now find themselves needing care for the rest of their life and they want periodic payments. They want to know that they will have those supports for the rest of their life.

I am glad Deputy Durkan raised the issue of the maternity hospitals. We had the first ever national maternity strategy published in 2016 under my predecessor, now the Taoiseach, Deputy Leo Varadkar. I find it incredible that before 2016 we never had a national maternity strategy. Thankfully, we have had cancer strategies and the likes for years and they are making great progress but we never had a maternity strategy. We now have a women and infants programme in the HSE to implement that strategy, which is mirroring the implementation structure of the cancer strategy. All our maternity hospitals now publish monthly incident reports. We can see monthly statements from each of our maternity hospitals so there is much greater visibility, which is very important also.

On the issue of waiting lists, the Deputy is correct. He will be familiar with the fact that I am using the audit function of the National Treatment Purchase Fund, NTPF, to ask it to audit our hospitals to see if they are adhering correctly to the waiting list management protocol. That protocol is clear that chronological scheduling is the most usual and fair way we treat people, but in terms of clinical priority, people who have been classified as urgent need to be seen above and beyond that chronological scheduling. I am disappointed that audits published to date have not shown that always to be the case. We have just gone through a comprehensive training process where the NTPF has trained hospital staff and administrators in terms of the classification.

The other point I want to make is on the idea of pooling lists. We have got to move beyond the idea that if I need a hip operation and I am to be seen by consultant X but consultant X cannot see me for 12 or 15 months, I have to wait until he or she can see me when consultant Y in the same hospital group might have capacity. There are parts of the public health service, and the Chairman and I have discussed this, that have capacity. The Royal College of Surgeons in Ireland, RCSI, group is a very good example in that it has pooled its lists. If someone is waiting for a scope in Beaumont Hospital but there is a long waiting list in that hospital, we can offer that person one in Cavan much more quickly. In the Ireland East group, if someone is waiting for a procedure in a busy Dublin hospital but we have theatre capacity in Navan, would they go there for the procedure? That must become the norm. I am pleased that it is beginning to creep into elements of the health service but it is not where it needs to be. That is a priority for me for 2018.

On the issue of public-private, I agree with the Deputy, and we have had many exchanges on that. The issue needs to be decoupled. Ireland is an outlier in that regard. We run the public health service for the benefit of public patients. They pay for it through their taxes and they expect to be able to access health services in a timely manner. That is not always the case in our country and, as a result, almost half the number of people in this country take out health insurance, not necessarily because they can afford it or want it but because they are worried that they will not get timely access. I want to see that lessen but it is important that as long as insurance companies are generating income from citizens in this country and insurance companies are utilising public facilities, there is a contribution from the insurance industry. We need to work our way through that issue.

I am glad to hear what the Deputy said regarding the NTPF. I agree there is no time for an ideological debate on that. We have got to use every tool at our disposal and contrary to mythical opinion, the NTPF also insources. It does not just outsource. In 2017, one third of its budget will have been spent on insourcing in the public health service, but I will give the Deputy an example of the difference that using the NTPF and investing in waiting lists can make. We have seen a situation whereby the number of people who were waiting more than 15 months for a cataract procedure was 1,694 in April and it is now 421. We will clear that list of people waiting more than 15 months. We talk about waiting lists in a global sense but there are particular procedures that make up a huge bulk of our lists, including ophthalmology, with cataracts being a big part of that, orthopaedics and urology. We have prioritised the area of cataracts and we are making real progress. That list has fallen from 1,694 to 421, and we will clear that. We must continue to home in on the specialties where there is a particular difficulty and life-altering impacts on our citizens.

On the issue of the cross-border directive, that is funded through the HSE. I will get the Deputy a note specifically on how much we have spent in recent years. I am informed it is approximately €14 million this year but if he would like to see a contrast with previous years, we can arrange that. This is an interesting one because in the past the HSE has been criticised for not making citizens aware of their rights in this regard. Sometimes we are criticised for making people aware of their right to go abroad for treatment, but the reality is that whatever country someone lives in, if they are a European citizen they have access to health services in other European countries. The cross-border directive and the treatment abroad scheme are two such examples.

Regarding other areas of overrun, it is fair to say they are scattered across a number of elements of the health service but the acute sector, perhaps unsurprisingly, is the largest proportion of it. I would make two points on that. First, when we were having this discussion last year, by the time that level of overrun crystallised in April, we would have expected it to be much larger than it ended up being. The HSE has shown, therefore, that it can redeem itself in some of these performance areas without impacting patient services.

Second, as a percentage of the HSE budget, which Deputy O'Connell alluded to, the Supplementary Estimate we are seeking is approximately 1.4%. I am confident, therefore, that the HSE has within its ability the opportunity to live within its budget.

I think it has to, but it has to do it in a way that does not alter patient services and that is where there should always be a healthy tension between this House and the HSE. You asked me a question about private insurance, Chairman. Have I answered that?