Jim Daly (Cork South West, Fine Gael) | Oireachtas source

Fáiltím roimh an deis labhairt leis an gcoiste. I welcome this opportunity to address the select committee on the Revised Estimates for 2018 for the Department's Vote 38. Unlike many other Votes, the health Vote is not configured along programme lines. While the Department is working towards the development of programme budgeting, this will take some time as the financial systems in the HSE will have to be adapted to allow for this in the context of the financial reform programme currently under way.

The level of funding provided in the 2018 Revised Estimates will allow the Department and the Health Service Executive, HSE, to deliver better access, more health for families and more supports for disability, mental health and older and vulnerable people. In addition, the welcome increase in the health capital budget over the period to 2021 will allow completion of key developments such as the new children's hospital and will ensure capital investment supports our strategic initiatives and ehealth improvements.

The improving economy has enabled the health service to achieve much-needed budget increases in each of the last three years. We are very aware that there are areas where further improvements are required and the Department will continue to work with the HSE to optimise service provision within the constraints of available funding.

The gross provision for the health Vote in 2017 was €14.801 billion, comprising €14.347 billion in current expenditure and €454 million in capital expenditure, inclusive of €195 million granted by means of a Supplementary Estimate. The supplementary requirement arose due to new initiatives approved in 2017, central pay decisions, a shortfall in income and additional funding required in the State Claims Agency. Funding was neither sought nor granted for deficits that arose in service areas which were within the management control of the HSE.

In framing the 2018 budget, the Oireachtas allocated €15.332 billion in Exchequer funding for the health sector. This represents an increase of €492 million on the 2017 post-supplementary current expenditure budget and €39 million, or 8.6%, on capital expenditure and recognises the Government's commitment to providing a health service that seeks to improve the health and well-being of the people of Ireland.

The issue of health funding is a major policy challenge internationally. Despite welcome increases over recent years, the need for effective financial management remains crucial as the health service deals with a larger and older population, with more acute health and social care requirements, increased demand for new and existing drugs and the rising costs of health technology. The costs associated with these service pressures will increasingly need to be managed not solely through increased Exchequer allocations but also through improved efficiencies, productivity and value from within the funding base in 2018 and beyond.

I would like to address the recently published Project Ireland 2040 and the Government's capital spending plans for the next ten years. Capital funding for our health service has been agreed at €10.9 billion for the next ten years, which is 165% higher when compared with the past ten years. We now have a solid ambitious plan to build a better health service for the future through the combination of this significant capital investment programme alongside the implementation of the Sláintecare reforms. The €10.9 billion funding over the next ten years provides a real long-term opportunity to improve our health services, provide modern fit-for-purpose health facilities, increase bed capacity and modernise how we deliver services through ehealth, reformed pathways of care and the implementation of Sláintecare.

Capital investments over the coming decade will support existing Government priority projects and commitments and will enable the roll-out of new additional capacity, guided by the Sláintecare report and the recently published health service capacity review.

The strategic investment priorities for the public health sector in Project Ireland 2040 include a number of major investment projects and programmes over its lifetime, including: the new children's hospital at St. James's campus Dublin and the two children's outpatient and urgent care centres at Connolly Hospital, Blanchardstown and at Tallaght hospital, Dublin. The priorities also included the national maternity strategy developments, including the relocation of stand-alone maternity hospitals to acute hospital campus such as the move of the National Maternity Hospital, Holles Street to the St. Vincent's campus; national cancer strategy capital developments, including the national programme for radiation oncology at Cork, Galway and Dublin and the expansion of BreastCheck; building the new national forensic and mental health service hospital at Portrane, Dublin; the primary care centre construction programme at various locations around the country; and the replacement and refurbishment of community nursing units for older people and long-term residential care units and housing in the community for people with disabilities at various locations across the country. In addition, the national development plan provides capital funding to implement the health service capacity review.

With this unprecedented capital investment in the health services we must ensure that we carefully plan and select projects.

To achieve that, we will put in place a robust method of project appraisal, assessment and selection in order to implement health strategies, including developing capacity to meet the population health needs and achieve value for money.

Along with my ministerial colleagues in the Department, I am committed to advancing a programme of both investment and reform for our health and social care services. The recent Health Service Capacity Review provides an evidence base to determine the extent and nature of the capacity that will be required up to 2031. It forecasts that by 2031, we will need an additional 1,000 general practitioners, GPs, and additional capacity requirements in primary care, acute hospitals and services for older persons for that period.

The Government is committed to making tangible and sustainable improvements in our health services and the Sláintecare report, published last March, provides a framework to do that. There is now an unprecedented level of consensus and support for the vision and strategic direction outlined in the report. We must harness that and work with colleagues across the political spectrum and with all stakeholders to move forward on a programme of health reform. The Government has already given its approval to move ahead with the establishment of a Sláintecare programme office in the Department of Health. This office will be tasked with implementing a programme of reform, as agreed by Government, arising from the Sláintecare report. The recruitment of an executive director of the Sláintecare programme is under way.

It is important to note that many recommendations in the Sláintecare are already policy priorities. These include: the roll-out of our ehealth and health and well-being strategies; the development of a new GP contract and proposals for an enhanced community nursing service; further roll-out of integrated care programmes; the undertaking of a capacity review; and development of an integrated workforce planning framework. The majority of additional funding for new health initiatives in budget 2018 has been targeted at areas identified in the Sláintecare report such as the primary care fund, additional home care and transition beds, reduced medicine and prescription charges and targeted funding for waiting list reduction. These actions are important first steps in a long-term reform process.

Work is under way in the Department to develop an implementation plan in response to the Sláintecare report. A steering group, with representation from both the Department and the Health Service Executive, HSE, has been directing this work over the past months. Work is well advanced and the Minister, Deputy Harris, expects to bring proposals to Government shortly. Furthermore, a memorandum will be brought to Government in the coming weeks with the general scheme for a Bill to introduce a governing board for the HSE, which is a key recommendation in Sláintecare.

Reducing waiting times for hospital procedures is a key priority for this Government. The HSE has been allocated €12 million for scheduled care measures, €10 million of which has been ring-fenced for scoliosis and Merlin Park University Hospital orthopaedic capacity and €2 million for other priorities.

Waiting list figures for the end of February published by the National Treatment Purchase Fund, NTPF, show that 72% of inpatient day case patients and 61% of outpatients are waiting nine months or less. There was a reduction of 1,165 patients waiting for an inpatient or day case procedure compared to the end of January 2018 and a reduction of 7,175 when compared to the numbers waiting at the end of July 2017. That is against a background of increasing demands on our acute hospitals which, since 2000, are carrying out four times more procedures for patients aged 65 and over and twice as many in the under 65 age group. An additional €35 million has been allocated to the NTPF for commissioned patient treatment, which brings its total budget for 2018 to €55 million. It is estimated that the NTPF initiatives in 2018 will enable the provision of treatment for up to 20,000 patients on the inpatient-day case waiting list across a range of specialties and procedures.

This winter has been very difficult for our health services. During February, there was a 7.7% increase in attendances and a 5% increase in emergency department admissions compared to February 2017. That growth in demand is well ahead of population growth and reflects international evidence that emergency department demand is driven by more than demographic factors. This increased demand was further exacerbated in March by the impact of Storm Emma and the associated severe weather experienced across the country since the beginning of March.

While demand for services is growing considerably, the inpatient bed capacity to meet the demand is constrained, resulting in an 11.8% increase in the number of patients waiting on trolleys, compared to February 2017. While fully acknowledging the need for productivity improvements and reforms across the health service, the bed capacity review outlines that in order to reach international standards of bed occupancy levels, the acute hospital system needs an immediate injection of additional beds. It is only through continued investment in capacity, in hospital staff and in reform of our health services, in line with Sláintecare, that we will deliver better services for patients.

The Government provided an additional €40 million for measures to alleviate the pressure on emergency departments during winter 2017-2018. Timely discharge of patients is vital to ensuring that a ready supply of beds is available to those patients requiring to be admitted through emergency departments. Delayed discharges are a major contributory factor to emergency department overcrowding and adversely affect patient flow throughout the hospital. It is essential that, in so far as is possible, egress meets demand, and that hospital and community health care organisations, CHOs, processes support timely and safe discharge. Accordingly, over 60% of the 2018 funding for unscheduled care access measures is being targeted towards providing additional social care supports. These additional supports have been targeted at the hospitals with the greatest number of patients awaiting discharge home and will help improve patient flow in those hospitals, which will in turn help to relieve congestion in their emergency departments. As of today, 189 additional beds have been opened this winter and further beds will open throughout 2018.

In the light of the recommendations of the Health Service Capacity Review and the current pressures on the hospital system, the HSE has been asked to develop a plan to identify the location and mix of beds across the hospital system which can be opened and staffed by 1 November 2018 in order to improve preparedness for winter 2018-2019 and relieve overcrowding in hospital emergency departments. In addition, the HSE and the Department have started the process of reviewing the winter initiative 2017-2018, with a view to providing a report in late April and ensuring the learning from this year will inform the agreement and early implementation of measures for next winter.

Primary care services can provide key opportunities in the implementation of Sláintecare as it proposes the adoption of a new model of integrated care, centred on comprehensive primary and community care services. In 2018, primary care funding of €850 million will continue to build on the significant additional resources that have been invested over the past number of years in the State’s primary care services. For example, we have seen the extension of eligibility for GP cards to the under-sixes and the over-70s and the development of the diabetes cycle-of-care programme.

Quite significant investment has also been made in the development of primary care capacity, particularly in the therapy area, continued investment in the development of community intervention teams and enhanced community diagnostic programmes with the delivery of ultrasound and X-ray in the community. We have also invested significantly in our primary care infrastructure providing modern, well equipped primary care centres - 114 to date - to enable patients access health care in their communities in a more integrated manner. Capital funding of over €29 million will continue to support the roll out of these centres.

The funding allocated in 2018 will continue to deliver these key services and dedicated additional funding of €25 million therein will focus on disease prevention and early intervention, particularly through the further development and expansion of GP services.

In line with the Government’s commitment to promoting care in the community, the Department is developing a new statutory scheme for the financing and regulation of home care services. Pending this, the Department and the HSE are continuing efforts to incrementally improve the existing services. Home support services were a particular area of focus in budget 2018, with an additional €18 million allocated. The additional resources made available brings the total budget for the direct provision of home support services to €408 million. The HSE’s national service plan provides for a target of 17 million home support hours to be provided to 50,500 people.

Of course, there will always be a cohort of people who require long-term residential care, and the nursing homes support scheme, NHSS, commonly known as fair deal, continues to provide financial assistance to those who need long-term nursing home care. The aim of the scheme is to ensure that long-term nursing home care is accessible and affordable for everyone, and that people are cared for in the most appropriate settings.

Mental Health remains a priority care programme for the Government. For this reason, budget 2018 made allowance for an additional €57.5 million for mental health services for 2018, inclusive of €22.5 million of pay-related costs and €35 million to continue to progress new initiatives. The additional funding will help build on the work commenced in 2017 on the enhancement of community teams for children, adults, later life and mental health intellectual disability services. It will also help to continue our move towards a full 24-7 service, with an initial focus on increasing the provision of services on a seven-days-a-week basis. The HSE has been asked to prioritise this work in 2018 as well as develop a service response which is as seamless as possible for every service user.

Budget 2018 announced a reduction in the prescription charge and the drug payment scheme, DPS, monthly threshold. Since 1 January, medical card holders have benefited from a 50 cent reduction in the prescription charge, from €2.50 to €2 per item, and the maximum monthly cost reduced by €5, from €25 to €20. For approved treatments under the DPS the maximum monthly payment reduced by €10, from €144 to €134. This will benefit all families who exceed the threshold in any month.

While wehave secured a significant increase in funding for the health services in recent years, I do not underestimate the challenges involved in the delivery of a safe, efficient health service for the Irish people. Despite welcome increases in recent years, a financial challenge remains as we deal with a larger and older population, with more acute health and social care requirements, increased demand for new and existing drugs and the rising costs of health technology.

The costs of payments under the State Claims Agency are also rising, adding to the overall cost of health above the operational costs funded to meet the health demands of a growing and ageing population. We must maintain our focus on improving the way services are organised and delivered, and on reducing costs, in order to maximise the ability of the health service to respond to growing needs. It is essential that those managing and delivering the service demonstrate good practice by delivering the best possible health care within the limits of the resources that have been made available by Government each year.