Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Chairman and the committee for the invitation to discuss the implementation of Sláintecare. I am pleased to be joined by Ms Laura Magahy, who was recently appointed as executive director of the Sláintecare programme office. She was appointed following a comprehensive recruitment process and brings a wealth of experience to the role. I formally welcome her to the position and assure her of my full support in this challenging but exciting role. She took up the post officially on 1 September and has hit the ground running since then. I will ask her to outline her immediate plans for implementation and progress to date shortly.

Just as the Government and I value the cross-party support that produced the Sláintecare report, we recognise that the same support and cross-party co-operation will be required to successfully deliver the Sláintecare implementation strategy. Every party and grouping in the Oireachtas, bar perhaps one, has said that it is in favour of Sláintecare and the implementation thereof. We need to all work together now to make that a reality. As I have said to this committee previously, we will only succeed in bringing about change if everyone, including politicians, clinicians, patients, service users and others, is united on the overall goal and we are all pulling in the same direction.

The publication of the Sláintecare implementation strategy in August marked another important step in this process. The strategy provides an implementation framework for the transformation process and it outlines 106 specific actions that will be taken over the next three years, which are the first three years of the strategy. I firmly believe that this process is different from others that came before it because this is not my plan and it is not just the Government’s plan; this is the long-term plan, everyone's plan and the only plan. Change of this magnitude cannot be delivered overnight and it is important that we acknowledge this is a strategy that will take time to implement. The publication of the strategy was an important step, but this is a process that will have many steps over its lifetime. We have also paid particular attention to getting the implementation governance and structures right, which was rightly important to the Committee on the Future of Healthcare. In the past, this has been lacking. We have had many strategies previously and the lack of an implementation structure has often caused challenges. I will return to this later.

We are committing to the development of detailed action plans each year and we will measure our progress transparently with twice-yearly progress reports. This is a new departure in health reform and we are trying to use a model that has been used in the Action Plan for Jobs, for example, where we will not just say that we will do something but we say that we will do it and then report against it. Every six months, we will publish a progress report to show what we said we would do, who we said would do it, to check if it is done and if so that is great but if it is not why is it not done. That transparency in reform is something that has been lacking in our health service over many years and it is a focus that I hope we can bring to it.

The Sláintecare report will be delivered over a 10-year period and, at its core, it will do a number of things. It will move our system to a population-based approach of healthcare planning and delivery. This will involve the development of a citizen care master plan for the health service, which will inform service planning, resource allocation, workforce planning and policy prioritisation. This is important because, in the past, we have tried to develop the health service to suit the health service. It was the system for the system but what we are trying to do now is find out what services our citizens need, what is the citizens care master plan and then put the structures in around that rather than the other way around. Informed by this framework, new models of care will be designed that are structured, coherent and tailored to population need. It will continue the focus on promoting the health and well-being of our population through the implementation of Healthy Ireland, the framework for improved health and well-being. A priority action is the publication of the Healthy Ireland outcome framework this year.

A significant part of Sláintecare will be the focus on bringing the majority of care into the community. This will require a much stronger system of community care, with increased resources and an expansion in the range of services that are available. The initial focus will be on developing capacity to manage chronic disease in the community, development of community intervention teams, which we have made some progress on by increasing investment in, and access to, community-based diagnostic facilities and the development of community nursing services. We will also move towards a health service where care is provided on the basis of need and not on the ability to pay. This ambition must be planned carefully and introduced over a period that is appropriate in terms of making sure we have the workforce and the investment in place. If we get the sequencing of this wrong, all we will do is end up rationing care in the community rather than ensuring that people can access it. Progress is being made in extending entitlement, including providing medical cards to those in receipt of domiciliary care allowance, and GP visit cards to those in receipt of carer's allowance. The Government has also committed to the introduction of a statutory scheme for home care to support people to live in their own homes. It is my intention that this scheme will be operational within this first three-year period of the strategy under discussion today.

Under Sláintecare, we will move our system from long hospital waiting times to a timely service, especially for those who need it. There is no single solution to this but additional bed capacity both in hospitals and the community is a big part of it, along with investing further in home care services, multi-annual plans for reducing waiting times and considering how best to introduce a waiting time guarantee. One development that I believe will be significant, which is mentioned in the Sláintecare report, is the development of elective hospitals. We have funding to deliver three elective hospitals with one each in Galway, Cork and Dublin.

I had the opportunity to visit Golden Jubilee Hospital in Scotland just last week with Ms Magahy to see exactly how an elective-only hospital was developed. The good news is that the hospital administrators have managed to significantly reduce their waiting lists. When the hospital first opened, people were waiting three years for a hip or a knee replacement but that is down to 12 weeks while people were waiting two or two and a half years for cataract surgery but that is down to an average of four weeks. We must move on with the development of our elective facilities. We have seen that it has worked in Scotland and we now need to reproduce that model here. We will pick the sites for these three hospitals next year. Our focus is always on driving down waiting lists and ensuring patients can have access to services as soon as possible.

Sláintecare will also bring about improved governance, performance and accountability, which is something that this committee spends a lot of time talking about and scrutinising for very good reason. This will be achieved through the establishment of a HSE board, defining new organisational and operational structures for the future reconfiguration of the health services. The HSE board legislation will be introduced in the Seanad on 10 October and I hope to pass it through both Houses of the Oireachtas this year with everyone's co-operation so that it can take effect at the beginning of next year. I was pleased to announce Mr. Ciarán Devane as chair-designate of the new board. He brings a wealth of experience to what will be a challenging role and I look forward to him having an opportunity to come before the committee to be scrutinised on his views and plans for that role.

I have mentioned the importance of implementation governance and structures and I would like to briefly outline a number of key elements. There is widespread agreement that significant change and reform requires a well resourced programme office to champion, lead and manage the process. The Sláintecare report recommended the establishment of such an office and a Sláintecare programme office has now been established. It will be led by Ms Magahy and it is being resourced with the skills and expertise necessary to lead the reform programme. The programme office is, as I said in August, working on a detailed action plan which will be published before the end of the year. This will include a review of all the actions and associated timeframes, the development of detailed milestones and, crucially, the assignment of responsibility for each action. In the Sláintecare report produced by the committee, it asked that when we published the plan, it would then be reviewed by the executive director. That is the process we are undertaking and it will be published by the end of the year.

There are two other structures which I wish to draw to the committee's attention. The first is the Sláintecare advisory council. It is important that we get the stakeholders and ask experts here to help us out in the delivery of this plan because it cannot be something merely owned in the Oireachtas or in the HSE. I am eager that an advisory council would be in place. I am delighted that it will be chaired by Professor Tom Keane, an eminent clinician and clinical leader, who came to our country and worked with my predecessors and previous Governments to reform our cancer services, and we are seeing the benefit of those outcomes today. I am delighted that he has agreed to lend his services to Ireland again.

Professor Keane will chair the advisory council. It will comprise 23 members. I am pleased to be in a position to announce the membership of the council. For the record of the committee, the membership is: Professor Tom Keane, the former director of the national cancer control programme; Ms Laura Magahy, executive director; Dr. Siobhán Kennelly, consultant geriatrician; Dr. Anthony O'Connor, consultant gastroenterologist; Professor Patrick Broe, general surgeon in Beaumont Hospital and clinical director in the RCSI group; Dr. Colm Henry, chief clinical officer of the HSE; Ms Annette Kennedy, president of the International Council of Nurses; Dr. Ronan Fawsitt, a GP in Kilkenny who has done excellent work in the development of primary care; Ms Gillian O’Brien, director of clinical governance at Jigsaw; Ms Róisín Molloy, an incredible patient advocate with a wealth of experience in this area; Mr. Brendan Courtney, a patient advocate who shone a spotlight on the importance of getting home care and looking after our older citizens' rights in this country; Ms Sarah O'Connor, CEO of the Asthma Society; Mr. Brian Fitzgerald, former CEO of St. James's Hospital and deputy CEO of the Beacon Hospital; Mr. Liam Doran, former general secretary of the INMO; Mr. Leo Kearns, CEO of the Royal College of Physicians of Ireland, RCPI; Dr. Josep Figueras, who, I believe, appeared before the Committee on the Future of Healthcare and is a director of the European observatory; Ms Joanne Shear, former national primary care clinical programme manager at the US Veterans Health Administration; Dr. Heather Shearer, clinical governance expert; Dr. Eddie Molloy, management consultant; Mr. Paul Reid, CEO of Fingal County Council, who brings a wealth of experience in change management; Professor Mary Higgins, obstetrician, National Maternity Hospital; Dr. Anna McHugh, GP registrar, Donegal; and Dr. Emily O'Conor, president of the Irish Association of Emergency Medicine and a consultant in emergency medicine at Connolly hospital. The committee is almost gender balanced, with a split of 12 to 13. There are a wide range of skill sets, from a patient advocacy point of view, from a change management point of view and, importantly, from a medical point of view. I thank those people for stepping up and serving, and offering us their wealth of experience. The first meeting of the advisory council will take place, and be chaired by Professor Keane, on 24 October. I hope this committee will at some point have an opportunity to engage with him on his role and how he envisages the advisory council helping us deliver it.

The second structure is the high-level delivery board. This will comprise the Secretaries General of the Departments of the Taoiseach, Public Expenditure and Reform and Health, the director general of the HSE and the Sláintecare executive director. This is important. The Committee on the Future of Healthcare stated that it wanted a whole-of-government approach to this and having a high-level delivery board that the executive director can feed in to and that can then feed in to the Cabinet Committee on Health, chaired by the Taoiseach, is crucial. Having in the room the Secretaries General of the Departments of the Taoiseach, Health and Public Expenditure and Reform is important and very much in line with the committee's strong recommendation on the need for cross-government support.

We have begun progressing a number of recommendations. We moved ahead with the establishment of the HSE board. That legislation will commence in the Seanad next week and I would appreciate co-operation on that.

Crucially, we have carried out a public consultation on the geo-alignment of hospital groups and community healthcare organisations. This has been completed and I will publish the results shortly. I want to move ahead with outlining what geo-alignment will look like this year and I will need the committee's support on this. Drawing lines on maps is never the easiest exercise for any politician to do. The Sláintecare committee helpfully left it to my Department to work out how best to divide up the country, but what the committee was keen on, and what I am keen on, is that we move away from this siloed approach that there are duplicate management structures for community care and hospital care. If we are to deliver Sláintecare, we need geo-alignment. We need a singular budget for a certain part of the country to deliver the whole spectrum of care. That is what we need to get to.

I have taken the decision, in consultation with Ms Magahy, to move forward on that at a quicker pace than originally envisaged and I intend to announce my proposed geo-alignment this year. This is the potential game-changer that the committee wants to see in terms of Sláintecare because one can no longer have siloed budgets with somebody saying that patient X needs to remain in the hospital because it will cost him or her to care for that patient in the community or vice versa. One budget with a board for each regional entity holding people to account at a regional level is an important way. It will help deliver integrated care. However, if we are to legislate for this, I will need cross-party support to deliver this. I would be happy to discuss with the committee the public consultation document in advance of that or to send that to the committee so that it could consider it. I would very much welcome, in the spirit of bipartisanship, the committee's consultation.

The Committee on the Future of Healthcare was also clear on the role of private practice in public hospitals. Let me be clear, because sometimes I hear myself described by my opponents wrongly in this regard, I am in favour of the removal of private practice from public hospitals but, like the Sláintecare committee, I am in favour of doing so in an intelligent, phased way. I have made my views on this quite clear. Our current mixed model system is an outlier. We cannot convince ourselves it is the norm. It is not the norm. It is an outlier that one can have a public hospital full to capacity and a patient who is in greater need of care not getting that care because somebody is carrying out private practice in that hospital. We cannot stand over that, but we also have to do it right and we cannot do it overnight. The committee asked me to set up an independent review group to examine the impact of separating private practice from the public hospital system. I have done that and it is being chaired by Dr. Donal de Buitléir. The work is ongoing and I expect to receive that report by the end of this year or shortly thereafter. This will provide valuable guidance and I would welcome an opportunity to discuss with this committee. However, my policy objective is clear. I believe we need to remove private practice from public hospitals but we need to do it in a way that makes sense.

I will briefly refer to the role general practice needs to play in this. We cannot deliver a decisive shift to primary care or community care and more services if we do not resource general practice. The committee will be pleased to hear that I have reached agreement with the Minister for Public Expenditure and Reform on significant multi-annual funding for general practice and I expect intensive engagement to commence on this matter in the next few weeks.

Finally, I have mentioned capacity. The health service, even when one implements reforms, does not have adequate bed capacity. We do not compare favourably internationally in this regard. The Government's national development plan, NDP, commits €10.9 billion, much of which is directed at Sláintecare. This will include 2,600 additional beds, the elective hospitals I mentioned and 4,500 community care beds that have been identified. It will also include the roll-out of eHealth, which is so important and which was a key recommendation of Sláintecare, and putting diagnostics into our primary care centres. There are 124 primary care centres in operation throughout the country. The key now is what more can they do. Can we put more X-ray facilities, more ultrasound facilities and more staff into these facilities? I am pleased that the development plan will deliver that.

I am confident that the plan that many members in this room worked so hard on and engaged on for such a long period of time is the right plan and that if we implement it, we will very much be on the right track. We agreed on a vision and we now have an implementation strategy. We have dedicated staff, led by Ms Magahy, to deliver and implement this strategy. We will report twice a year. We will publish detailed annual action plans and resource this through the budgetary process as well. This will require a broad coalition of support and I look forward to working with all stakeholders on the important agenda.

With the Chairman's permission, I will ask Ms Magahy to say a few words.