Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am delighted to be here this morning. I thank the committee for the invitation and the engagement that I know we will have. I welcome Mr. Paul Reid, the new director general of the HSE, and his colleagues in the HSE. I wish Paul well in his new role, as I am sure we all do. He is a very exciting and important appointment for our health service at a crucial time when we have record levels of investment but also an ambitious reform programme that we need to deliver on. I also take the opportunity to thank Ms Anne O'Connor, the deputy director general, for her tremendous commitment while serving as the interim director general of the HSE for the past months.

I am happy to be here to give an update on recent developments in the health sector and issues affecting the Department of Health and the HSE. I am particularly pleased to report on a number of positive developments. We have spoken at length in this committee about the need to transform how our health services are delivered. Our population is rapidly changing and brings with it changing healthcare needs. Like other countries, the Irish health service needs to change radically if it, too, is properly to meet the health needs of our population. We need to rethink how we deliver services, placing a greater emphasis on prevention and population health initiatives to support people to live independently in their communities for as long as possible. We need to deliver efficient, effective, sustainable health and social care services to meet the needs of all of our citizens. This will require a whole society approach with new ways of thinking and of working together.

The good news is that Sláintecare provides us with that roadmap and vision for the future of healthcare. We have talked a lot at this committee about where we are with Sláintecare. I am pleased to say that we are now making substantial progress. The focus of our implementation plan is on establishing the building blocks for a very significant shift in the way in which health and social care services are delivered in Ireland, through the provision of four overarching goals and ten high level strategic actions. These include changes and improvements to our health services and a range of new measures to strengthen structures, governance and accountability. This system-wide reform process commenced with the appointment of Laura Magahy as the executive director to lead the Sláintecare implementation office. I know Ms Magahy has engaged and will continue to engage with members of this committee because it is important that we retain that cross-party consensus and buy-in to the delivery of Sláintecare.

We have an action plan for 2019 in place. This sets out a detailed and programmatic approach to the delivery and clear structure of how we will deliver this ambitious reform programme. We have had many strategies in the past. There is now a very programmatic approach led by Ms Magahy saying exactly what we will do, when we will do it, and how we will track that delivery. The Sláintecare team published its report for the first quarter recently and that showed that 28 of the actions that were due for delivery were all on track. Every quarter, we will publish a progress report on how we are getting on in that regard. I will also report to Government every quarter, with a memorandum for the information of Government. There will be nowhere to hide for anybody who does not want to get on board with this reform agenda. There is great enthusiasm across the health service, including the HSE and the Department of Health, for the delivery of this programme.

The budget provided more than €200 million of additional funding to support a range of priorities proposed in the Sláintecare implementation strategy. This includes funding for a modernised general practitioner, GP, contract and ultimately for the expansion of free GP care; new therapy posts to address waiting lists for children with disabilities; new development funding aimed at further enhancing mental health teams; reduced user charges and out of pocket payments for prescription charges on the drug payment scheme; and increased investment for the National Treatment Purchase Fund, which will be used to treat 70,000 patients on waiting lists this year.

The overall additional funding also includes the €20 million Sláintecare integration fund, launched in March. This is very exciting and a different way of doing business. The health service is putting a dedicated, ring-fenced fund in place and inviting people involved in the delivery of healthcare to pitch their ideas. It asks how people can make Sláintecare happen in their primary care centres and organisations. Organisations do not have to be a part of the HSE. They can be voluntary organisations which provide health services. The enthusiasm for this fund has been overwhelming. Many people have put forward very good ideas. The fund will focus on proposals that support the development of existing and new best practice projects that deliver integrated care, which shift services to the community and which have the potential to be scaled nationally. We will be announcing the projects to be funded by this year's integration fund in the next number of weeks.

I am delighted to say that the transformation process required to deliver Sláintecare is well under way. However, there is a lot of work left to do. I am sure that this committee, under the chairmanship of Deputy Harty, will lead in that regard.

I have been asked many times when talks on a new package for GPs would conclude. I have always said that they would be finished shortly, and now they are done. I am particularly happy that my Department has concluded a landmark agreement with the Irish Medical Organisation, IMO, on a major package of GP contractual reforms. As I said in Killarney at the annual conference of the IMO, this is not the end of our engagement with GPs. We are far from finished. Indeed, the new agreement commits to a strategic review of general practice. This is a landmark agreement which will help transform and reform the Irish health service. It will help to stabilise general practice after very significant cuts during the austerity years and restore levels of funding. In return, GPs will sign up to do things in a new and different way. It represents a €210 million investment in general practice over the next four years. This is a 40% increase on the funding currently available.

A sum of €80 million will be available for the management of chronic diseases, which is a crucial Sláintecare initiative. The idea is that people with certain chronic diseases such as certain heart diseases, diabetes and asthma can now be treated in the community under this deal, seeing their local GP rather than going to the hospital. A wide-ranging set of modernisation measures has also been agreed in the areas of e-health, medicines management and multidisciplinary working. That agreement has been published on my Department's website, and I am sure it will be happy to continue to engage with the committee.

We are making good progress on our primary care centres. We now have 127 fully operational care centres, up from 70 at the end of 2012. In 2018, 18 primary care centres became operational, a further nine will open this year, and 11 more will open in 2020. We are beginning to fill in the gaps throughout the country in terms of the provision of primary care centres. These should not just be viewed as buildings but also as infrastructure that can help enable change. In addition, eight primary care centres are at theadvanced planning stage.

We are expanding our community intervention teams, CITs, and have increased the number of paediatric home care packages, PHCPs, being provided. The HSE is also progressing the improvement of access to radiology services for patients in primary care. There is no point in just having these buildings. We also need diagnostic tools in the buildings where appropriate. I recently saw an example of this in the Athlone primary care centre, where X-rays and ultrasounds are being carried out, taking significant pressure off the Midland Regional Hospital in Mullingar.

I will comment briefly on the progress we have made on the industrial relations front.The Labour Court recommendation on nurses and midwives envisaged a range of tangible and specific nurse practice measures that the court viewed as the basis for a fundamental change in the role of the staff nurse grade. It spoke of the need for a new enhanced nurse practice role. I welcome that there was a positive ballot by the Irish Nurses and Midwives Organisation accepting this Labour Court recommendation. This will result in a new contract for a new enhanced practice nurse who will be working in different, more flexible ways, help us realise transformative change in the nursing profession, and help us to better support many of our nurses financially as well. I had an opportunity to speak to the INMO at its annual conference in Trim on that issue.

We need more capacity in the health service. We can carry out many reforms in the primary care system, but it does not get us away from the fact that we still need additional capacity in terms of beds. I am now regularly publishing an open beds report. I have or am about to publish the latest report, showing that the number of open hospital beds in Ireland continues to increase. The graph is very clear. After dips during the recessionary years, and perhaps before that, the number of hospital beds in our system continues to grow.

I have received the report of the de Buitléir group to examine the removal of private practice from public hospitals.This was a key recommendation of the Sláintecare report. I have nailed my colours to the mast politically. I am in favour of it. Not everyone else has. I welcome people's views on the matter. My Department is considering the report and its recommendations. We cannot have a situation where public patients are deprived access to healthcare in busy public hospitals when private practice continues, in some cases unabated, in those settings. This will not be done overnight but will involve significant work and consideration by the Government. We will consider the report and its recommendations, engage with other relevant Departments and ultimately go to the Government for its decision. Under Sláintecare I gave a commitment to carrying out this independent review, and I thank Mr. Donal de Buitléir and his colleagues on that group for their work. It is a very comprehensive examination of private activity in public hospitals and contains a small number of recommendations. It takes a practical approach to removing private practice from public hospitals and details the impacts this removal would have, the timeframe that should apply and how it should be phased out.

The committee will be aware that we intend to bring in a new independent board and governance structure for the HSE. This will be very important and will coincide with the arrival of our new director general, who will become the new CEO. I have engaged with the Opposition on this, Deputy Donnelly in particular, in terms of amending the composition of that board. I expect to return to the Seanad next week to finalise the amendments we agreed in the Dáil. I certainly hope the Seanad will consider it. I will then return to the Dáil finally to adopt the Bill with a view to that board taking up office in June. It is very important. This was also a key aspect of the Sláintecare report.

It would be remiss of me not to acknowledge the Cross judgment. I have discussed it in the Dáil with the Chairman and other colleagues present. I continue to consider the judgement with officials, the State Claims Agency and the Office of the Attorney General. As discussed, we received correspondence from the HSE which sets out potential implications for, in particular, screening services arising from the judgment. It is important that we be allowed some time to tease through these issues and that we collectively work to address them. I ask those in leadership positions in the medical profession to work with me during this time as we reflect on the judgment and form a fuller understanding of the potential implications and what other jurisdictions do in this regard. I want the clinical community to know that I, as Minister for Health, the Government and the Oireachtas understands its concerns. We are committed to working with it to address its concerns. I intend to meet the leadership of the medical profession as part of my response to the issues arising.