Oireachtas Joint and Select Committees

Wednesday, 4 December 2019

Select Committee on Health

Estimates for Public Services 2019
Vote 38 - Health (Supplementary)

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

It is a very fair, important and interesting question. The Chairman will appreciate that the answer is not simple. There is a continuous challenge to keep a healthy tension between the pull and drag in this. We cannot have an open door, with money for everything, in a demand-led service. We have to achieve a scenario such as that driven by the chief executive officer, which is to get people to live within their budget. That is all part of the drive coming from the political side to not have overruns. We cannot on one side tell the chief executive officer that he must meet every demand and deliver every service looked for while at the same time telling him he cannot come back to look for more money.

On one side there are Government and Opposition Deputies saying there cannot be an overrun and the chief executive is doing his job in telling every health manager under his remit that we need to live within budget and if more is needed at the end of the year, a conversation can be had on the amount. On the other hand, there is the issue raised by the Chairman, as patients are real people. They are our mothers, daughters, sisters, brothers, grannies and other loved ones. If we see them on trolleys etc., we are given a challenging pause for thought. There is much more to this system than just money and that is where we can bring in Sláintecare's move away from the current process. Any additional euro we are putting into the system, such as with the nursing wage increases, are negotiated with respect to process, change and better productivity, with more efficiencies and an increase in capacity in our health care system. That can be done and there are initiatives such as the lean sigma programme. I have referred to Sláintecare and the Chairman is well aware of the GP contract. There is also care of patients with the likes of chronic obstructive pulmonary disease and other chronic illnesses in the community, which is a better way.

This is about achieving efficiencies that increase capacity in the system. There is a healthy tension that will continue and must be maintained. We cannot just say that we will give everybody what they need but we must continue to monitor the finances. We are dealing with real people and patients and getting that balance right is not an easy call. There must be structural and procedural change. We must look at how we do what we do and find better ways of doing it. This can only be brought about by having this kind of tension and attention to finances.

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