Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the committee members for inviting me to attend today. I am pleased to be joined by the Secretary General of the Department of Health, the chief executive officer of the Health Service Executive and senior HSE officials, and to have an opportunity to update the committee regarding current issues.

Regarding Sláintecare, officials at my Department have been engaging with stakeholders to gain insights into what they want and expect from our health services. One of the resounding messages to emerge is the need to have a clear and coherent plan. Sláintecare is now that plan. I am pleased to say that the implementation of Sláintecare is now well under way. Planning and co-design for the new regional health areas has begun. Co-design is an important part of Sláintecare and means that patients and staff who live and work in the region play a part in setting up that regional structure. Following consultation with the Sláintecare office, I will make a recommendation to the Government on the exact structure of each region early in the new year.

A forum to provide a regular platform for dialogue between the State and voluntary providers of health and social care services is also being set up. It will have an overarching mandate to build a stronger relationship between the State and voluntary providers for the benefit of patients and service users. The forum will meet for the first time in December. I had an opportunity to address an initial meeting of that forum, and I thank Mr. Peter Cassells for agreeing to chair it. The integration fund of €20 million is supporting 122 projects across the country and, via that €20 million, we will hire 300 additional staff to work in the community. In each of the Deputies' constituencies, therefore, Sláintecare projects are now up and running in each county delivering reform in health services on the ground in our communities.

To reduce community waiting lists, an important and sensitive issue, we will spend €60 million between now and 2021 to employ an additional 1,000 community healthcare staff by the end of 2020. These will be people able to treat our citizens closer to home. In recent years, we have seen a significant increase in the number of primary care centres. Some 127 primary care centres are open, but it is fair to make the point that we need to staff them better. Deputy O'Reilly has made that point vigorously and regularly. We have fine buildings and they are needed because they bring about a new and better way of working and new opportunities for our patients to access services locally. We need to increase the staff in those facilities now, and that is what these 1,000 additional staff, the Sláintecare workforce as I like to call them, are about as well.

I am acutely aware that along with any long-term plan, and we do need a long-term plan, we also need to address the issues facing us today. I acknowledge the challenges facing accident and emergency departments in our hospitals and I accept that in some it is particularly difficult for our patients and staff. The Government allocated a budget of an additional €26 million to assist the HSE over the winter. Specifically, this funding was to support and improve access to the fair deal scheme, helping our citizens to get into nursing homes quicker and to also provide additional homecare, transitional care, aids and appliances and other local actions to facilitate timely hospital discharge and reduce congestion.

Specific funding has been allocated to local winter action teams to support initiatives at local level. This is important. Everything cannot just be about the Department of Health, the HSE and Dr. Steevens' Hospital deciding what individual areas are doing. This process has to be about resourcing and empowering local winter action teams to enable them to respond to issues as they arise in their regions. I am pleased to confirm a range of new and additional measures to alleviate pressures on accident and emergency departments. The HSE has reached an agreement with the National Treatment Purchase Fund, NTPF, to open up to 190 extra hospital beds in the coming weeks. When we factor in these 190 extra beds with the 40 additional beds in the modular unit in Clonmel, due to open in the new year, that brings us to a total of 230 additional hospital beds that will open between now and the start of 2020.

Importantly, the NTPF has written to each hospital groups and, as of today, I confirm that 83 beds have now approved, of the overall 190 beds. These additional beds are in Letterkenny, Tullamore, Waterford, Cork, the national children's hospital and Limerick, in St. John's Hospital.

It is a matter that Senator Kieran O'Donnell has pursued with me as well.

The NTPF is continuing to engage with hospital groups to finalise the details of the additional capacity but the message is very simple. If a hospital has opportunities to open additional capacity in its facilities, a nearby hospital or a level 2 or level 3 hospital, we will look at how we can fund that through the NTPF. I commend both the NTPF and the HSE on the collaborative way they are working in this regard. There are 230 additional hospital beds, including the Clonmel modular unit, and it is a very significant increase in capacity on top of the €26 million already provided.

I confirm that in the coming week, I will sign a new statutory instrument to reduce the cost of attendance at a minor injury unit to €75. For many years, people have commented on the fact that it seems a little bizarre that we are trying to encourage people to attend a minor injury unit if it is the appropriate place to go but the cost of going to the minor injury unit was the same as the cost of going to an accident and emergency department. That is €100 if a person does not have a medical card. In an effort to further incentivise use of our minor injury units, I have decided to reduce the cost to €75. That statutory instrument is currently being legally drafted and I expect to be able to sign it in the coming week. I know the HSE will then implement it with immediate effect. It will also provide an opportunity locally in the 11 minor injury units across the country to reinforce the importance of using the minor injury unit where we know people can be in and out in 90 minutes, two hours or even less time for many conditions. That is without needing to go to the accident and emergency department, which is good news.

I am also working with Government colleagues to identify some additional funding for more social care supports on top of what we have already done. There is €26 million already in a winter plan and additional money is going to the HSE for the NTPF to open more beds; this relates to the 190 additional beds and the 40 beds in Clonmel. On top of that I expect to be in the position within the next week to make further announcements on additional funding for extra support for home care, transitional care and some very good and innovative ideas that HSE colleagues have been working on at a hospital group level in recent days and weeks. I wanted to update the committee on those new measures to try to provide additional assistance to our health service at what is a very busy time.

We have seen significant progress on waiting times for scheduled care. It is not often heard or articulated but we should be clear that as a result of increased activity and the ongoing work between the HSE and the NTPF, the number of patients waiting for an inpatient or day case procedure - a hospital operation or procedure - fell to 66,594 in November from a peak of 86,100 in July 2017. Month on month we are seeing in this country the number of people waiting for a hospital operation falling and the number of people having their hospital operation in less than three months is increasing. Approximately 32% of people were getting their hospital operation in three months or less in 2017 and that figure is now 42%. More than four in ten of us are now getting a hospital operation in 12 weeks or less, which is the Sláintecare target. We must build on that and increase the 42% figure even further. We have seen an overall reduction of 23% in the number of people waiting for a hospital procedure. The number of patients waiting more than three months has fallen by 21,400, or 37%, from July 2017 to November 2019. There are fewer people waiting for a hospital operation and more people are being seen more quickly in connection with that operation. There are fewer people waiting longer for such hospital operations as well.

We speak of waiting lists as if they are part of a global conversation but we can consider some of the specialties. Ophthalmology relates to the treatment of eyes and the number of people waiting over three months for a procedure in this area fell by 63% from July 2017 to the end of November 2019. In the ear, nose and throat specialty, the number of people waiting over three months for a procedure fell by 58% from 2017 to 2019. The number of people waiting over three months for a cardiology procedure fell by 33%. The world and its mother knows there are major challenges in our health services but it is important to acknowledge the progress being made by very hard-working staff, coupled with significant investment from the Government, in decreasing waiting times for hospital operations or procedures.

The key must now be our outpatients. We need to consider how we can drive down the length of time people are waiting to see a hospital consultant. That is why we will use a significant amount of the additional resources being provided to the NTPF to put in place further targeted measures in this regard. We have seen the outpatient waiting list fall for three months in a row and we will see it fall for four months in a row.

For the first time in a long time the number of people waiting to see a hospital consultant is falling month on month, although it is still far too high. My conversations with consultants will focus on how additional money for them will be about reforming how they work and how we make sure that public patients are not continually pushed to the bottom of hospital queues over those who can afford to pay for private health insurance. We will be working with the HSE, the NTPF and the Sláintecare implementation office to produce plans for 2020 that will build on the progress that has been made to date. We are working to identify initiatives that will meet the objectives of Sláintecare. This is not the bad old days of the NTPF turfing out money to private hospitals. Any initiative funded through the NTPF in 2020 must meet the Sláintecare objectives and must include innovative approaches to increase activity, avoid hospital attendances and better utilise our smaller hospitals and our primary care centres. The NTPF is not the NTPF of the Celtic tiger, when it was just a funding pot for private hospitals. It must be used as an access fund for the public health service as well.

A key focus for 2020 will be on moving care to more appropriate settings. We have a number of specialties working in this regard, including ENT, orthopaedics, dermatology, ophthalmology, urology and gynaecology. There are significant opportunities to make progress in those areas in 2020. We will also be seeking to maximise the use of advanced nursing practitioners. The days of everything being done by the doctor is an outdated model. We have extremely well-qualified nurses in this country and advanced nurse practitioners who can lead clinics and provide entire episodes of care. We also have physiotherapists who can manage orthopaedic clinics and people who can provide ophthalmology services in the community. This extra funding must be about reform as well.

I would like to comment briefly on the UK Royal College of Obstetricians and Gynaecologists, RCOG, aggregate report on cervical cancer and the CervicalCheck programme. As the committee will be aware, on Tuesday, 3 December, I published the aggregate report of the independent expert panel review led by RCOG. The committee will have an opportunity to discuss the report in detail on 18 December, when it will hear from both patient advocates and the college. I do not intend to fill either of those spaces but it would be remiss of me not to make some comment.

I thank the expert panel who conducted this review and, in particular, all of the women and their next-of-kin who agreed to participate in it through the examination of the performance of the CervicalCheck programme. The findings and conclusions contained in the review provide reassurance and, I hope, assist in restoring confidence in our programme and address its importance and quality, while also highlighting the sad and painful reality of the limitations of all of our screening programmes. RCOG was asked to do this body of work for two reasons. First, we felt, and rightly so, that the women of Ireland who had had cervical cancer deserved to have an independent clinical review of their screening history. Second, the Government and I, as Minister for Health, wanted to be able to answer the questions that women were asking at a very difficult time for our screening service, namely, "Can I have confidence in our screening programme?" and "Is our screening programme working effectively?". The good news is that the report finds that the CervicalCheck programme is working effectively and, crucially, that women can have confidence in the programme. As I said earlier, the committee will have an opportunity next week to tease through the report in much greater detail with RCOG. The key conclusions of the expert panel are that the CervicalCheck programme has undoubtedly saved the lives of many of those who participated in the review, that the programme is working effectively and that women can have confidence in it.

The panel emphasises that it is important to recognise the serious impact that screening failures have on the lives of women and their families. Cervical cancer is a disgusting and devastating disease that disproportionately affects younger women. It takes the lives of approximately 100 Irishwomen every year. Some 300 women will get a diagnosis of cervical cancer each year. Screening, in every country in the world, inevitably will have limitations. There are limitations when it comes to cytology-based screening but this should not be taken to suggest the programme overall is not working. As Minister, I have to reference the importance of the programme and how effectively it is working but that is not to in any way not acknowledge the significant pain and trauma of those who have cervical cancer and those who have been caught up in this awful debacle in regard to the non-disclosure of an audit. If we are to achieve our goal of making cervical cancer a rare disease in this country, effectively eradicating it within a generation in Ireland, it is vital that women continue to attend for screening and that we continue to build on the considerable progress in other areas over the course of this year. Smear test turnaround times, an issue on which I have been rightly scrutinised at this committee on many occasions, has stabilised. I thank the staff of CervicalCheck and the HSE for their incredible work in this regard. Implementation of Dr. Scally's recommendations is well under way.

In the first quarter of 2020, which is only weeks away, we will move to HPV primary screening, becoming one of the first countries in the world to do so. I have written to the HSE to ask it to consider the recommendations from the review in the context of this crucial project to ensure it absolutely is delivered by the end of the first quarter of 2020. I know it absolutely will be.

I am also pleased we have put in place another key element in restoring trust and confidence not just in screening but in our health service. This is the patient safety Bill, which committee members will scrutinise here and in the Dáil. It will commence in the Dáil tomorrow. It will bring about mandatory open disclosure. As Dr. Scally said, when things go wrong in the health service, people want a sincere and genuine apology. They want to know there is an understanding of what happened and an assurance it will not happen again. The patient safety Bill will focus on open disclosure and will signal a new era for the health service. The legislation will establish a robust and future-proofed framework for mandatory open disclosure. Importantly, it will require notification of serious patient safety incidents to the external regulator, be it HIQA or the Mental Health Commission. No doubt, this will contribute to national patient safety learning and improvement.

Importantly, mandatory open disclosure will apply not just to the public health service but also to the private health service. For the first time we will extend the remit of HIQA to the private health service. The new patient safety Bill places clear responsibilities and obligations on health service providers to ensure mandatory open disclosure occurs and external notification to the regulator takes place. It is a significant cultural and legal change.

I understand the committee is interested in the care of women who have been affected by the use of mesh implants. I have met the mesh survivors group on a number of occasions, most recently on 11 November, and I have listened to their personal stories. I acknowledge very sincerely Deputy O'Reilly's work in this regard as an advocate and, perhaps, and interlocutor on occasion, for the advocacy group with the Government and the Department. I acknowledge the very constructive way she has put forward their case and engaged with me. I want to be very clear that I am fully committed to ensuring that all women who develop mesh related complications receive high-quality, multidisciplinary and patient-centred care.

Since the issue came to my attention in late 2017, an ongoing priority focus for the Department and the HSE has been to understand the clinical and technical issues and to put in place the necessary structures for, and the provision of, care for women who have been affected by the use of mesh. It is very clear to me when I meet the women and hear their stories the trauma, pain and agony they have been put through. Quite frankly, there has been physical agony and mental anguish. I requested the chief medical officer to do a body of work. He thoroughly examined the issue and prepared a report for me on the safe and effective provision of mesh procedures and responding to women experiencing mesh complications. We published the report in November last year. It includes a number of significant recommendations in a number of key areas. It also put a pause on the use of mesh in Ireland until we get to a point when we can be satisfied that all of the recommendations have been met. The HSE has advised that a package of care is now available for women who have been identified with urgent or immediate needs. In addition, the HSE's service plan will ensure the continued implementation of the chief medical officer's report on transvaginal mesh as a priority action. We are also continuing to progress the delivery of care pathways for women, including a specialist, multidisciplinary national mesh complications service.

I am also looking at the issue of access to medical cards. I had a very good discussion with the group and Deputy O'Reilly about whether we can provide a medical card in circumstances where somebody has been through the service and an identified issue has been established. I believe we can make progress. I have been asked to put in place a process for the voices of women to be heard and I have made a commitment to do this. We are developing proposals on an independent compassionate process for women affected by mesh to have their voices heard. I have written to Mesh Survivors Ireland in this regard. Work is under way. I am happy to deal with any questions in this regard.

I do not underestimate the significant challenges our health service faces but I do not accept that everything in the health service is bad or in crisis. Every day our staff do an excellent job of providing high-quality care to many people. We are making progress when it comes to waiting lists. Today, I announced a significant number of measures on additional capacity in the health service and additional resources for the winter. We will build further on this in the days and weeks ahead.