Simon Harris (Wicklow, Fine Gael)
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Since our last meeting, there has been a significant spotlight on aspects of our health service which are of great public concern and which I will address in my opening statement. However, at the outset, I want to be very clear that my resolve and my determination to improve our health service has only been strengthened. Members know that I believe this requires an all-party effort and that this committee and the Committee on the Future of Healthcare are vehicles for building the kind of political and societal consensus we need in the delivery and future direction of our health service. I am happy, of course, to be held to political account for the challenges and problems we face but I would also like to acknowledge that my engagements with the Oireachtas have continued, in large part, to be constructive and co-operative in nature.

As I think members would expect me to, I am going to start with waiting lists. I hope that everyone understands that I believe, as Minister for Health, I should express my genuine feelings on the impact on patients of waiting too long for treatment but it is wrong to characterise my honest response to their suffering as my only response. I want to focus on what we can do and what we are doing to address waiting lists and waiting times for patients. This has been a consistent focus of mine since becoming Minister. During 2016 there were growing numbers of patients waiting excessively long times for inpatient or day case treatments and the trajectory being forecast by my Department and the HSE was stark. Consequently, with limited additional resources, I unapologetically targeted resources at the specialties with particularly long waiting lists, such as scoliosis and orthopaedics through the winter initiative funding.

The HSE put in place an action plan to halve the number of patients waiting 18 months or more for their inpatient or day case procedures. Through that action plan, over 11,500 patients came off the inpatient-day case waiting list from August to December 2016. Also in 2016, the NTPF undertook an endoscopy waiting list initiative to arrange for the provision of endoscopy procedures to all patients waiting over 12 months. By the end of December, over 5,500 people had come off that waiting list. However, as members know, overall waiting list figures rose in January 2017. I am disappointed by this increase but not surprised as our hospitals responded to the ongoing pressures of high emergency department attendances and admissions during this peak winter period.

I am also aware that it will take some time before waiting list figures will start to go down. This year, waiting list initiatives have been planned and scheduled to take into account peak emergency department activity in hospitals and times when the private sector capacity is most available. Scheduled care will be the main priority from spring through to winter 2017. Some €20 million has been allocated to the NTPF, rising to €55 million in 2018. The NTPF is starting with a dedicated €5 million day-case waiting list initiative with the aim that no patient will be waiting more than 18 months for a day case procedure by 30 June 2017. It is expected that in excess of 2,000 patients will receive treatment through this process and it is expected that patients will commence receiving appointments for treatment during March.

The main areas of focus will be those lists with large numbers of long waiting day case patients, namely, ENT, ophthalmology, general surgery, dental, urology and vascular surgery.

The HSE is also producing a waiting list action plan for 2017, which will outline waiting list initiatives to be driven by hospitals and hospital groups. I expect to receive this plan by the end of the month. This plan will concentrate on reducing the length of time patients wait for an inpatient, day case or outpatient appointment with the aim that by the end of October no patient will wait longer than 15 months. While I consider this is still far too long, it would mark a significant and solid reduction in waiting times with the aim of building on it to reduce waiting times even further. In order to ensure the best outcome for patients waiting, the HSE and the NTPF are working together to utilise all available capacity, public and private, and the plan will be supported by the NTPF’s proposal for the remaining allocation in 2017. I am also considering what further measures should be taken to ensure patients have access to more timely procedures and, in that context, I am of the view that a number of individualised targeted initiatives are required. I have visited a number of hospitals in recent months and am particularly concerned about waiting lists in the specialties of gynaecology, particularly in Cork, and cardiology, as well as waiting times across a number of specialties in certain regions. I have asked the HSE to address these specialties in particular in the action plan it has under development.

I want to make specific reference to scoliosis. While some progress was made in 2016 as a result of the extra investment in the scoliosis service, it is clear there is much more to do to provide the level of service that is needed. Additional funding has been provided - €2 million was made available under the winter initiative in 2016, which saw over 50 additional children and teenagers treated and receive their procedures for scoliosis. While this investment made some progress, there is much more to do to. I recently met with the CEO of the children’s hospital group and the CEO of Our Lady’s Children’s Hospital, Crumlin. I can confirm that the new theatre will provide the additional capacity for scoliosis procedures from April, following the recruitment of additional theatre nurses. An orthopaedic surgeon post in Crumlin Hospital will be filled by June. This means that from July, the hospital expects that the theatre use will be further increased. The HSE is now working on a specific action plan for scoliosis, which it will submit by the end of the month. I will be happy to share it with the committee. This is all with a view, as the director general has said, to making sure no child or adolescent waits longer than four months by the end of this year for a procedure. It would bring this country in line with other jurisdictions, including with the NHS.

I will briefly address the situation regarding our emergency departments throughout the winter period. I acknowledge the distress for patients and their families and the impact on staff caused by overcrowding. I also acknowledge the intensive efforts by staff, management and the HSE on a daily basis to work to ensure that patients receive quality care in a challenging environment. While the number of patients waiting on trolleys continues to be far too high, over the last couple of weeks emergency department congestion has been easing in many hospitals. I commend all the teams across acute hospitals and social care that work together on a daily basis. I acknowledge the achievements they made, particularly on delayed discharges, which reduced from a high of 659 earlier in 2016 to a low of 496 on 15 February 2017. In addition, we have seen extra patients avail of aids and appliances, 900 additional home care packages and 90 newly opened beds in the Mercy hospital, Cork, University Hospital Galway, the Mater, Beaumont Hospital and Mullingar hospital. I have repeatedly made clear that if we want to break the vicious cycle of overcrowding, we will have to do things differently. That involves extra bed capacity, extra staff capacity and also doing more in primary care. During the last year, over 100 additional hospital consultants, almost 250 extra non-consultant hospital doctors and nearly 500 additional nurses and midwives have been employed by the HSE. In addition, my officials are working with the HSE to develop a national integrated strategic framework for health workforce planning with the objective of recruiting and retaining the right mix of staff. I expect to receive a report and implementation plan during 2017. Members will know that the bed capacity review is a commitment in the programme for Government and is now under way. I am keen the review is progressed sufficiently to enable it to feed into the mid-term review of the capital programme, which will take place later this year. While the review will consider capacity requirements over the next decade or so, I am also anxious for it to have a short-term focus and determine how capital investment over the coming years can be targeted, given the current pressures being experienced within our hospital service.

Information technology can also play a significant role in underpinning a more integrated approach to managing waiting lists which would achieve a more patient centred approach. One of the critical enablers of any integrated waiting list management system is the unique individual health identifier, IHI, which was given a legislative basis in 2014. The system of identifiers will be deployed across the public and private health care system. The electronic health record became a reality in December 2016 with the arrival of Ireland’s first digital babies in Cork and the deployment of the IHI register in the health sector.

I will take this opportunity to acknowledge the tremendous commitment and dedication of all our health care professionals working throughout the health service. I am very pleased we have reached agreement with the IMO, the HSE, my Department and the Department of Public Expenditure and Reform on the issue of the restoration of the living out allowance for non-consultant hospital doctors. The agreement reached with the IMO and management provides for restoration of this from 1 July 2017 in the context of the forthcoming public sector pay negotiations. It also provides fulfilment of the Government's commitment to implement the recommendations of the MacCraith report, which will see a review of the continuing education requirements of NCHDs undertaken under the auspices of the WRC between March 2017 and May 2017. I am very pleased the IMO will now not proceed with the ballot for industrial action. It is a very welcome development for our health service.

I will take this opportunity to address the recruitment and retention of nurses and midwives. I, my Department and the HSE recognise the importance of recruiting and retaining nurses and midwives within the public health service. It is also recognised that the fall in numbers employed between 2008 and 2013, from 39,000 to 34,000 had to be addressed when the moratorium ended. There are many initiatives under way to improve staffing levels throughout the country. The HSE is offering permanent posts to 2016 degree programme holders and full-time permanent contracts to those in temporary posts. The HSE ran a three-day open recruitment event over the Christmas holiday period which will be the first of number of events this year. In September 2016, the HSE set up a project group to review nursing workforce planning, recruitment and retention. This group is due to report back to the national director of HR this month.

The Government is committed to 1,000 additional permanent nursing posts in 2017 as part of the programme for Government. These posts are provided for in the HSE’s service plan. The HSE’s management is committed to engaging constructively with the INMO to address its concerns and to address a range of initiatives. I appeal to everybody to redouble their efforts. We have just under two weeks before the INMO is due to commence working to their contract. It is not in the interest of the health service. The INMO, the HSE and Government would like to see a resolution to this. We all need to work together on that.

I should circulate the rest of my statement to allow members to ask some questions, which I know are on people's minds. I will deal with issues on the national children's hospital, prescription charges, patient safety and a number of other areas but in the interest of time I am happy to have my script circulated.