Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Absolutely. I thank the Cathaoirleach.

I thank Deputy O'Connell for raising a number of important issues, as always. On the issue regarding the morning-after pill, I obviously do not have enough facts to comment with any degree of certainty other than to say I want to live in a country and see a health service that provides women with access to the supports that they are legally entitled to, such as the morning-after pill, without any degree of judgment, cross-examination, interrogation or anything else. While I do not know the facts in that case, I would suggest that there are a number of avenues open to anybody in highlighting that with the regulatory authorities. Everybody has a professional responsibility in terms of discharging the law of the land. As the Deputy correctly points out, in my time as Minister for Health I have made a number of policy decisions to try to help improve access to that, most particularly, the fact that a person with a medical card can now access it directly through her pharmacy, as a person without a medical card could always do, without her now needing to go to her general practitioner. I take the point the Deputy makes about the need to ensure that information is publicly available and I will certainly undertake to do that.

On access to contraception and free contraception, I am very much of the view in reading the report of the Oireachtas Joint Committee on the Eighth Amendment of the Constitution, of which the Deputy was a member, that it is not all about terminations. The report is not all about abortion and anybody who represents it as such has not read it correctly or at all. If one reads the report, while it obviously makes a number of recommendations on termination in Ireland, and the committee's view that the eighth amendment should be repealed in full, a view which I support, it also addresses a number of things the State and the health services must do to protect pregnant women, to support pregnant women, to support people in crisis pregnancy, to increase access to counselling, and to improve sex education and access to contraception in general. As the Deputy will be aware, I have set up within my Department, as a response to the Oireachtas committee's report, a working group chaired by the Chief Medical Officer to work through what I refer to as ancillary recommendations. I nearly think it is unfortunate that they are called "ancillary" recommendations as no doubt they are core to the broader and wide debate that is already under way in this country. We will examine it in that context.

On the issue of medical cards, I will ask the director general to comment in a moment but I would just make two points. First, we have seen a massive increase, rightly, and thankfully, in the number of discretionary medical cards in this country. On 1 January 2014, there were 50,294 discretionary medical cards. One year later, there were 76,665. Another year later, there were 99,396. Another year later, on 1 January 2017, there were 116,362. On 1 January of this year, the number was 131,160. We had 50,294 people with discretionary medical cards at the start of 2014 and have 131,160 now. I hope that is reflective of a compassionate system, that when somebody does not qualify on means grounds there is a compassionate approach in that regard.

On the issue of children with cancer, the director general prior to my time in the Department of Health took a decision on their automatic eligibility which was the right decision. For children with cancer, there is automatic eligibility. I will ask the director general to comment on that in a moment.

Regarding the issue of the HPV vaccine for boys, as the committee will be aware, I have asked HIQA to carry out a health technology assessment, HTA. We will know the final outcome of that by the autumn. We may begin to have an indication of the likely outcome of that a little earlier than that. Obviously, I will be guided by that. Instinctively, I see great benefit in it. However, I need to be guided by the HIQA HTA as well.

On the issue of a case before the court, I need to do something I do not like doing which is bite my lip. I will say as long as I am Minister for Health I will always take the approach of trying to put systems and structures in place to ensure that people who suffer a bereavement who loose of a loved one through the maternity services can have access to all of the facts and all of the information and that the system can learn from such tragedies. It is a matter of public fact that I met Mr. Thawley and when I sat in a room with a grieving widower who has lost his young, beautiful and healthy wife, I told that man we would establish the facts. I intend to honour that commitment. As the committee will be aware, we have made a policy decision that all maternal deaths will now be subject to an external review. That is appropriate. It is good practice. It is something that should be welcomed by the maternity services in general in terms of ensuring learning across the system. We have established in the HSE a women and infants' health programme and we have Dr. Peter McKenna, the clinical director, there as well. We are making positive strides in that regard. On matters before the court, I am happy to let them play out but, instinctively, my view is we should not be finding people in court in these situations.

I thank the Deputy for her comments regarding the issue of trauma policy. As Minister for Health, I have the honour of bringing it to Government and publishing it. The only reason I am able to do that is because of the incredible work of clinicians of the HSE and of patients and patient groups over a sustained period of time since 2015. This is something that every doctor will tell one will save lives and will improve outcomes. It is something we badly need in this country. We cannot have a situation where we can stand over a system where almost 30% of patients are ending up effectively in the wrong location when they suffer a major trauma and are being transferred to other locations. I have heard commentary that simply is not true about ED reconfiguration. It is really not about this. Approximately, 1.2 million people attend the emergency departments each year. We are talking about a cohort of major trauma patients of 1,600. When one divides that up, it amounts on average to four a day. We are talking about getting those patients to the right place. There probably is not an Oireachtas Member who has not been in contact with the HSE over his or her years as a public representative about a patient in a hospital who really needs to get to Beaumont or CUH. I have heard the Chair on this and she is correct. There are issues of connectivity and that is why this is a plan that will not be implemented overnight. We have published the plan now and we will implement it.

I really believe that, despite all the difficulties our health service faces, we have shown as a country that when we publish a policy plan in key specialties, we can make real differences. We have seen this with cancer. We are now beginning to see it with our national maternity plan, and I believe we can also see it regarding trauma. The point made was entirely correct. The plan emphasises heavily the fact that it is not just about treating the major trauma incident in the hospital; it refers to a five-step pathway. One is obviously prevention. How do we prevent and reduce major trauma? I particularly welcome the support of agencies such as the Road Safety Authority in this regard. There is a need for us to make our workplaces more safe and to minimise the number of workplace accidents. There is a need to continue with the mental health agenda to reduce the incidence of self-harm. All of these can cause major trauma. There is a very important piece on rehabilitation. The idea is not to put all the patients in the major trauma centre and say "Job done." The point is that a patient who requires a major trauma centre should be able to get there quickly and receive the expert care needed and then be transitioned back to the community, or local hospitals, thus freeing up space in the major trauma centre. Therefore, there has to be a full continuum of care. We have a lot of work to do in that regard.

On Senator Colm Burke's point, I will ask the director general of the HSE to talk about over-prescribing and what the HSE is doing in that regard. Much of the data associated with the excellent work done by The Sunday Business Postprobably came from the HSE's medicines management programme. It is very important work that Susan Mitchell put into the public domain.

The point the Senator made is a very interesting one. When I talk about value improvement programmes in the health service and the idea that the Irish health service, like most other health services in the developed world, should have value improvement programmes, which view is shared by the HSE, I do so in the belief that this is an area we have got to consider. We must consider how we can achieve better value and clinical outcomes for our patients. We all know that over-prescribing of medication is a challenge in this regard. I hope to be in a position very shortly to make a significant announcement on Ireland's participation in international collaboration on drug pricing. We have been working quite hard on this for quite a period, and we are almost at decision point in terms of formalising our involvement in international collaboration. I will ask the director general, as the employer of the administrators and others referred to, to comment on this.

My Department received almost 12,000 parliamentary questions last year, which is good. Almost all of them, or very many of them, get referred to the HSE because they refer to operational matters. Those questions are answered by administrators. I take Senator Burke's point absolutely that there needs to be a plan and an understanding of the appropriate level to be reached. That is a very well made point. I differ slightly on the assertion that only front-line staff can produce a direct patient benefit. Bearing in mind much of the Healthy Ireland agenda, if one goes to see a hospital consultant today one notes the man or woman managing the files outside that consultant's door is making sure the waiting list continues to decrease. Therefore, I very much see a role for administrators. In fairness, the Senator acknowledged in his contribution that we saw, during the recession in particular, significant reductions in administrative roles in an effort to protect the front line, but to the point where it may now be having an adverse impact on the front line. Nurses and doctors are asking me who should answer the telephone when it rings in the ward. Therefore, there is a need to get this right. I take the Senator's point. It is right that he has highlighted the matter. I shall ask the director general to comment on it.

With regard to the idea of having a forum on nursing home care and how we interact with the nursing home sector, I appreciate the director general's view but I am positively disposed to the idea and instinctively believe it is good. We will not be able to deal with all the challenges facing the demographic trends in this country on our own. We already know that the nursing homes sector, including both public and private elements, plays a major role and is likely to play an even more significant one in the years ahead. Structured engagement on best practice and the exchange of ideas are a good use of everybody's time.

I thank Senator Rose Conway-Walsh for her questions, most of which I will ask the HSE to answer. I will start the answers on some of the questions.

With regard to the Versatis patch, the decision was made by the medicines management programme on clinical grounds. I have heard people's concerns. I have been listening to people expressing concern. As Professor Michael Barry stated eloquently in recent days, there is a process whereby a general practitioner can say to the medicines management board that a certain patient needs the patch. It is important to point out that there is already an appeals process in place. The director general might expand on that.

On the issue of Translarna, I had a meeting with the Senator in Castlebar. I thank her for facilitating that. I very much understand the sensitivities and the importance of this issue. The Senator is talking about a mother who wants to keep her son out of a wheelchair for as long as possible so he can have as much quality of life as possible. I understand his condition affects quite a small number of patients in this country. As a result of the meeting in Castlebar, I had a meeting with representatives of Muscular Dystrophy Ireland in Dublin. They brought along a clinician, from Temple Street, I believe. At that meeting, we had a good discussion on the process that is still under way and the importance of the relevant company and the HSE engaging of this matter. I am conscious of the various legal aspects, on which I will not comment.

On the issue of smaller hospitals, I have two points. The capacity review makes it very clear that we do need to increase capacity significantly. It also makes it very clear that all the capacity does not need to be in major acute hospitals. The step-down, transitional-care and elective facilities have a role to play. I envisage a very secure, sustained role for our smaller hospital network now and in the future. I believe it is likely that bed stock in a number of smaller hospitals will have to increase for clinically appropriate purposes in those locations. All of this will be determined by my working through the capacity review with the capital plan on which I am engaging with Government colleagues.

It is important to refer to the idea of setting up hospital groups and of having hospital group boards. We now have such boards for all our hospital groups The idea is that the centre does not dictate to everybody. We do not say a certain hospital must do a certain thing now. The hospital groups come up with strategic plans and ascertain how best they can use the health infrastructure available within their area. I look forward to receiving strategic plans from all the groups this year.

Most of the questions of the Vice Chairman are more appropriate for the director general. On the neurorehabilitation strategy, the idea that there would be an inclusive process of involvement makes sense. The HSE is undertaking that body of work so I will ask it to respond.

The Vice Chairman asked about the position on the specialist register. Comhliosta is a matter we have talked about for quite a while. The NTPF has a body of work on this. There are two parts to advancing any body of work. One involves the e-health agenda, on which I am hoping to make good progress in our capital plan. The second concerns the operational aspect. Mr. Liam Woods might be in a position to expand on that. The director general can talk about the cost of the private beds.

With regard to the administrative validation of waiting lists, the point I was making in response to Deputy Margaret Murphy O'Mahony was based on a patient who was told they no longer needed their treatment. The patient was told by a clinician, not an administrator. Even when we do administratively validate lists, there is a role for the general practitioner in terms of reinstating someone's position on the list.

I am very positively disposed to the idea on living donors. We have made some changes in that regard. I have asked officials to examine the Vice Chairman's suggestions-----