Mary Harney (Dublin Mid West, Progressive Democrats)

The purpose of health policy is to achieve the best health status and health outcomes for the whole population. We are succeeding in Ireland in many respects. Life expectancy is now at the highest level it has ever been. Infant mortality is one of the lowest in the world. Survival from many cancers is improving. Death rates from cardiac disease are falling.

We are now allocating €16 billion in current funding across three health Votes. Even if there was scope to increase this, it would be vital that we allocate resources so that the clear focus and the economic incentives created are about achieving the best health status and health outcomes for people, within affordable limits. Many health care systems are seeking to achieve this. It is not about changing the funding basis from tax-based funding to insurance-based funding. It is about how resources are allocated. There is certainly every reason we should avoid changing to a system dominated by fee-per-item payments to doctors and hospitals, where simply more activities, such as tests, investigations, surgeries, get more money for the providers. This system has a cost dynamic that can bankrupt either insurers or the State or both, and worst of all, can result in worse health outcomes for patients. However, I do want to move away from the tradition in our country of allocating resources to public hospitals on the basis of incrementally adjusted historic block budgets.

I want to allocate resources to support the best outcomes for patients, in a way that would avoid unnecessary hospitalisation, reduce the lengths of stay in hospital, manage chronic conditions in the community, and reward better preventive primary care. This is what we mean when we talk about making money follow the patient. For this reason, I established an expert group on resource allocation and financing in the health sector in April this year to do the complex, detailed work required. This group is being chaired by Professor Frances Ruane, director of the ESRI. It includes many independent experts who will bring their experience and judgment to bear on how to achieve the objectives I have set in practical ways. The group is to report to me and the Minister for Finance by April 2010.

In the meantime, I fully support the work being done by the HSE in conjunction with the three Dublin children's hospitals. The real challenge in paediatrics is to maximise the efficient use of all our health care capacity, both in Dublin and across the country. The paediatric services in Crumlin, Temple Street and Tallaght need to be increasingly working in a co-ordinated, shared and efficient fashion to prepare for the eventual merging of the three institutions in 2014 into one national paediatric hospital. In the meantime, the HSE is actively pursuing ways in which services across the three hospitals can best be co-ordinated, in order to avoid unnecessary duplication and to achieve savings that can be put back into patient care.

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