Barry Andrews (Dún Laoghaire, Fianna Fail)

During the debate, the improvements that have taken place in the health services in recent years, for example, under the national cancer control programme and in addressing waiting lists, have been outlined by the Minister for Health and Children and other speakers. The Government has a serious job to reduce the general government deficit to 3% of GDP by 2014 but its priority remains to protect frontline health services and ensure they meet appropriate quality and safety standards.

Over the past decade, Ireland has achieved a rapid and unprecedented improvement in life expectancy. Irish men can now expect on average to live until they are 76 years while Irish women can expect to live until they are over 81 years. Much of this increase is due to significant reductions in major causes of death such as cancer and circulatory system diseases. The health services have played a significant role in these remarkable improvements.

The national service plan for 2010 commits the HSE to a range of measures to ensure that services are delivered more efficiently, including carrying out an increased proportion of surgery on a day basis, increasing rates of day-of-surgery admissions and working to reduce average length of stay consistent with patients' clinical needs. I should also point out the service plan refers to commitment under the children and family services area, which was not referred to during the course of this debate. Some 200 additional social workers have been appointed or will be appointed by the end of this year in order to tackle the issues that have arisen in regard to child care in this country, in particular to ensure every child has an allocated social worker and a care plan, and that all of our foster carers are properly assessed.

The actions being taken by the HSE to control expenditure and ensure that budgets are not exceeded are focused on protecting front line services and, in particular, emergency services, maintaining the quality and safety of services, delivering on service plan targets and protecting jobs. Notwithstanding the difficult financial environment, the Government is determined to do everything possible to protect patient services, to respond to priority demographic and other needs and to support ongoing reform of the public health services within the resources available for health. To achieve this, staff at all levels will have to work together to deliver services in a more flexible way. Without that co-operation and flexibility, services to patients cannot be protected. It is not just for HSE management to protect services; there is also a responsibility on everyone involved to deliver services within budget in new ways that will better serve patient needs.

Patient safety is at the forefront of the Government's health policy. As well as having potentially devastating consequences for individuals and families, poor patient safety represents both a severe public health problem and a high economic burden on limited health resources. A large proportion of adverse events, both in the hospital sector and in primary care, are preventable. Major components in this process are the establishment the Health Information and Quality Authority in 2007; the report of the Commission on Patient Safety and Quality Assurance in 2008; the modernisation of legislation regulating key health professions, particularly the Medical Practitioners Act 2007; and the Health Information Bill, which will be published shortly and will provide for the mandatory reporting of serious adverse events and, to support this initiative, will give legal protections to those reports. Legal protections will also be given to the voluntary reporting of other adverse events. The Bill will also provide legal protections for open disclosure of patient safety incidents to patients.

The overwhelming consensus among clinical experts, as seen in cancer care, is that patients have demonstrably better outcomes where complex care is delivered with the necessary staff and equipment and with sufficient volumes of activity. The evidence also emphasises the need to provide timely emergency care to patients in an appropriate setting. Achieving better outcomes for patients will require hospitals to change the services they deliver to their communities and how those are delivered. The clinical benefits for patients will be significant and the treatment offered will be of the highest standard.

Patients get the best health outcomes when complex care is delivered in hospitals with high volumes of patients. We have seen this in cancer care and it is an accepted international medical principle. Less complex care and much diagnostics can and will be provided locally throughout the country. In 2012, we will have a new licensing system underpinned by standards. All hospitals will have to meet these standards which will ensure that people are getting the right care in the right place at the right time from the right person.

The clinical director of the HSE has appointed a number of medical specialists to examine different areas of medicine. They will consult widely and recommend how we can provide a better and safer service nationally. Areas being examined include obstetrics, stroke services, neurology, rheumatology, diabetes, epilepsy, heart failure and cystic fibrosis. All decisions in regard to how we provide our health services will be guided by this work. One of the specialists is Professor Michael Turner, who is examining how we currently provide our obstetric services nationally. He will be consulting with colleagues throughout the country before he makes his recommendations and no decisions have yet been made. There will be no change to obstetric services anywhere in the country, including in the south east, as some speakers suggested, until Professor Turner concludes his work on the national clinical programme on obstetrics, which is expected to be late next year.

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