James Reilly (Dublin North, Fine Gael)

In common with other public services, the health services are facing significant financial challenges. The key priority for me in dealing with the serious budget pressures on the health services is to minimise the effect on services for patients to the greatest degree possible.

The Government has a radical programme for reform of the health service. It is no accident that this reform programme is headed 'Fairness' in the programme for Government. I want to shift the debate away from beds to the actual number of patients treated. I want to focus on access to services based on need and on those services being provided in the best place, be that a big or small hospital, the community, a GP's surgery or in the patient's own home. I want to see a health system providing a service quickly, efficiently and safely.

Activity in acute hospitals has been increasing year on year. A modest increase is planned for 2011 despite the budget cuts. The most important thing is to drive out costs by relentlessly challenging practices which affect efficiency. We must increase the proportion of day case work, reduce the average length of stay and perform surgery on the patient's day of admission to the greatest extent possible. One hospital which I will not name has a day of admission surgery rate of 39% when the international standard is 75%. That has huge cost implications. In fact, physicians and surgeons in the hospital concerned have negotiated a change. I believe in fairness in that regard too; that if people do not understand and realise where they are going wrong we can hardly expect them to fix it. One of the problems that has affected the health service in recent years is that we find areas where excellent services are performed in a more clever, better way but that does not seem to get transposed across the system. That is something we intend to address. There is clear evidence of major variations in performance under various headings across the system. That means we are not getting the best value for patients and the taxpayer from the beds we have.

Additional information not given on the floor of the House.

I am determined to see these inefficiencies addressed. The special delivery unit, SDU, which I will set up will be a robust driver of improved performance which holds providers to account. It will also be a source of expert support for providers which helps them achieve better results quickly.

The purpose of the SDU is to unblock access to acute services and to do that by dramatically improving patient flows. That will free up capacity in the public health system to get more patients treated more quickly and-or to enable resources to be reallocated out of acute hospitals and into primary and community services.

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