James Reilly (Dublin North, Fine Gael)

I move: "That the Bill be now read a Second Time."

The purpose of the Clotting Factor Concentrates and Other Biological Products Bill 2012 is to transfer responsibility for the procurement of the national stock of clotting factor concentrate products and other biological medicinal products from the Irish Blood Transfusion Service to St James's Hospital, which is the national centre for hereditary coagulation disorders and the national haemophilia centre. Clotting factor concentrates are used in the treatment of haemophilia and other clotting factor disorders such as Von Willebrand disease. Over €37 million was spent on the purchase of these products in 2011 and the bulk of products purchased were either Factor VIII or Factor IX concentrates. My Department, the Health Service Executive, the Irish Blood Transfusion Service and St James's Hospital are all in agreement that procurement of these products should be transferred from the Irish Blood Transfusion Service to St James's Hospital. Administrative arrangements have already been made to prepare for this, which will ensure that the changeover happens as smoothly as possible and that there will be no disruption to the supply of products for patients.

Clotting factor concentrates and other biological medicinal products are almost all non-blood or blood product based and are classed as medicines, so it is appropriate that the responsibility for their management moves from the Irish Blood Transfusion Service, IBTS, to St. James's Hospital. Furthermore, the IBTS has no role in the management of patients to whom these products are administered.

Enabling St. James's Hospital to become the contract holder for the procurement of these clotting factor concentrate and other biological medicinal products will result in a more streamlined system of procurement for the products and will also achieve financial savings for the health budget in relation to their purchase. I will say more about that principle later.

If usage patterns were maintained, compared to 2009 the cost of these products should have reduced by 19% by 2013. This would result in a total saving of approximately €7.9 million relative to 2009. When the country is in such financial strife and when our health service has had to suffer budgetary cutbacks of €2.5 billion over the last three years, this is a serious quantum of money which can be used for other purposes. For example, vaccinating our female children with the HPV vaccine against the scourge of cervical cancer costs €3 million. That puts this saving in perspective. However, usage patterns have increased. Even so, savings have been realised, as the IBTS mark-up has been removed in anticipation of the transfer of procurement to St. James's. For example, purchase of Factor VIII increased by roughly 5 million units and usage of Factor IX by 3 million units between 2009 and 2011, yet the cost of these products to the health system has decreased from almost €40.8 million to €37.6 million in the same period, a decrease of €3.2 million.

To protect the health of consumers of the clotting factor concentrates and other biological medicinal products, the IBTS at present and St. James's Hospital into the future, as the contract holder, must take the advice of the Product Selection and Monitoring Advisory Board in relation to safety and efficacy of all products prior to selecting the successful tender bid. This board was set up on an ad hoc basis following the Lindsay tribunal of inquiry by the then Minister. Its membership includes the Irish Haemophilia Society, the National Disease Surveillance Centre, clinical consultants and nurses, the National Virus Reference Laboratory, the Irish Medicines Board, the HSE and my Department. Deputies can see that there has been wide consultation on this issue.

It is also important to note that a very small number of private facilities currently obtain clotting factor concentrate products from the IBTS. All hospitals, in the public and private sectors, will be contacted to confirm the new arrangements for procuring these products into the future.

The issue of savings is critical in the current economic situation. It does not relate to this area alone. The principle of procuring both medicines and services more cost effectively if we are in a position to do so must be followed. I have long been a critic of the failure of the HSE to transpose good practice across our system. In other words, when we find an area that is delivering good practice and efficiency, we have not been able to transpose that across the system. That will no longer be the case. It is the purpose of the special delivery unit, in particular, to ensure that where best practice has been identified it is put in place across all our hospitals. This does not relate only to hospitals, but to primary care, mental health and social care.

We have rostering issues. We have asked, through the Croke Park agreement, that those working in the health service would look at this situation and agree to change. The Croke Park agreement is clear. There will be no further pay cuts if there is an increase in productivity. One of the clearest ways of increasing productivity and of having a better and safer service is to ensure that when there is a surge in activity, which is often predictable, we have the maximum number of staff available. There is a historic situation, whereby one can work three 12 hour days and have four days off. Although this is convenient for those who avail of those rosters, have become used to them and find it difficult to change, nonetheless change is essential. Without this change we cannot continue to deliver the efficiencies we must deliver or to give the care we want to give.

We have undertaken to reduce the waiting time for inpatient treatment. Last year, every person who had seen a consultant and been put on a waiting list was treated within 12 months, except in Galway. This year, that waiting time is to reduce to nine months. To achieve that with a reducing budget will be particularly challenging, but it must be done. We need and appreciate the co-operation of those working in the service. Many of our medical consultants now come in to do ward rounds at weekends. In one instance, where we were faced with a critical number of people on trolleys, one consultant came in at midnight to do a ward round and allow people to be discharged.

We are achieving change through the clinical programmes and the special delivery unit because of co-operation from the front line. This is critically important. The success in reducing the number of people on trolleys in our emergency departments is due to the fact that, unlike before, those on the front line are being listened to. Their suggestions are being taken seriously, analysed and, if found to be cost effective and workable, being implemented in consultation with the clinical programmes. In Drogheda, for example, there was a serious problem with the number of people waiting in the emergency department for admission. It took more than one particular action to resolve that problem. It took a host of actions, including opening up additional medical beds, opening more beds in the community, availing of long-term beds and wards in Louth County Hospital and Our Lady's Hospital, Navan, more intervention by the community intervention teams so that people who were seen in accident and emergency could continue their intravenous therapies through nurse visits at home, more home help and more home care packages.

We require a holistic approach, taking into account all the services we have available to us. I have always said no part of the health service works in isolation. We cannot fix an emergency department problem if we do not fix the problems within the hospital itself and in the broader community. These include long-term care, home help, home care packages and tiered support. In the south east we have some excellent models where people who do not need to be in a nursing home live in a setting where they have considerable support. It has been put to me that HIQA needs to address this issue in relation to its standards for nursing homes because these are not, strictly speaking, nursing homes. We have spoken to HIQA. It has a clear understanding of this issue and it will be addressed. There will be a different set of standards for those facilities because they provide a different type of service, but a very valuable service just the same. It is a case of using all the community supports to facilitate as many people remaining independent and out of long-term care for as long as possible. I know of nobody who wants to be in long-term care, as in a nursing home, before he or she needs to be, yet a survey of 1,200 patients in long-term care found that many such patients had not been offered home care packages and a majority had not been assessed for home care packages. If one third of people in long-term care institutions are low dependency with another one third who are mild dependency and one third who are high dependency, it is perhaps not too extreme to say we have condemned people to long-term care before they need it. In my view this is not right; it is certainly not cost-effective for the taxpayer and it is not fair on those people who find themselves in that situation. In the next few weeks our clinical programmes are examining a number of initiatives involving emergency and acute medicine and care of the older patient, particularly the frail older patient over the age of 70 years. It is planned to have specialist wards providing aggressive early treatment so that patients can move within a number of days to a different facility where their treatment could continue and which would provide rehabilitation. The final details will be announced in the next few weeks and this will have a major impact on treatment and will allow for an increased throughput of patients so that they will not have to linger on trolleys in emergency departments for longer than necessary. I have made it clear that we are moving from merely counting the number of people on trolleys in the mornings to a real time patient experience so that from the middle of this year, anyone who registers at the desk of an emergency department will either have been sent home, discharged or admitted to a ward within nine hours and this should be the case for 95% of clients within six hours. I visited between 15 and 18 hospitals before the 29 February deadline for retirements under the old scheme. I was very pleased to note that most hospitals were reasonably confident of being in a position to meet that target. Some hospitals will need particular support and this is what we will provide by supporting the front line and the hospitals that have had legacy issues going on for years, in some cases. Doctors are doing ward rounds at the weekends to expedite patient care but this needs to be formalised through the Croke Park agreement and I believe this will be done in the near future.

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