Róisín Shortall (Dublin North West, Labour)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"— noting that the Health Service Executive (HSE) is facing a significant challenge in 2012 given the need to set expenditure levels within the parameters of the National Recovery Plan;

— acknowledging the significant reductions which the health sector has experienced over the last three years, both budgetary and staffing;

— further noting that the HSE has operated the Croke Park Agreement very effectively, with over 3,500 staff redeployed, and a reduction in overall numbers of over 6,000;

— further acknowledging that a range of measures are being actively progressed during 2012 to enhance income collection;

— commends the Minister for Health for managing within this difficult environment, and at the same time achieving;

— a 7% increase in in-patient discharges and a 6% increase in emergency department admissions;

— in relation to a basket of 24 procedures, the national target of 75% of cases treated as day cases;

— significant improvements in hospital waiting times, with 9,100 fewer patients waiting on trolleys when compared to the same period in 2011, which equates to a 19% year-on-year improvement;

— implementation of clinical programmes which saved 70,000 bed days last year, thereby allowing for more patients to be treated more efficiently;

— cost reductions within the health sector which are impressive by international standards, particularly within the hospital sector;

— 1.8 million people now with medical cards, and 130,000 with GP visit cards;

— the passing of legislation to abolish restrictions on GPs wishing to become contractors under the General Medical Services scheme which is now in place;

— progress on the preparation of legislation to allow for the extension of free GP care to persons with long term illnesses;

— progress in building primary care capacity and in chronic disease management, particularly for the management of diabetes;

— significant advances in mental health services in the implementation of A Vision for Change, in particular improved child and adolescent mental health services;

— advances in the care of older people, with almost 23,000 clients now supported under the Fair Deal scheme; and

— accelerating the type of service delivery reforms that will move to models of care across all service or care groups which treat patients at the lowest level of complexity and provide services at the best possible unit cost; and

— welcomes the determination of the Minister and Government to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent 'money follows the patient' system of funding that will be supported ultimately by Universal Health Insurance."

I welcome the opportunity to speak on this motion. As the Minister for Public Expenditure and Reform indicated on the publication of the Estimates, the Government has a significant fiscal deficit which needs to be closed. Our country has suffered the greatest economic crisis in living memory leading to a large fall in Exchequer revenues. I am sure I do not have to remind the Fianna Fáil Members opposite of the reason that is the case.

It is in this challenging context that expenditure plans for 2012 were set and the health sector, as with other sectors, incurred a reduction in the resources allocated to it. The health service budget has been reduced by €2.5 billion over the last three years. The number of health service staff has fallen from a peak of 111,000 in 2007 to less than 103,000 now.

As we are all too well aware, the country still faces serious challenges in respect of the public finances. In order to meet the targets agreed with the troika, there will be further reductions in the level of resources allocated to the health sector.

The Government faced difficult choices in setting the health Estimate and set, as its priority, the aim to maintain services to the greatest extent possible within the reduced resources available. The HSE's national service plan was prepared in the context of the challenges faced by the health services this year in terms of reduced staffing levels and a reduced budget, combined with increasing demand for services.

It also took account of additional funding being invested this year to critically change the models of care we are providing in areas such as mental health services, primary care, the national clinical care programmes and children's services. It is not enough to reduce services in order to meet budgets; we must also commit to the radical programme of reform that is set out in the programme for Government. We can no longer continue with business as usual. That is simply not a sustainable position.

It is clear that the savings targets set for the health service are ambitious, particularly in light of the fact that significant numbers of staff retired under the grace period. Budget reductions pose a major challenge to the system's ability to maintain services at an acceptable level. In the six months to the end of February this year, almost 5,000 staff members retired from the health service. All key services, including maternity, critical care, neonatal and essential social services were maintained without interruption. That is a significant achievement on behalf of the HSE. This was facilitated to a large degree by the flexibility provisions in the public service agreement. In some respects, the response and co-operation of staff went far beyond the terms of the agreement. I commend and welcome the flexibility and adaptability staff showed during this difficult period.

This agreement is a key tool in enabling the health service to respond to these staffing reductions. Since its inception in 2010, the agreement has helped the health sector to manage the reduction of staff numbers by over 6,000.

Another significant success of the Croke Park agreement in the health sector has been the redeployment, to date, of some 3,500 staff within the services. This number is exclusive of 1,000 staff who transferred to the Department of Social Protection. Other achievements include an extended working day in hospital laboratory and radiography services, the ongoing revision of rosters at local level and co-operation with clinical care changes in hospitals.

It is also clear, however, that further change is required, and at a faster pace, if we are to be able to reduce the impact on front line services. Therefore the 2012 health sector action plan contains a demanding and relevant set of measures. These include a comprehensive review of rosters, changes in skill-mix, productivity improvements and a focused approach to reducing sick leave levels.

The motion specifically addresses the issue of the drugs bill. Drugs spending represents 17% of total health expenditure and, clearly, this is not sustainable. The comparable figure in the UK is 9%. I would like to set out some of the work that has been under way in this regard. Significant savings on the drugs budget have already been made in recent years. Changes in wholesale mark-up paid on medicines, and the introduction of a common sliding dispensing fee across all schemes, along with the reduction of the retail mark-up paid on a number of schemes, resulted in on-going annual savings of approximately €120 million.

The Health Professionals (Reduction of Payments to Community Pharmacy Contractors) Regulations 2011 reduced certain payments made by the HSE to community pharmacy contractors with effect from 20 June 2011, with a further saving of over €34 million. This included a reduction in wholesale mark-up on drug items from 10% to 8%. These reforms have contributed to savings in the drugs budget this year along with changes to the threshold of the drugs payment scheme.

An interim agreement with the Irish Pharmaceutical Healthcare Association, IPHA, provides €10 million in savings in 2012 through reductions in the price of off-patent medicines. This agreement is in advance of more substantive discussions to deliver a new agreement and significant price reductions. It is intended to bring these discussions to a conclusion shortly.

I am glad to report to the House that further savings will be achieved later this year through the introduction of the health (pricing and supply of medical goods) Bill 2012, to which Deputy Kelleher and others have referred. This Bill was approved by the Cabinet this morning and will be published in the coming days. The Bill was promised a number of years ago, during the term of the last Government, by the then Minister, Mary Harney, but unfortunately little or no progress was made in this regard.

The Bill will provide for the introduction of a system of reference pricing and generic substitution for prescribed drugs and medicines, which will lead to savings for taxpayers and patients. This is a significant development and in the coming years we look forward to making savings in the overall medicines bill and also for individual patients.

In addition, a national task force is being established to deal with the prescribing and dispensing of existing medicines. It will address this from the perspective of quality and patient safety primarily, but it can be anticipated that significant cost savings will result. By addressing the issue from the perspective of quality and safety, and by working with the leadership of the medical, pharmaceutical and other professions, we have the best means of securing a sustainable means of improving value for money from the State's significant expenditure on prescribed medicines.

The task force will be made up of a number of key leaders from the healthcare system and will be chaired by the chief medical officer of the Department of Health. Its terms of reference will require it to oversee and direct analysis of the extensive information that is held on prescribing patterns through the HSE's primary care reimbursement service. It will use this information to establish priorities to be addressed concerning quality and patient safety prescribing and to allow that to inform decisions on the nature and scale of interventions that should be undertaken. These can range from providing advice, guidance and support to prescribers and dispensers to help them to improve prescribing practice, to assessing the suitability of maintaining a supply of certain items with limited efficacy where more appropriate items are available. The work of this task force will be based primarily on evidence. The criteria that underpin these decisions will be clear and explicit to everybody working in this area.

I understand a preliminary meeting of the group will take place next week and that it is anticipated an executive office to support the very important work of this group will be established as a priority in the HSE so that the committee can be fully functioning before the end of September.

I anticipate that the Minister, Deputy Reilly, will in his closing statement to the House tomorrow evening speak about developments in hospital waiting times, the work of the special delivery unit and other issues. My colleague, the Minister of State, Deputy Lynch, will speak about the ongoing development of specialised care services and the work under way to improve client experiences in mental health and disability services and care of older people.

For my part, I want to report on progress in primary care. If we are to achieve savings in health spending while also reforming and improving the health services we provide, we must develop new models of care. As I stated earlier, business as usual is not acceptable. It is particularly not acceptable in the current climate when there is such pressure on budgets. We want to ensure that primary care can meet 90-95% of people's health needs and so we must move away from the old hospital-centric model where health care was episodic, reactive, fragmented and expensive. Through modern and strengthened primary care, we can achieve much better health outcomes and much better value for money.

I can assure the House that front line services in the primary care area will not be cut. I hope Deputy Kelleher heard that. Primary care services will be significantly strengthened in the coming months. We recognise the importance of primary care and of switching the focus and orientation away from hospitals to the primary care setting. An allocation of €20 million set aside in the budget will enable us to recruit some 300 people in the primary care area, including public health nurses, RGNs, occupational, physio and speech and language therapists. These posts will be allocated to the areas of greatest need, using an objective resource allocation model. Full details of this allocation will be announced next week.

In January, I established the Universal Primary Care Project team to drive implementation of primary care reform. The projects overseen by the UPC team include policy, planning, costing and legislative preparation for the extension of free GP care, preparation of legislation in respect of which is at an advanced stage; development of implementation plans for chronic disease management in primary care - last week I approved the recruitment of 17 diabetic nurse specialists to commence the roll-out of the diabetes programme; development of a detailed programme of capital investment in primary care centres; preparation for a new GP contract to reflect the programme for Government commitment to universal free GP care and intensive chronic disease management; and preparation of new governance and funding arrangements for primary care, which is well under way. I assure Members opposite that a great deal of work has been done on preparation for the development of the new directorate within the HSE. Work on identification of the cohort of staff who will be working under the new directorate and, crucially, on separating out those budgets is ongoing. For the first time ever, there is a commitment to the establishment of a primary care fund which will enable us to meet the commitment to strengthen primary care.

Our health services are essential to the functioning of our society. Our citizens expect and demand a modern, high quality, safe single-tier health service which guarantees access to care based on need not on ability to pay. They expect a health service that is continually evolving and improving and delivering services more efficiently, effectively and with fewer staff. The programme for Government sets out a clear pathway for the future development and strengthening of our services, notwithstanding the enormous financial challenges that this Government inherited. Despite the challenges posed by reducing resources, this Government has already made significant advances in improving services and delivering on the commitments made in the programme for Government.

I urge the House to reject the Opposition's motion and to support the Government as it deals with the challenges it faces by supporting its amendment.

See this speech in context