Regina Doherty (Meath East, Fine Gael) | Oireachtas source

One of the key priorities of the Department of Health, the HSE and Department of Public Expenditure and Reform has been to make savings in the health budget through measures that are concentrated, implementable and durable. There has been significant progress against the backdrop of extraordinary cuts. The Minister, Deputy Reilly, has said that his principal stand is not to cut services, but to cut the cost of those services. In 2010, the cost of operating the GMS for 1.7 million users was €1.9 billion. The specific cost of the over 70s medical card scheme is €750 million per annum. It is forecast that the measure in this Bill will generate €12 million in savings during the second half of 2013, and €24 million in a full year. This saving is part of the €781 million in savings that budget for 2013 set out to achieve in the health budget, to include an overall reduction in the cost of primary care schemes of €323 million. The Government's primary aim is to cut the cost of services and not the services themselves.

I challenge the scaremongers, who mostly exist on the Opposition benches. Let us remember that 92% of people over the age of 70 will retain their medical card. The Government's commitment to protect the most vulnerable remains more steadfast than ever. The maintenance of health services will be a key priority next year despite the need for significant savings.

A significant part of this Bill allows for data sharing between the HSE and the Department of Social Protection, and the HSE and the Revenue Commissioners. This will include the sharing of personal and sometimes sensitive data between these bodies for purposes of assessing and reviewing eligibility, entitlements and liability for taxes and charges. The Data Protection Commissioner must be consulted before such data can be shared. We have repeatedly been given the hoary excuse that the computer systems of the Revenue Commissioners and Department of Social Protection were not up to scratch and communications between those two statutory bodies were impossible. If this problem has been known about for so long, why was it not tackled and sorted out years ago? It will certainly be tackled now.

Instead of engaging in across-the-board cuts the Government is taking a measured approach as outlined in the Bill. It is vital that any possible changes are made in a manner that takes full account of those most in need. Having worked all their lives, the least we can do for the older community is to ensure that they can live out their years with decency, and without having to scrimp and save every penny.

The changes proposed in this Bill are happening in the context of broader health service reforms which will create a single-tier health system, where the need of the patient is put at the centre of the health system. These include the phased introduction of free GP care for all and the introduction of universal health insurance, which will effectively end the two-tier health service.

The reforms are working. Not alone have we proven that we can maintain a safe service, despite the naysayers, we have actually improved services in the past two years. There has been a reduction in the numbers of people on trolleys and a reduction in waiting times for elective procedures. Figures published last November showed that the number of adult patients waiting longer than six months for an elective surgical or medical procedure had fallen by 37% since the Government took office. The number of children waiting longer than three months for a planned procedure had fallen by 66%. The recent response to a parliamentary question also showed there have been far fewer operations cancelled during the Minister's tenure than during the tenures of his immediate predecessors, who had plenty of time and money to address the health services.

Eight years ago, the HSE was established in response to the excessive spending and certain difficulties within the regional health boards. It became a catch-all, obese organisation, independent and over-staffed, presiding over a succession of health scandals. The measures detailed in the recently published Future Health - A Strategic Framework for Reform of the Health Services 2012-2015 are very different. The actions are now specific and time-bound. The Government is confident to be held to account. The goal of all these reforms is to put the needs of the patient at the centre of the health system. The essential public nature of the health system will not be changed. We will see a new focus on keeping people healthy while moving away from simply treating ill people.

The Government is conscious of the importance of health and health care to all members of our society, particularly during a time of economic crisis. We will move away from the current hospital-centred model of care towards a new model of integrated care that treats patients at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. Structural reform is key to addressing the problems of the health service according to the document, which emphasises the need for good governance, the avoidance of duplication and a strong regional focus in delivering value for money.

The complexity of the health care environment necessitates that health policy, legislative objectives, resource allocation models and management structures be aligned to plan and deliver health care services strategically. Health care systems around the world struggle to reconcile three competing objectives: equality of access, high quality and low cost. These are objectives which the Minister, Deputy Reilly, has made the cornerstones of his reform programme.

The Government's health strategy focuses on the key aims of the integration of health and social care services to better meet the needs of the population of Ireland. This integration of service delivery across professional and institutional boundaries will deliver health care based on client needs and in the most cost-effective location. Ensuring that patients are able to move easily through the entire care system requires services that are well organised and informed by best available evidence and practice. In this context, there is an emphasis on the provision of a model of integrated care that leads to greater integration between primary and secondary care with the development of care pathways, referral protocol, guidelines and shared-care arrangements. Using performance data and other available information will help to determine performance and improve services based on the needs of patients. Nobody ever said it would be easy but it is going a long way with the reforms started by the Government.

The document is highly significant in that it will affect our well-being and economic social performance like no other initiative. In addition to the aspects already mentioned - universal health insurance and free GP care - I wish to highlight the new patient safety agency to be established and also the health and well-being agency.

This shows the holistic approach the Government is taking towards the delivery of services, particularly its proactive rather than reactive measures in the area of health and well-being.

The value for money report and access to care variations are key components of the implementation of any process and need to be closely aligned to the strategies outlined in that document. The focus now is on keeping people healthy rather than treating them when ill. It is also proposed to move from the hospital centre model of care to a new integrated service which treats patients as close as possible to home while ensuring the best possible value for money for the State.

This Bill is only one small step towards the delivery of the €700 million savings required this year in the health services. However, it is a measured and effective cost-saving exercise. I commend the Bill to the House.

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