James Reilly (Dublin North, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:"agrees that the 2014 national service plan provides a comprehensive basis for the Health Service Executive, HSE, to continue to deliver safe and high quality health and social care services to the general public throughout the year;

notes that the overriding priority reflected throughout the 2014 national service plan, at a time of undoubted financial constraint, is the commitment to patient safety;

notes that the HSE has set the advancement and implementation of the Government's programme of health reform at the centre of its service planning for 2014; and

notes, in particular, the progress that has been made in reducing the waiting times for patients on trolleys in emergency departments, with a reduction of 8,814 in the year to 27 December 2013, down 34% from 2011."

I welcome the opportunity to address the House regarding the 2014 national service plan for the health services. As Deputies have pointed out, this is a time of significant challenge for the health system as a consequence of the emergency financial situation the State has had to address in recent years. Conveniently, all of the speakers opposite omitted to explain how we ended up in that financial morass. Fortunately, as a result of the hard work of the Irish people, we are now emerging from it.

Along with significant and sustained financial pressure on the health system and reductions in health and social care funding and workforce numbers, the health services have also had to respond to significant demographic pressures, with the population of the State increasing by 8% and the proportion of persons aged 65 and over growing by one fifth since 2008. Several Deputies referred to Mr. Tony O'Brien's statements before and after the Cabinet meeting in December. The differences in his second statement are reflective of the decision at that meeting to provide an additional €47 million, which makes the delivery of the service plan much more achievable. Nonetheless, we are facing a serious challenge in 2014. Indeed, it might well be the most challenging year so far for the health services.

The 2014 service plan outlines a comprehensive response to these challenges. Fundamentally, it is about patient safety, with the emphasis throughout on enhancing and improving measures in that regard. The plan also reflects our focus on reform and builds on the significant progress we have made in implementing our historic programme of reforming initiatives. The evidence of our success thus far in these two areas - reform and patient safety - can be seen in the year-on-year reduction in the number of patients on trolleys in our hospitals. Despite the significant challenges, we have not only ensured that the health services are responding to the day-to-day pressures of providing high quality care with reduced resources but have also begun putting in place the building blocks of a health service fit for the 21st century. Since the publication of our strategy for reforming the health services in November 2012, we have set about redesigning a health service that provides access according to need rather than ability to pay, enables best health outcomes for available resources, and treats patients at the lowest level of complexity that is safe, timely, effective and efficient, and as close to home as possible.

In 2014, we are implementing the money-follows-the-patient funding system in hospitals on a phased basis, building on the work we did in 2013. Participating public hospitals will be paid for the actual level of activity undertaken rather than receiving a set annual grant. This will support greater efficiency in hospitals and help to enhance patient safety. It will also ensure a patient-centred service. Simply put, if there is no patient, there will be no payment to the hospital. We will continue the work on hospital groups that we began in 2013, appointing new group chief executive officers where required and developing memoranda of understanding between the Health Service Executive and each group. In addition, we will be seeking new industry partners, including from abroad, in the areas of pharmaceuticals, medical devices and other areas of research. The objective is not just to improve health care but also to create jobs in these areas.

Embodied in hospital groups is the fundamental principle of system reform whereby care will be given at the lowest level of complexity and as close as possible to home. This reflects our desire to empower health service staff, within a robust system of governance, to make better decisions in the interests of patient safely. Alongside this reform of hospital groups, we will be working on the establishment of new community areas, with associated governance and organisational arrangements, following the completion of the review of integrated service areas. We will implement new internal management structures with specific programmes relating to shared services, procurement, human resources and information. This builds on the abolition last year of the HSE board and establishment of the HSE directorate, and will be complemented by reform of the Department of Health. Our shared goal is to enable the health sector to respond in a more effective way to patients' health needs and empower health service staff.

Signal among these reforms, as set out in the 2014 service plan, is the establishment of a patient safety agency, initially on an administrative basis within the HSE structure. This will represent a major step in improving safety and quality. The agency will have an advocacy role in regard to patient complaints, supporting patients by directing them to the appropriate provider or agency that can provide a response to the issues they raise. If patients do not obtain satisfaction, the agency will be able to help them to advance their complaint in another forum. Based on a detailed analysis of complaints throughout the system, the patient safety agency will provide national leadership for patient advocacy services, including the health service charter, You and Your Health Service. The agency will also focus on leadership and capacity-building for patient safety, clinical effectiveness, adverse-event learning and clinical audit.

Patient safety is our watchword and the number one priority in respect of both clinicians and health system management. It must be fully built into governance, management and accountability systems throughout the health services. In 2014, there will be a particular focus on the priority areas of medication safety, health care-associated infections, HCAI, and the national early warning score, NEWS. The plan also seeks to implement the recommendations contained in the reports of the Health Service Executive and the Health Information and Quality Authority regarding the maternal death at Galway University Hospital in 2012, by targeting necessary patient-centred improvements in maternity care.

Our programme of reform extends beyond the health services into addressing the growing incidence of chronic illnesses and the challenges of an aging population. In 2013, we published Healthy Ireland - A Framework for Improved Health and Wellbeing, which sets out a whole-of-government and cross-sectoral approach to addressing the demands placed on health and social care services.

The commitment in the 2014 service plan to the health and well-being reform agenda set out in Healthy Ireland is critical in terms of enabling the required shift in emphasis towards health prevention, promotion and improvement in the years ahead.

The Government is not unfamiliar with the need to achieve savings. It is reflected in the service plan in the shape of €619 million worth of savings measures, which reflect an additional €47 million in health funding provided by the Government in the Revised Estimates. As already outlined, this target is challenging. The House will be aware that as part of budget 2014, I sought an objective verification process to focus on medical card probity, for which the original budgetary target was €133 million. The outcome of the verification process is that €23 million, rather than €133 million, has been targeted in medical card probity. This takes account of the progress already made on probity and of the Government's commitment that everyone who is entitled to a medical or GP-visit card will have that entitlement guaranteed. I reiterate for the benefit of the House and the public that no person who meets the eligibility conditions for a medical card will be affected by this measure. In fact, the 2014 service plan provides an additional €35 million to meet the cost of new applications for medical and GP-visit cards this year. The Government will ensure that those who are entitled to medical cards will continue to hold them.

The implementation of the Haddington Road agreement is now well advanced in most sectors and is delivering on its objectives. The agreement involves a demanding set of targets for the health service, which accounts for approximately one third of the overall public service workforce. The focus and responsibility of HSE management is on the delivery of the necessary savings and a HSE national assurance and support team is working with managers to ensure that measures to deliver these savings are implemented. Under the service plan, the €108 million in pay-related savings form an integral part of the overall savings target. This will be subject to a separate process and will, of necessity, remain unspecified and be held centrally by the HSE until measures to realise these savings have been agreed between the Departments of Health, the Taoiseach and Public Expenditure and Reform.

Of course, we are going to achieve significant savings from reference pricing and generic substitution. Price reductions of the order of 30% per item reimbursed have been achieved since 2009 and the average cost of items reimbursed is now running at 2001-02 levels. It is anticipated that reference prices will be set for 80% of the off-patent market by the end of this year. We introduced the first reference price in November of last year for atorvastatins and the HSE now pays 70% less for these products compared to what it was paying last May. This will ensure that the medicine prices in Ireland fall towards European norms. This year will also see continuation of the HSE's preferred drugs initiative to facilitate the most cost effective prescribing, particularly in respect of high-cost medicines and the continued full-year impact of pricing agreements concluded with the Irish Pharmaceutical Healthcare Association, IPHA, and the Association of Pharmaceutical Manufacturers in Ireland, APMI, which will result in savings of €28 million in 2014.

For people and patients, a key barometer of the success of our reform programme must be the performance of emergency departments and waiting lists. I am proud to report that there has been a 34% reduction in the number of accident and emergency department patients waiting for ward bed accommodation when one compares 2013 to 2011. That is almost 30,000 fewer patients waiting on trolleys. The figure for the number on trolleys in accident and emergency departments today stands at 327. The remainder are on wards, some on trolleys and some in beds. Two points need to be made in this regard. One cannot compare today's figures for those of years past because Ward Watch did not exist then and the trolleys and beds in wards were not counted. More importantly, outcomes for patients are absolutely proven to be much better when they are on wards and regardless of whether they are on trolleys or in beds. It is patient outcomes with which I am concerned.

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