Damien English (Meath West, Fine Gael) | Oireachtas source

I am thankful for the opportunity to contribute to the debate on this Bill. It is another important and practical piece of legislation to come through the House in recent time, which will enhance the delivery of greater reform of the health sector. It is a simple and straightforward Bill. It is a common sense measure. It is hard to believe that it was not brought in years ago. One would assume that this system was already in place but having worked in the health service I know that it is not in place. It is a basic system that should have been implemented a long time ago to ensure our modern health service is run as efficiently as possible. It is another measure on the list of reforms that the Government has said must be brought in and we will bring in those reforms. We have ticked this box and it will lead to greater reforms as we move forward.

The Bill, as passed by the Seanad earlier this month, will provide the legal framework for individual health identifiers for those using the health service and unique identifiers for those who work in the health service, irrespective of whether they are in the public or private sectors. It is important to note also that the Bill is another step in providing a more modern, efficient and safer health care system, and safer is the key word. Matching the right information with the right patient is basic and key but it does not always happen because there can be human error and mistakes can be made but systems must be put in place to ensure that does not happen. That is what this measure is. It is putting a simple system in place which will attach the right information to the right patient and that it can be found when it is needed. In that way we will know who everybody is in the system and when they go from one doctor to another they will not have to repeat themselves and fill in the same forms over and over again.

I am encouraged by the general support for the Bill on all sides - if I am correct on that - in both Houses. It is encouraging with all the party politics that have been going on in recent weeks that we are dealing with a Bill such as this on which everyone can agree and that makes common sense. In reforming the health service generally, most parties will agree with what has to be done. There might be slight ideological differences about certain aspects of it.

Overall, the majority of us want this system reformed as much as possible. We recognise there are outstanding people working in all parts of it. However, we need to have a system that allows them to do their work to the best of their ability, efficiently and at the lowest cost to the taxpayer and the insurance payer.

The Bill does deal with privacy concerns, so I hope that issue will be put to bed and that everybody will accept this and use the number. It is important that we find some way to encourage those who might have doubts and might not want to use the number. I also spoke about what information will be attached to this. However, I hope it will be realised that the system is there to help people and make sure they get the best health care. They will buy into it once it is explained properly and there is help for them in using it. I have no doubt there will be a great take-up of this.

The Bill is about safety and quality of care. It will enable better promotion of patient safety to include clinical audit and investigation, reporting of patient safety incidents, management of the health services, including planning, monitoring, delivering, improving and evaluating health services, and also investigating and resolving complaints. During his speech in the Seanad, the Minister said this would take away some of the duplication of diagnostics. This should not be necessary because the information should be attached and there should be no need to repeat the same test again a few months later or in a different part of the health service, be it private or public. That is what we are told and I believe it is outlined in the Bill that previous test results can be attached and used again. I hope that is the case and is what will happen in practice.

With regard to the management of the service, when I worked in the payroll end of the service, it was a nightmare, with all the different grades and people who worked half-time, full-time, quarter-time and so on. For someone who was just in college trying to learn accountancy, it was a pure nightmare trying to put a system in place that would work out people's wages and pay them properly. A couple of years later, when I was in the Dáil, the Taoiseach of the time was Bertie Ahern, the Minister for Finance was Brian Cowen and the Minister for Health and Children was Mary Harney. On the same day, in three different speeches, although I could be wrong on who gave which figures, one member of the Cabinet referred to the HSE and the health service employing 140,000 people. That evening, another Minister, possibly Mary Harney, referred to the service employing 110,000. Lo and behold, before the night was out, Brian Cowen referred to the figure as 120,000. Therefore, the Government of the day did not even know how many people it employed and paid in the health service.

That alone shows that a basic system like this, which would show who is who and who is working on what patient, is fundamental to bringing reform and managing the health service. There is so much money and so many people involved in this area that it is important we get it right. Therefore, while this is not a large Bill, it is essential. We have been talking about it for years and I am glad to see it happen.

It goes back to the reform agenda, which states that we will not just talk about reform but that we will go and do it. I accept that reform can take time. In any reforming agenda, especially in regard to health, any given Minister, such as the Minister, Deputy Reilly, or the Minister of State, Deputy White, will be picked on at certain times because a certain part of the health service is not performing. It cannot all be fixed overnight and it will take time. However, it is possible to pick off the bits we can do and say, for example, that this year we will do X, Y and Z, and, over a period of time, we can get it fixed.

To be fair, when it comes to health, both Labour and Fine Gael very clearly said before and after the election that it would take time to fix it. There was no false promise that we would fix this in seven months, a year or two years. In fact, seven years was the general figure talked about and it was said that it would take two terms of Government to completely reform the health service. I believe we are on track to achieve that and I have no doubt we will do so. It is not the end of the world if we are six or eight months behind in our schedule provided we have most of it on track, know where we are going and have a plan of action.

Measures such as this small Bill feed into the idea that money follows the patient and into universal health care, which will reform the health service. I totally believe universal health care will solve our problems. Yes, we will have to tease it out and work out the details but if we get it right the first time, it will work. It will level the playing field and will give a genuinely single-tier health service, once it is implemented correctly. I have no doubt about that.

I presume that, at end of the day, the Government will provide the basic cover that will get people equal access to health treatment and to an operation, which is what is fundamentally important. If people want to have a room of their own, have more flowers in the room or have a nicer dinner, they will pay more for that, which is their choice. However, the access to treatment is what we must have equality on, and I have no doubt that will be achieved if we see this through correctly.

It has been said that this is the key to the money follows the patient approach and the whole e-health agenda. Money follows the patient is another simple concept that has worked very well in the last year or two while on trial, and it has been rolled out much further this year. No hospital has been penalised due to this and the money still stays in the system but, eventually, hospitals will be rewarded for activity. This works very well and has driven huge change and efficiencies in the orthopaedic unit of my own hospital. The results speak for themselves. There has to be a system of reward as well as penalty. If someone does well and benefits from the money follows the patient approach, which is a form of activity-based costing, there is a reward for that in terms of extra resources, which hospitals will get to keep. If a hospital is three months ahead of its target towards the end of the year, it will get extra money to do more work. Ideally, if the money follows the patient concept provides efficiencies and frees up time, we should be able to use that extra space to carry out more operations. I presume that is the overall agenda.

As I said, the sooner we have universal health insurance, the better. Across the board, the e-health agenda will make it much easier for health practitioners and all those involved in the service to deal with people and make judgments. If they can use IT systems at the highest level, they can give a judgment no matter where they are based, and a consultant based in Cork can give an opinion on a case in Dublin. That is what we need. It is partly in place already but we need more of that, and it can only happen if systems such as this are rolled out. I am all for that. The sooner we get it, the better.

This area is part of a wider overall reform. The Minister in his speech in the Seanad referred to the medical card situation. Even a Bill as simple as this should help the situation because information is getting lost at present. This happens in other Departments also, although it should not happen. It means that, while people eventually get their medical card in any case, there is the trauma of trudging through the system, repeating the information and asking Deputies to send the information again. It is embarrassing and should not happen. I trust a Bill like this will help with the reform of the system, ensuring that information flows more easily and will not get lost or attached to the wrong file. Departments should not lose information, in the same way that the private sector should not lose it. It should not happen and I hope this Bill is the beginning of the end of that.

While I could address other areas of reform, I am happy when I see a Minister outline that, this year, we will fix X, Y and Z. The plan for this year was to tackle the outpatient waiting list. It was embarrassing to admit at the start of last year that there were 350,000 people on outpatient waiting lists. However, we had to admit that, count the figure and then say that we would bring it down. That figure has now been reduced, and instead of the 100,000 people who were waiting more than one year, the figure is now 4,000 or 5,000, which is a massive achievement. The Government has to be strong at the start and admit how bad the situation is, and then say "Give us a year or two and we will fix it". We did not have that in the past. People were afraid to admit to things. I am glad we are on the right track. While it will take more time to fix everything in the health service, we will get there. There is no doubt about that.

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