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

It is clear that 2014 will be a very challenging year, perhaps the most challenging for the health services. However, as a country, we have made significant progress since the Government came to office in March 2011. I wish to reflect on the progress made and to outline the Government's priorities in the health sector for the year ahead, which is not to ignore the real difficulties that remain and the hardship that people have been obliged to endure. The Government inherited an economy in free fall and a health service in crisis. It has since stabilised the economy, as it has stabilised the health service. Just as the Government seeks to implement fundamental reform in the economy to boost job creation and make Ireland the best small country in which to do business, it is implementing fundamental reforms of the health services to provide the people with a health service that has the needs of the patient at its core.

Ireland has some of the best doctors and nurses in the world. Moreover, some of the best managers in the world are Irish. Therefore, the question is: why do we not have the best health service in the world? I believe Ireland can have one of the best health services in the world, but to achieve this, the service must be reformed. It must be reformed in a way that allows those who work in it deliver the excellence with which they have been trained and that they wish to deliver. Reform is critically important but so is making a difference today for today's patients. That is the reason my first priority on taking office was to tackle the issue of trolleys in emergency departments and to tackle waiting lists in outpatient and inpatient departments. I am proud to report on behalf of the health service that there has been a 95% reduction in the number of people waiting more than 12 months for an outpatient appointment. In addition, a 33% reduction in the number of patients who must endure long trolley waits was achieved between 2011 and 2013, with a 13.4% reduction between 2012 and 2013. The present Administration is the first Government to actually quantify the number of people waiting on an outpatient list. As I have stated, now that the Government has this information, it can target resources and implement innovative solutions to address these waiting lists, because, quite simply, unless one can identify and quantify the problem one has no chance of dealing with it.

Given the economic situation, it has been imperative for the Government to reduce costs, and this has been done. Savings measures of approximately €3 billion have been made and staff reductions of approximately 10% have been implemented, while all the time maintaining services. While I acknowledge that other areas of the public service have been obliged to put in place similar plans to achieve the Government's fiscal targets, as Minister for Health I am particularly proud of how the health service staff have responded to this challenge and of how the men and women who work in the health service on a daily basis continue to deliver safe care despite the challenges they face. I wish to place on record my support for them. The Government also has sought better value for money for patients and the public by reducing the costs of drugs and medicines. Again, it has done so in a sustained and planned way through legislation on reference pricing and generic substitution, and by so doing, it has cut the costs for the customer while maintaining quality and safety. Moreover, the Government has not just cut costs for today but has done so for tomorrow.

I have mentioned a patient-centred health service and that is the reason that in 2014, the Government intends to establish a patient safety agency on an administrative basis. I am pleased to state that the advertisement for a chief executive officer for the aforementioned agency will be placed in the press this week. The patient safety agency will support patients in securing an appropriate response to issues or complaints they raise about safety or any other complaints they may have. Patients will have an advocate who will act on their behalf and help them by directing them on how to pursue their complaint and to get satisfaction for that complaint. From my 30 years of experience as a doctor I know that when things go wrong, what most people seek is an apology, an acknowledgement that something wrong happened and an assurance that it will not happen again because things will change. This is what the purpose of the patient safety agency will be, but it will also promote and disseminate lessons from complaints nationally. The Government also preparing the way for a licensing system for both public and private health service providers, which will put in place a framework for enhanced accountability and monitoring, and this licensing authority will have teeth.

It is often said to me that one can be sitting in a restaurant about to enjoy a meal when an environmental health officer can come in, take the plate from under one's nose and say he or she is closing the place down as it is not safe to eat in, yet we do not have a similar system in place for hospitals, or departments of hospitals, which have not been safe. We need to ensure that system is in place, particularly when it comes to private facilities which are unlicensed and for which we have very little remit.

Since 2011 we have cut the cost of health care for patients and the public and reduced expenditure on health services, while reducing waiting times and numbers and maintaining patient safety and quality, but this is not enough. The population faces significant public health threats not just to this generation but to future generations also. Obesity and the misuse of alcohol and tobacco are not just individual threats, they represent public health risks which will consume us if we do not address them at a strategic level in a planned way. That is why we published Healthy Ireland, our strategy for improving the health of the people and enhancing health and well-being. It is an ambitious strategy which aims to embed health and well-being across public policy and services. A healthy population is a productive one and clearly it is cost efficient to combat public health threats through initiatives such as Healthy Irelandrather than through the health care system, which would be unsustainable and not fair. I will give the analogy of investment in fire tenders, ambulances and all of the personnel at the bottom of the cliff as they deal with casualties instead of putting up a proper fence to stop people falling off the cliff in the first place.

Healthy Ireland is about prevention. Under it, we have published Tobacco Free Ireland, our strategy for making Ireland tobacco-free by 2025, by which we mean a prevalence of smoking of under 5%. In 2014 we are progressing legislation on plain packaging for tobacco products, smoking in cars with children present and licensing the sale of tobacco products. These are immediate initiatives that will have long-term benefits for the people, health services and, most important of all, our children. I thank the Acting Chairman, Deputy Jerry Buttimer, for his conduct of the Oireachtas Joint Committee on Health and Children in dealing with these matters.

I sought and received Government approval for a package of measures to tackle the misuse of alcohol through a public health Bill. We want to bring our average annual alcohol consumption figures down and combat the ill-effects of the misuse of alcohol not just for the health service but also the economy and, most importantly, society.

Healthy Ireland is a framework through which we want to tackle obesity, in particular childhood obesity. I am sure everyone in the House agrees that our future lies with the next generation and that we need a sustainable strategy to protect them from the wide-ranging negative health effects of childhood obesity. We will be focusing on this issue in 2014. I am very pleased that, as I say these words, the Minister for Children and Youth Affairs, Deputy Frances Fitzgerald, who is equally committed to this task is sitting beside me.

If Healthy Ireland seeks to address future health issues in the population, Future Health,our strategy for reforming the health service, seeks to put in place the building blocks for a 21st century health service - a single tier health service where care will be available on the basis of need, not income, through universal health insurance and with equity at its core. Since its publication in November 2012, we have made significant progress. We have established hospital groups and appointed a chairperson for each group. We are recruiting chief executive officers for them. Throughout 2014 work will continue to fully establish them on an administrative basis. The creation of hospital groups is a critical step in improving hospital performance and, ultimately, patient outcomes. In the short term the groups will harvest the benefits of increased independence and move away from the traditional command and control style of the HSE.

In July 2013 we established the directorate of the health service under the Health Service Executive Governance Act which also abolished the HSE board. We are bringing the HSE Vote back to the Department through the Health Service Executive (Financial Matters) Bill which is going through the House. A finance reform board is in place and a chief financial officer has been appointed in the HSE. A new financial and cost management system has been identified and is being costed. Throughout 2014 we will progress the legislation and continue to work on the management system. This will enhance accountability, as well as establishing a sustainable system for controlling costs which is essential in the current and future fiscal environment.

In 2013 we published the phase 1 report of the chair of the consultative forum on health insurance. The chair is proceeding with phase 2 and will report back to me very soon. As the House knows, we must continue to address issues in the private health insurance market as a basis for the introduction of universal health insurance. I am determined that the cost of private health insurance will be reduced. Astonishingly, there has been no clinical audit of the insurance system prior to this. There was no one to challenge doctors on why they were doing certain tests and the value of doing these tests. We have had a pretty loose audit of hospitals in the past, but that has changed. I am happy to say VHI has a cost containment programme and put in place measures which have resulted in one private hospital having to repay €5 million. I am sure there will be more. Equally, we must benchmark what we are paying consultants and why we are paying the money we are paying. The House will have heard me say often that we are still paying the same rate for procedures which used to take two hours but which now take only 20 minutes with modern technology. This has to stop.

Another key element of Future Health is the concept of the "money follows the patient". The introduction of the new funding system on a phased basis lays the foundations for universal health insurance. Following a pilot study in 2013, it is being introduced across the health service in 2014. It will provide the funding framework for improved and enhanced outcomes for patients, as well as the professionals who serve them. Put simply, if there is no patient, there will be no payment; therefore, the patient will be king or queen.

Despite the challenging financial circumstances, as part of budget 2014, we will introduce free GP care for children aged five years and under. Work is well advanced on drafting the required legislation and the development of an associated GP contract to ensure this service will commence this year. We will continue work on the development of options for the provision of a GP service without fees for the entire population. I say to those who query the wisdom of providing this service when we have other issues with which to deal that we really need to drive home the message that primary care and general practice is where most medical needs can be met. It is also more cost effective and convenient for patients. That is the direction in which we must move as we cannot continue with the hospital-centred approach as it would break the economy, even if we did not face the fiscal challenges we currently face. As I said, the Government is committed to a major enhancement of primary care services as part of the move towards universal health insurance. This step towards a phased introduction of free GP care must be seen in that context.

In December 2013 we published the Health Identifier Bill and launched our e-health strategy. Technology can enhance health care, improve outcomes and drive efficiency. To implement it, e-health Ireland will be established initially in the HSE. It will be headed by a chief information officer for the health service who will be recruited through an open competition. Priority areas for initial development include e-prescribing, online referrals and scheduling, telehealth and the development of summary patient records. Again, on a day-to-day basis, the judicious use of technology brings greater efficiencies, but in the long term the use of technology gives us more information and, therefore, enables us to make better health care decisions. Ultimately, it saves lives and money.

I would like to make the point Dr. Susan O'Reilly, director of the National Cancer Control Programme, has often made that better organisation and management can yield a 10% improvement in outcomes for patients. If there was any doubt about this, last week I launched Lollipop Day for the oesophageal cancer support group and while none of the treatments has changed, the organisation and delivery have and the outcomes for those with oesophageal cancer have improved by 20%. That shows how organisation and management are such a critical part of improving outcomes for patients; it is not just about medical care.

Health service staff are of high quality and dedicated individuals who need and deserve high quality and dedicated facilities. Despite the significant challenges we face, since 2011 the Government has progressed 34 primary care centres and a further 12 have been approved for building. As resources permit, the network will be expanded. We are also developing the national children's hospital, with the aim of starting to build next year. We are relocating the National Maternity Hospital, Holles Street, to the campus of St. Vincent's University Hospital at Elm Park. A project team has been appointed and we expect a design team to be appointed shortly.

We are also developing a new central mental hospital in Portrane for the care of those with mental health issues and work on that project is well advanced.

As well as looking to the future, we have sought to address legacy issues. In particular, the State Claims Agency is implementing a redress scheme for women who had been excluded from the 2007 Lourdes Hospital redress scheme on age grounds alone. I commissioned a research report on symphysiotomy and appointed Judge Murphy as mediator. When she reports, I will consider that report and bring proposals to the Government for approval. We cannot move forward on the issues of tomorrow without having resolved the issues of the past.

The House will be aware of the significance attached to the plan by this Government to introduce universal health insurance. Universal health insurance is fundamental to the reform of our health services and goes to the core of Future Health. It has garnered significant media attention in past weeks and while universal health insurance is undoubtedly the final destination for health care reform, the White Paper represents the beginning of the journey. The Government and I are at one in agreeing that we need the input of the Irish people. The health services serve the people and they have the right to interrogate rigorously this Government's vision of the future of those health services. We will put a comprehensive plan for consultation in place so we can have a national conversation on the future of our health services. The Acting Chairman, Deputy Buttimer, will find himself at the centre of that conversation in his role as Chairman of the Joint Oireachtas Committee on Health and Children. I wish him well in his work and know he will allow a full and frank discussion and debate involving all who are interested in this issue. This principle is key, not just to the consultation but to universal health insurance itself. If universal health insurance is about one thing, it is about fairness. A fair system is one where everyone pays according to his or her means, where the basket of health services is decided on transparently and openly and where good performance is nurtured and encouraged and bad performance is addressed and improved. This is the health service we envisage under universal health insurance.

All of the various reforms I have outlined, including the money follows the patient principle, hospital groups and eHealth, are designed as building blocks for universal health insurance and for a health service that is pragmatic, practical and rational. We want a health service that is open and transparent and one that can deal with future challenges. That is where we are going and I look forward to working in partnership with stakeholders and the health services in achieving this goal, always with the clear purpose of improving outcomes for patients.

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