Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:"welcomes the Health Service Executive’s national service plan for 2015;

recognises that the Government, in next year’s budget, has made provision for a welcome increase in the total financial resources available to the Health Service Executive, HSE, in 2015, and that this is reflected in the plan;

notes that this increase in funding, which is comprised of additional Exchequer funding of €305 million, increased projected once-off revenues of €330 million, and minimum savings of €130 million in areas such as procurement and drug and agency costs, is part of a two year programme to stabilise and improve health funding after seven years of significant retrenchment as a direct consequence of the emergency financial situation the Irish State has had to address;

further notes the fact that the Health Service Executive's 2015 national service plan provides generally for the delivery of existing levels of service while additionally targeting service enhancement in a number of priority areas through increased funding provision and further progress in the health service reform programme;

further recognises that:

— these enhancements include programme for Government commitments to extend the BreastCheck programme, the introduction of free general practitioner, GP, care without fees for those over 70 years of age and under six years of age, an expansion of mental health services, and further investment in suicide prevention; and there is also provision for 20,000 additional day surgery cases, additional funding of €2 million to improve maternity services, improved pilot ultrasound access for GPs in priority care sites and additional spending on community orthodontic and ophthalmic services; and

— an additional €25 million is being provided to help address delayed discharges from acute settings which will fund a range of community and non-acute supports, including an additional 300 places under the nursing homes support scheme, the provision of 115 short-stay beds, including the opening of Mount Carmel as a community hospital for Dublin, 600 additional home care packages and the extension of community intervention teams; and

supports the fact that the plan includes a considerably enhanced governance and accountability framework for 2015 which describes in detail the means by which the HSE and, within this, hospital groups, community health care organisations and other units will be held to account in 2015 for their efficiency and control in relation to service provision, patient safety, finance and human resources."

While those of us who live outside Dublin are used to community hospitals, the opening of short-say beds in Mount Carmel marks the first time such a hospital has opened in the capital. I will not address the suggestions made by Deputy Ó Cuív as I propose to stick to the prepared script for a change because it provides a detailed statement on the service plan. Private Members' business is structured in a way that does not allow for the type of informal debate that would be well worth having. Perhaps we should seek to arrange an informal and respectful debate on the issues raised by the Deputies opposite. All of us agree that the difficulty lies in the cost of change and how we would allow people to live a different life. A serious examination of this cost of change is needed.

I very much welcome this opportunity to address the House on the Health Service Executive's national service plan for 2015. It is important to recognise that the funding provisions set out in the 2015 plan constitute a very welcome turn of the tide after an unprecedented seven years of significant and continuing reductions in funding for health and social care services. In the period between 2008 and 2014, funding in excess of €1.5 billion was taken out of the health budget as a direct consequence of the financial emergency the State had to address. During this period of unprecedented budgetary constraint, the number of health sector staff was also reduced by more than 11% or almost 12,000 employees at a time when demand for health services continues to increase owing to the welcome growth in and ageing of the population. It is important in this context to acknowledge the resilience demonstrated by workers across the health service during these most difficult of times and the significant efficiencies and improvements in productivity that were achieved during this period. It is also important to acknowledge the improvements across a range of services, including stroke, cardiac and cancer services. Improvements in cancer services had their origins in measures which were introduced and driven by the previous Government. These achievements were made despite ever reducing budgetary ceilings and staffing resources.

Against this backdrop, it is most welcome to be able to report to the House that in 2015 the Health Service Executive will have an improved rather than sharply reduced level of resources to work with in delivering health and social care services to members of the public. The health allocation provided for in the 2015 budget constitutes a first step in reversing the prolonged cycle of budget cuts and is part of a two year process to stabilise and improve health funding. With this in mind, the spending ceiling for health in 2016 has been also already increased upwards by a further €174 million. For the first time since 2008, health funding is moving in the right direction. The net result is a very welcome increase in the financial resources available to the HSE in 2015.

The HSE will have €635 million more to spend next year than it did this time last year. This figure is made up of additional Exchequer funding of €305 million and projected once-off revenues of €330 million. The HSE has also identified a minimum savings target of €130 million in areas such as procurement and drugs and agency costs. In a welcome new development, any further savings that can be achieved over and above this target will go back into the delivery of health and social care services and will not be used to reduce the Exchequer provision, as occurred in previous years. Given overall expenditure constraints and other pressures on the public purse, it is important that full use is made of this incentive as a dynamic contributor to the delivery and reform of services within the expenditure level determined by government.

The more realistic budget parameters for 2015 have allowed the HSE to prepare a service plan which further progresses key elements of the health service reform programme and targets certain priority health and social care service enhancements in a number of areas, while providing generally for the delivery of existing levels of health and social care services. Deputy Kelleher should note that this was the point made by the director general of the HSE, Mr. Tony O'Brien.

Next year will be an important year for demonstrating the benefits of key reforms in the health service. We must all work collectively to improve safety, quality and the patient experience for those who depend on our services. It is also vital that qualitative aspects, such as the personal care and attention that patients receive, are the subject of focused efforts in order that people's experience of the health service is not only safe but also caring and pleasant.

I particularly welcome the integrated approach across acute, community and residential care settings to which the HSE has committed in its service plan to ensure patients are supported at all stages in the care setting that is most appropriate to their needs. This is most important in the context of the establishment and further development of the hospital groups and community health care organisations. The reorganisation of public hospitals into hospital groups is designed to deliver improved outcomes for patients. The hospitals in each group will work together to provide acute care for patients in their area, integrating with community and primary care.

The objective is to maximise the amount of care delivered locally while ensuring that complex care is safely provided in larger hospitals. The next phase of implementation of the hospital groups to implement fully the seven hospital group constructs is provided for in the service plan. Hospital groups will also develop and deliver strategic plans in 2015, setting out how each group will provide high-quality, safe, integrated patient care in a cost-efficient manner during next year.

The Government is also committed to the introduction of activity-based funding, formerly known as money follows the patient, whereby hospitals are paid for the quality care they deliver. This funding model will drive efficiencies and increase transparency in the provision of high-quality hospital services. The HSE intends to implement this new funding model further on a phased basis during 2015. In addition, 2015 will see the establishment of national community health care organisations and their management structures by the HSE. This represents an important step in improving how primary care in the community is delivered. The new structures will improve services for the public by providing better and easier access to services, closer to where people live and in which people can have confidence.

I also want to highlight the work of the national clinical programmes as an example of clinical leadership. They have already greatly improved services in many specialised areas, such as stroke and cardiac services. The HSE service plan will see the development of these national clinical programmes into five integrated care programmes, dealing with patient flow, older persons, chronic disease prevention and management, children's health and maternal health, and will improve the integration of services, access, and outcomes for patients generally. These developments will ensure that the new integrated clinical programmes are very much at the centre of operational delivery and reform, and I warmly welcome this development.

There are many positive service developments provided for in next year's HSE service plan. Key commitments in the programme for Government that will be delivered next year include the extension of the BreastCheck programme, the introduction of free GP care to the youngest and oldest in our society, an expansion in the level of investment in our mental health services, and further investment in suicide prevention. There is also provision for 20,000 additional day surgery cases, additional funding of €2 million to improve maternity services, improved pilot ultrasound access for GPs in priority care sites and additional spending on community orthodontic and ophthalmic services.

An additional €25 million is being provided to help address delayed discharges from acute settings which will fund a range of community and non-acute supports, including an additional 300 beds under the fair deal scheme, the provision of 115 short-stay beds, including the opening of Mount Carmel as a community hospital for Dublin, 600 more home care packages and the extension of community intervention teams. As Deputy Ó Cuív correctly said, this is an issue into which we need to put more resources and plan well for into the future.

I will provide further detail on a number of the priority health and social care service enhancements set out in the 2015 service plan. Breast cancer survival rates in Ireland have improved significantly in recent years through a combined approach of screening, symptomatic detection and improved treatment. Additional funding is being provided in the HSE service plan to commence the extension of the BreastCheck screening programme next year to women aged 65 to 69 years of age. Screening of the extended cohort will commence towards the end of 2015 and will be expanded incrementally. The additional eligible population is approximately 10,000, and when fully implemented, 540,000 women will be included.

The 2015 service plan provides for the implementation of the first two phases of a universal GP service, making available a GP service without fees to all children under six years of age and all persons over 70 years of age . The aim is to have universal GP care without fees for children under six years of age implemented early next year, subject to the conclusion of discussions with the Irish Medical Organisation and the completion of a fee-setting process. The measures for those over 70 years of age will be facilitated under the existing general medical card contract after the relevant legislation has been passed by the Oireachtas. By the end of next year, almost half of the population will have access to GP services without charges. That is a major step on the way to universal health care.

In response to Deputy Calleary, there are many medical cards in the system. What happened in the case he cited should not have happened, but when there are many cards in the system, one will always have hard cases because of the human element. We need to ensure what he described happens to as few people as possible.

The service plan also provides an additional €30 million to fund access to new hepatitis C drugs in 2015. This has the potential to bring major benefits for patients with serious illness as a result of hepatitis C. As with other countries, Ireland must ensure that access to high-cost treatments such as these is managed so as to prioritise access for patients who can benefit most, while also ensuring that the financing model is sustainable and affordable. The aim is to provide access for as many patients as possible with the resources provided by taxpayers. An early access programme for more than 100 patients with the greatest clinical need for these new direct acting anti-viral drugs is already in place.

Budget 2015 provides an additional €35 million in ring-fenced funding for mental health. This will bring to €125 million the total investment by the Government in mental health services since 2012. The additional funding will enable the HSE to continue to develop and modernise our mental health services in line with A Vision for Change. This includes the ongoing development and reconfiguration of general adult teams, including psychiatry of later life, and also child and adolescent community mental health teams, along with other specialist mental health services. This will be delivered through further recruitment and investment in agencies and services to achieve a consistent provision of quality services across all areas.

It will supplement the considerable investment since 2012 in the recruitment of up to 1,100 posts, which is due to be completed in 2015 when all the posts allocated for 2014 will be fully recruited. The funding will also permit urgent specialist needs to be addressed, including services for those with mental illness and an intellectual disability, psychiatric liaison services and addressing the gap for low secure acute care and rehabilitation services for service users with complex needs. Suicide prevention services will continue to be funded under the mental health heading, in line with the mental health promotion and stigma reduction objectives of A Vision for Change. A new suicide prevention strategy to replace Reach Out 2005-2014, the current national strategy, is in the final stages of development. Subject to Government approval, it is expected to be launched in early 2015.

Deputies will be aware that there has been a continuing upward trend in delayed discharges since the beginning of this year, with approximately 850 delayed discharges reported nationally. That is the equivalent of a large hospital. This is having a knock-on effect on hospital emergency departments, levels of elective admissions and on the health and welfare of the patients. I am very conscious of the upset this causes for patients and their families. Many of these patients are elderly and have been medically assessed as being well enough to leave hospital. Their health needs would be better met at home, in step-down facilities or in long-term residential care.

In response to these concerns, the 2015 service plan includes an additional €25 million to help address the issue of delayed discharges. This includes €10 million to support an additional 300 long-stay care places under the nursing home support scheme and to reduce waiting times for funding under the scheme to 11 weeks; €8 million to provide 115 short-stay beds, including the opening of Mount Carmel as a community hospital for Dublin; €5 million in extra funding to support an additional 400 home care packages; and €2 million to expand community intervention teams to deal with 2,000 referrals each year.

This additional funding in the service plan will allow the HSE to continue to progress the realignment of services towards home care and other community-based support services, where appropriate, to maximise the potential for older people to be cared for in their homes, close to their families and within their own local communities. Services will continue to be provided to avoid hospital admission and support early discharge through step-down, transitional care and rehabilitation beds, while maximising access to appropriate, quality, long-term residential care when this becomes necessary. It is also recognised that the matter of delayed discharges is not a matter that can wait until the new year to be addressed further and, in this regard, measures are under way to deal with this area of concern throughout the closing weeks of this year.

Other developments for 2015 include provision for 20,000 additional day surgery cases, additional funding of €2 million to improve maternity services and further development of primary care services, with an additional allocation of €14 million to fund measures to allow people to receive a wide range of high-quality services in their communities without having to present at hospital accident and emergency departments. This, in turn, will ease pressure on our hospital system. An example of developments that will be initiated in this area in 2015 include the extension of the pilot ultrasound access project to additional primary care sites on a prioritised basis next year and the provision of additional minor surgery services in agreed primary care settings and sites. There will also be an extension of GP out-of-hours services, within existing resources, to areas currently not covered, and additional spending on community orthodontic and ophthalmic services.

It is of utmost importance that patient safety remains an overriding priority across the health service in 2015, and this is reflected throughout the HSE's service plan. All health service staff, individually and collectively, will continue to have responsibility for the quality of services they deliver to the patients and service users in their care. It is important that they integrate a commitment to quality and safety into their core work and practice. Priority areas that were identified in this year's service plan will continue to be the focus of attention. These include medication safety, health-care-associated infections and the implementation of the national early warning score system.

The HSE will also have more autonomy with regard to staffing and human resources in 2015 and will be in a position to take on more temporary or permanent staff in order to achieve savings on agency costs, subject to compliance with its overall pay allocation. The HSE will be in a position to more readily contain and control the frequency and cost of agency staffing across both the HSE and HSE-funded services in 2015. The plan includes measures to bring this into effect, including the replacement of agency staff by fixed-purpose employment contracts and a focus on the retention of graduate nurses.

Management of health spending within available resources next year will require an exceptional management focus, with strict adherence by all services and budget holders to their allocations. However, with greater autonomy and greater capacity to utilise any further savings achieved within the health service comes an even greater responsibility for cost containment and cost avoidance. With this in mind, the HSE's 2015 service plan will continue to develop and strengthen its governance and accountability framework. The service plan provides for a considerably enhanced governance and accountability framework for 2015. This framework describes in detail the means by which the HSE, hospital groups, community health organisations and other units will be held to account throughout 2015 for their efficiency and control across the balanced scorecard of access to services, patient safety, finance and human resources.

A key feature of the new accountability framework will be the introduction of formal performance agreements between the Director General and each national director for services and between each hospital group and community health care organisation head and the relevant national director. The framework is primarily focused on supporting improved performance. However, a feature of the framework is an arrangement for escalating areas of underperformance and specifying the range of interventions to be taken in the event of such underperformance.

Notwithstanding the positive and welcome developments that are provided for in the 2015 service plan, HSE management, the Minister, Deputy Varadkar, and I have been honest and up-front about the limited nature of what can be achieved with the additional funding available next year. It is also apparent that we do not have sufficient funds to address all areas of concern across the health sector immediately. For example, on the matter of the increasing demands and demographic pressures being placed on our hospital system, health care demand continues to rise due to our growing and aging population, the increasing incidence of chronic conditions and advances in medical technologies and treatments.

While the service plan provides for an increase in combined inpatient and day case activity in 2015 as against 2014 projected outturn, the Minister and I have acknowledged that there are too many people waiting far too long for operations and outpatient appointments. The service plan includes a number of measures that the HSE is putting in place to address waiting lists more efficiently, including flexible usage of theatre capacity within and between specialties and prioritisation of day surgery admissions where appropriate. Other initiatives set out in the service plan, such as action on delayed discharges and developments in the primary care area, will also help to reduce the pressure on the acute system.

Against this background, the increase in health funding secured for next year cannot address all of the challenges the health service undoubtedly faces. What the additional funding can do is to make a very welcome start, after seven years of reduced resources, in the restoration of stability to the health service budget. The increase in funding will not solve every problem, but it does make the funding situation more manageable and the targets set out in the service plan more realistic and achievable. For the first time in seven years, the HSE service plan has not been prepared against a background of further retrenchment and reductions in both funding and staffing resources. As a result, the HSE has been able to prepare its service plan in the knowledge that the increase in funding available next year is the first part of a two-year process to restore stability and certainty to the health system and the funding of health services. This, in turn, has allowed the HSE, in its plan, to continue to provide existing levels of service while maintaining an overriding focus on quality and patient safety, and to deliver certain new service enhancements in line with programme for Government commitments.

The early completion and approval of the 2015 service plan also means that the HSE can complete its detailed operational planning within the next two to three weeks. This will ensure that the executive is in a position to monitor its spending and performance from the outset of the year, which is of central importance from a governance and accountability perspective. I strongly commend the Government's amendment supporting the HSE's 2015 service plan to the House.

See this speech in context