Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I will certainly follow up on the matter raised by Deputy Charlie McConalogue.

One of the most frustrating things about reports, into which those involved put a great deal of hard work, is that people do not understand them fully. The HIQA report on the ambulance service is silent on whether there should be additional ambulances. That issue will be addressed in the HSE's capacity report. HIQA talks about the age of the fleet, but it does not call for additional ambulances. However, it points out that we use ambulances very inefficiently. We do not conduct a dynamic dispatch system. There are too many ambulances sitting in fire stations, ambulance centres and hospitals when they should be available for dynamic dispatch. HIQA criticises the communications and speed of dispatch. It also points out that if we were to apply what is done in other countries, 40% of those covered by ambulance calls would not require to go to an emergency department at all. It is a good report and people should read it, rather than just default to the obvious stuff about providing more resources, the fleet and journey times.

Deputy Robert Troy mentioned the Government's decision, intervention and U-turn in the case of St. Christopher's. To be clear, there was no decision, intervention or U-turn in the case of St. Christopher's. Deputy James Bannon expressed his concerns to me many times, as did the Taoiseach. It was a matter of great interest and concern to the Deputy, but it was one for the HSE. They were not decisions made at ministerial or government level, which I hope is clear.

I am pleased to have the opportunity to contribute to this debate on the funding of the health service and, in particular, the HSE's national service plan for 2015. I will deal with a number of specific matters that have been raised by Deputies during the debate.

Several Deputies raised the issue of discretionary medical cards. The HSE is taking the necessary steps to improve the operation of the medical card scheme and especially the arrangements for the issuing of medical cards on a discretionary basis, generally on medical grounds, even though the means test has not been satisfied. I do not claim that the new system will be perfect, but I will continue to oversee implementation of these steps and, if further improvements are deemed necessary, I will consider them. It will, however, be six to eight months before the ten actions announced last week are implemented and I ask for patience until then and also that issues or shortcomings be flagged to my office.

Waiting times under the fair deal scheme are now approximately 14 weeks. This is not satisfactory and I am anxious to address the issue. It is recognised that the matter of delayed discharges is not one that can wait until the new year. Last night the Minister of State, Deputy Kathleen Lynch, outlined a number of measures that were already under way to start to deal with this issue of concern. It requires an integrated response across primary, community and residential services and my Department is working closely with the HSE to ensure the available resources are deployed in the most effective way.

A number of Deputies mentioned health reform in general. Next year will see the establishment and development of hospital groups,community health care organisationsand the development of the national clinical programmeswhich will be delivered through these new structures. These core health reforms are essential if we are to deliver better quality care.

I share the concerns of Deputies about waiting times; too many are waiting too long for surgical procedures and outpatient appointments. We know from past experience that throwing money at the problem of waiting lists does not make it go away. This was particularly demonstrated during the Celtic tiger economy years, when waiting lists remained a significant and ongoing cause of concern, despite the increasing level of funding provided. Providing more resources without reform simply does not work. If we learned anything from the years of boom and bust, the years of splurge, followed by years of austerity, we should have learned that. That is the reason the Government wishes to address the underlying structural issues which are contributing to increasing demands on the hospital sector and the resultant rise in waiting times. The establishment and development of hospital groups and community health care organisationsand the development of patient-centred integrated models of careare central to this structural shift and will, over time, ensure quality patient care is delivered in the setting most appropriate to the needs of the patient which, in most cases, will be a primary care setting or a setting close to home. The service plan provides for an additional €14 million to further develop primary care services, including an extension of the pilot GP ultrasound access projectand the provision of additional minor surgery servicesin agreed primary care sites.

The HSE is also putting in place a number of measures next year to tackle waiting lists more efficiently, including prioritising day-of-surgery admissions, pre-admission clinics to ensure patients are fit for surgery and flexible use of theatre capacity within and among specialties.

I am also pleased to inform the House that I have, this week, approved an initiative to provide additional GI scopes for endoscopies and colonoscopies up to the end of 2014. This decision was taken to address very long waiting lists for these procedures in certain hospitals which, between them, are responsible for over 80% of the waiting list.

During last night's debate, Deputy Kelleher referred to a level of pretence that exists around the health budget for 2015. The opposite is the case. The HSE management, the Minister of State, Deputy Kathleen Lynch, and I have been honest and up front about what can be delivered in 2015 with the increased resources available. We have not over promised, but have been realistic, and have explained that the modest increase in resources being provided in 2015 is but the first step of a two year process to stabilise the health service budget. I have already secured an increased ceiling of €174 million for health expenditure in 2016.

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