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

I welcome the opportunity to address the House on the budget and the 2016 health Estimates. This is my second year as Minister for Health to address the House on this matter and, as was the case last year, I am pleased to be here to talk about a budget that provides additional funding for public services such as health, education and child care.

The budget will assist in continuing the improvement of the economy. It will create an environment to sustain more jobs, more investment in public services, health, child care, education and more housing, in particular, social housing.

Last year we were able to achieve the first modest budget increase in health service funding in seven years. Additional funding was provided during the course of 2015 to address delayed discharges from acute hospitals, waiting lists and emergency department overcrowding. I am pleased to announce that the Government is asking the Oireachtas to allocate additional Exchequer funding for the health sector for 2016. The gross current budget for the health sector for 2016 is €13.175 billion. This is equivalent to an increase of €880 million compared with the 2015 allocation of €12.295 billion voted through last year. This represents a 7% increase on the budget for 2015 and a 12% increase on the voted budget for 2014. It is an indication of the Government's commitment to addressing the reductions experienced by the health sector arising from the economic downturn.

Our spending ceiling continues to rise and once again, all savings and efficiencies achieved will be available to reinvest in improving health services. Some €817 million will be available to address service pressures. Funding to cover the full-year cost of a number of initiatives commenced in 2015 - commitments under the Lansdowne Road agreement and the programme for Government. The remaining €63 million goes to meet the residual cost of once-off measures introduced in 2015. In addition, savings and efficiencies of €125 million have been identified in the areas of procurement, prescribing and drug costs, bringing the total available to support existing levels of service and new developments to €942 million.

The funding secured will ease the pressure on the health service to continue providing the optimum level of safe services for patients within the budgetary limits. However, it is essential that we continue to focus on cost containment and cost avoidance as there continue to be major cost pressures on the health service. We have an increased and aging population, an increase in chronic conditions, and new expensive medicines and technologies that we must fund.

I am pleased to confirm that there will be no change to hospital or prescription charges, the monthly DPS threshold, or income thresholds for eligibility for medical or GP-visit cards. Funding for the fair deal will be maintained at a level to keep waiting times at a maximum of four weeks. I believe this shows the Government’s continuing commitment to stabilising the direct cost of health services for citizens.

I am grateful to my colleagues, the Ministers, Deputies Michael Noonan and Brendan Howlin, for their support and understanding in dealing with the challenges faced by the health sector.

The level of health services to be provided within the available funding will be set out in the HSE’s 2016 national service plan which is being prepared by the executive. I want to take the opportunity to outline some of the issues which will be more extensively covered in the service plan. Funding is being provided to reduce delayed discharges from our hospitals and emergency department overcrowding and to provide for ongoing implications of winter capacity planning.

I have taken a personal interest in emergency department overcrowding and have secured €74 million in additional funding this year to alleviate the problem. This funding came on top of measures already taken in budget 2015, when the Government provided €25 million to support services that provide alternatives to, and relieve pressure on, acute hospitals. This has allowed the waiting time for the nursing home support scheme to be reduced from 15 weeks to four, which in turn has reduced delayed discharges in hospitals from 850 to under 600 - it is actually down to 560 today - freeing up 250 acute beds in hospitals. It has also allowed us to open another 150 district hospital beds, including at Mount Carmel community hospital, formerly a private hospital.

More community beds will be opened before the end of the year. It has also allowed us to increase investment in health services and keep patients out of hospital altogether, or allow them to get home earlier, thanks to community intervention teams, day hospitals and acute medical admission units. This funding rolls into the budget for 2016 in order to continue this initiative.

While we have seen an improvement in patient experience times in our emergency departments, and a fall in numbers of people waiting on a trolley for more than nine hours, morning peak overcrowding has not improved and is still worse than the same point last year. I understand the distress and hardship that all of this is causing to patients and their families and, of course, staff. Further additional funding of €18 million was provided in July for a winter initiative, which starts in a few weeks time. This includes the provision of approximately 30 additional beds in hospitals across the country in November and December.

The director general and his team are visiting the worst affected hospitals to see what can be done to address other blockages such as diagnostics and rapid access to outpatient services. It is also clear that we need more weekend discharges, more evening ward rounds to reduce length of stay and for senior decision-makers to review patients shortly after or before admission in order to reduce unnecessary admissions and length of stay. The full year cost of the winter initiative is being provided to run into 2016, as we will need it for that part of the winter also.

In 2015 significant investment was made to improve the standard of care in residential services for people with a disability, through providing enhanced staffing levels and improving the quality and standard of their surroundings. That investment will continue in 2016 to further improve facilities and to advance the policy of de-congregation of institutions and supporting people to live more self-directed lives in the community.

The Government is committed to the negotiation of a comprehensive new GP contract with the Irish Medical Organisation, IMO. The negotiations have commenced and I look forward to them producing results which we can start to implement in 2016. In the context of the talks, the Government yesterday signalled that it was providing for the extension, in the latter part of 2016, of GP care without fees to children aged between six and 11 years. That will be subject to negotiation with the IMO in relation to the scope of the service to be provided and the fee arrangements to apply and will be implemented in the context of overall new arrangements and not as a stand-alone extension or amendment to the current contract.

As clear evidence of the Government’s commitment to primary care, funding will be provided in the service plan to expand direct access for GPs to ultrasound and X-ray. It will reduce the need for people to be referred to hospital to access these investigations on an outpatient basis or through the emergency department which currently occurs on occasion.

The Government is committed to the development of a modern, patient-centred, and recovery-orientated mental health service. We are committed, in particular, to reforming our model of delivery in order that more and better quality mental health care is delivered in the community in line with A Vision for Change. Since coming into office, the Government has increased funding by €125 million for mental health and suicide prevention and there will be a further increase in funding in 2016.

I am committed also to improving access to therapy services. Accordingly, funding is being provided, as announced by the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, to expand the provision of speech and language therapy within the primary care setting and to support the reorganisation and expansion of speech and language and other therapies under the progressing disability services programme for children and young people. That will include funding for the development of early intervention services to facilitate the inclusion of children with a disability in mainstream preschool settings, which comes under the remit of the Minister for Children and Youth Affairs, Deputy James Reilly.

The further improvement of maternity services is a priority for me, and I am pleased to confirm that additional funding will be provided in the service plan for further maternity service developments in 2016. That will include the necessary funding to establish the national women and infants programme, which is intended to drive improvements and standardise care across all 19 maternity units based on the model successfully used previously for the national cancer control programme. In recognition of the fact that there are staffing deficits in maternity hospitals, and our staffing ratios do not compare well internationally, even if outcomes do, funding will be provided to reduce front-line staff pressures through the appointment of additional midwives, consultant obstetricians and gynaecologists.

As promised, development funding will also be provided for necessary posts in the Dublin Midlands Maternity Network, the country’s first managed clinical maternity network between the Coombe and Portlaoise hospitals. In addition, resources will be provided to ensure that every maternity unit has a director of midwifery in place, a recommendation of the HIQA report on Portlaoise. Funding will also be provided to establish bereavement teams in all units and to support the implementation of the maternal neonatal clinical management system which is due to be phased in, initially on a pilot basis early next year.

Significant advances have been made in the National Ambulance Service in 2015, in particular, with the opening of the new national emergency operations centre in Tallaght and the establishment of a single control and dispatch system. In 2016, funding will be provided to build on those improvements and, in particular, to address deficits in the provision of services in rural areas as well as the development of community first responder schemes and increasing capacity in intermediate care, critical retrieval and children’s ambulance services.

The recently announced capital envelope provides funding to continue the major programme of investment to replace, upgrade and refurbish health care facilities. Over the period 2016 to 2021, a capital allocation of more than €3 billion is being provided. This includes a significant increase in funding of €568 million over the period of the plan. The increased funding available in the later years provides scope for the commitment of additional investment concentrated towards the end of the programme.

In addition to the five priority projects and the wider capital programme, the additional funding will enable further progress in delivering accommodation compliance in many areas of social care. Quality accommodation is important in supporting the needs of older people and people with disabilities who need long-term care. Additional funding of €300 million over the 2016 to 2021 multi-annual period will enable an expanded programme to replace, upgrade and refurbish long-term care facilities.

The further enhancement of maternity services through the co-location of maternity hospitals with adult acute hospitals will also be carried forward. Co-location enables critical care facilities, such as ICU, to be shared, ensures specialists are nearby and that mothers are not separated from their babies if either mother or baby becomes very sick. The increased funding will enable the development of a wider maternity capital programme towards the later years of the programme.

Both my Department and the HSE recognise that continually strengthening accountability and good governance within the health service is of critical importance. For that reason, the HSE’s 2015 national service plan included, at my request, an enhanced accountability framework which makes explicit the responsibilities of all managers to reach the targets set out in the service plan across the balanced scorecard of quality and safety, access, finance, and HR. A key feature of the framework has been the introduction of formal performance agreements at several levels within the HSE and the establishment of a national performance oversight group to serve as the key accountability mechanism for the health service. The group meets with each national director for services each month and completes a full assessment of all key measures across the divisional balanced scorecards. Areas of underperformance are identified and explanations and remedial actions are sought. Where performance does not improve, the matter is escalated according to the escalation and intervention process developed by the HSE, which is up and running since April. At each level of escalation, there is a clear distinction between supports, interventions and sanctions and there is a menu of options available under each heading.

While the escalation and intervention process is still in its early stages, a number of significant improvements in performance have been made as a result of the level of focus and scrutiny placed on areas of underperformance. These include improvements in the number of child and adolescent mental health patients waiting for more than 12 months for a first appointment and a reduction in the number of patients waiting for more than four weeks for an urgent colonoscopy. Recently, the HSE has begun to take measures against some hospitals that are not meeting their targets in respect of waiting times for inpatient and outpatient treatment.

The need for ongoing strengthened accountability and good governance within the HSE, voluntary hospitals and other voluntary bodies remains of critical importance in 2016. The HSE is involved in an ongoing review of the accountability framework, which will focus on its operation, effectiveness and application throughout the organisation to date in 2015. The review will identify the changes that are required in order to improve the process and will examine, in particular, the intervention and support processes in place to address areas of underperformance. The outcome will be reflected in the HSE’s 2016 national service plan which will detail how the executive intends to develop and build on the framework in 2016 to further enhance and strengthen accountability arrangements next year.

Before concluding I acknowledge the hard work and dedication of health care staff throughout the country who provide a good service in what can be very challenging circumstances. There are problems with the health service but there are also many positive elements which too often get overlooked. We must maintain our focus on improving the way services are organised and delivered and reduce costs in order to minimise any negative effect on service provision. We have secured an increase in funding for the health service but I do not underestimate the challenges involved in the delivery of a safe, efficient health service for Irish patients. I remain focused on meeting the challenge in the months ahead.

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