Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I move:

That, notwithstanding anything in Standing Orders, Dáil Éireann:

recognising:

— the severe pressures on the Irish health service, the unacceptable waiting times that arise for public patients, and the poor outcomes relative to cost;

— the need for consensus at political level on the health service funding model based on population health needs;

— the need to establish a universal single tier service where patients are treated on the basis of health need rather than on ability to pay;

— that to maintain health and well-being and build a better health service, we need to examine some of the operating assumptions on which health policy and health services are based;

— that the best health outcomes and value for money can be achieved by reorientating the model of care towards primary and community care where the majority of people’s health needs

can be met locally; and

— the Oireachtas intention to develop and adopt a 10 year plan for our health services, based on political consensus, that can deliver these changes,

orders that:

(a) a special all-party Committee, which shall be called the Committee on the Future of Healthcare, shall be established, to devise cross-party agreement on a single long-term vision for health care and direction of health policy in Ireland;

(b) the Committee shall be made up of fourteen members of the Dáil, of which four members shall be appointed by the Government, three members by Fianna Fáil, two members by Sinn Féin, one member by the Labour Party, one member by Independents4Change, one member by the Anti-Austerity Alliance-People Before Profit, one member by the Rural Alliance and one member by the Social Democrats-Green Party group, and four shall constitute a quorum; members may be substituted as provided under Standing Order 95(2);

(c) notwithstanding the provisions of Standing Order 93, the Committee shall elect one of its members to be Chairman, who shall have one vote;

(d) the Ceann Comhairle shall announce the names of the members appointed under paragraph (b) for the information of the Dáil on the first sitting day following their appointment;

(e) the Committee shall have the powers defined in Standing Order 85 (other than paragraphs (3), (4) and (6) thereof);

(f) the Committee shall examine existing and forecast demand on health services, including the changing demographics in the Irish population;

(g) the Committee shall examine and recommend how to progress a changed model of healthcare that advocates the principles of prevention and early intervention, self-management and primary care services as well as integrated care;

(h) the Committee shall examine different funding models for the health service and make recommendations on the funding models that are best suited to Ireland and have these models fully costed;

(i) the Committee shall examine and make recommendations on how best to reorientate the health service on a phased basis towards integrated, primary and community care, consistent with highest quality of patient safety, in as short a time-frame as possible;

(j) the Committee shall be mandated to hold hearings in public with expert witnesses; invite and accept written submissions; draw up a report(s); make findings; and-or suggest recommendations if the membership so agrees in unison or in majority/minority format;

(k) the Committee shall produce an interim report, containing also its proposed work schedule, to be debated at a meeting of the Dáil no less than one week, and no more than two months, after its establishment;

(l) the Committee shall, within six months of the initial meeting, present a final report to the Ceann Comhairle for earliest possible discussion in the House;

and

(m) the Committee shall meet as frequently as appropriate to fulfil its remit.

This motion is real evidence of the new Dáil responding to the message the people delivered at the recent general election. The message I heard loudly and clearly in my role is to put the benefits of economic success to work for people to deliver the services that matter to them. However, the people also gave us the challenge of finding a new way of working together and responding to this challenge presents an historic opportunity.

The new Dáil is diverse but need not be divided. Together we can achieve one thing that has never happened in health policy, namely, a long-term consensus on its fundamental principles. I am excited about this and grateful to everyone who has agreed to this motion. I acknowledge, in particular, the role of Deputy Róisín Shortall in liaising with me on the motion on behalf of the Opposition. Opposition Members presented a motion on this issue and we worked together to arrive at this hybrid motion, if one likes.

While members of the public and the people who work so hard in our health service have no lack of appetite for reform, they are certainly fatigued by piecemeal reforms that do not really change anything and the shifting priorities that often come with political change. The work of the new committee will mean members of the public and those working in the service can have a sense of certainty that there is a long-term strategy agreed by political consensus and, I hope, societal consensus that will not change no matter what the make-up of the next Dáil.

We all know the health service faces many challenges. Moreover, the programme for partnership Government acknowledges that we have an ageing population who are living longer and whose needs will become greater and more diverse. We also have the highest birth rate in Europe. As citizens, all of us at some point in our lives will need to access health services. Therefore, we have a common interest in finding a common way forward for improving and developing our health services.

The Government comes to this motion with a clear objective in sight. As set out in the programme for partnership Government, the Government is committed to the goal of universal health care, a concept endorsed by the World Health Organization, United Nations, OECD and European Union. As an overall goal to improve our health services, universal health care involves four main objectives, as set out by the WHO, namely, reducing unmet health needs; reducing inequalities in access to health goods and services; improving service quality; and improving financial protection, which means patients must not face catastrophic or impoverishing levels of health spending as a result of seeking health care.

The World Health Organization notes that no country fully achieves all the universal health coverage objectives for 100% of the population, 100% of the services available and 100% of the cost, without waiting lists. However, it believes that every country can improve efficiency, reduce waste and increase value from its health spend. By doing so, we can advance the cause of universal health care.

In striving for the optimal single tier health service for Ireland, there are inevitable policy trade-offs to be confronted. These trade-offs often involve tensions between efficiency and equity or between comprehensiveness and cost control. In all countries, not only Ireland, the trade-offs centre on three basic dimensions of the health service which must be confronted when designing a health service. These are the proportion of the population to be covered, the range of services to be covered and the proportion of the total costs to be met.

We also know there are factors outside of the health service which affect universal health care, including housing, employment and education. This requires a whole-of-Govemment, health in all policies approach and this is echoed in the Healthy Ireland framework. There are, therefore, tough policy choices, trade-offs and decisions to be made, especially in terms of managing resources, addressing performance and ensuring accountability.

The previous programme for Government, 2011-16, committed to a major programme of health reform, the aim of which was to deliver universal health care, with access to quality services based on need and not ability to pay. In April 2014, the White Paper on Universal Health Insurance, UHI, was published. It proposed a competitive, multi-payer model of universal health insurance as the means to achieve universal health care.

Having reviewed the results from the UHI costing project, it was concluded that the high costs associated with the White Paper model of UHI were not acceptable and further research and cost modelling were needed before definitive conclusions could be drawn on the best means to achieve universal health care. This is the current position and whatever approach we adopt, there is a need for consensus on the direction of health policy. The new committee offers a great opportunity to try to achieve this consensus.

One of most important features of any country's health service is how it is funded, both in terms of the amount of money required and the manner in which it is financed. These are difficult questions to answer and will clearly be central to the deliberations of the all-party committee. Making changes to funding levels and financing methods takes time and requires careful management, not least to avoid disruption to what are vital existing services. That is one reason it is important to take a long-term view of how the health service can be developed.

The 2016 health budget is €13.1 billion and increases in the health budget have been possible in the previous two budgets.

It is the Government's intention to work with the Oireachtas to sustain these annual increases going forward, basing health expenditure on multi-year budgeting supported by a five year health service plan.

One aspect of the motion we can all support is the need for a decisive shift within the health service towards primary care and the effective delivery of primary care in every community. The more intervention we can have for patients at the earliest possible stage and as close to home as possible, the more likely there will be a better outcome for patients. To do this, it will be necessary to build up GP capacity to respond to patient's needs and the expansion of chronic disease management in general practice. We will continue to support the provision of mental health and disability services within the community where appropriate. Developing primary care services and integrating primary and secondary care services is a vital component in any strategy to address the issues facing our hospitals, in particular emergency departments. In developing models of person centred, co-ordinated care, we can draw on the work of the national clinical programmes, in particular the piloted integrated care programmes.

While the new committee will have many health service challenges and difficulties to examine, which should not be underestimated, we should also acknowledge that the health service has been changing and it would be wrong not to acknowledge where success has happened. For example, we have seen life expectancy in Ireland increase by two and a half years since 2004 to where it is now above the EU average. We have seen mortality rates for circulatory system and respiratory diseases fall, an improvement in cancer care, a reduction in the in-hospital mortality rate following admission with a heart attack, a decrease in the average length of stay in hospitals and significant progress in reducing tobacco consumption. Progress has been made in many health areas and it is important to recognise that progress along with recognising those who work so hard at the front line.

There is much more to do, particularly in regard to prevention and integrated care. However, there are important changes already under way on which we can build. Universal health care is not just something to implement but is a direction and a journey. Ultimately, how far and how fast we proceed in the direction of universal health care is a question of choices and how we make them. I pledge my full support as Minister, and that of the Government, to assisting the committee in any way we can. I passionately believe that if we can arrive at a political and societal consensus about our direction of travel for a universal public health service, we can provide a degree of certainty to citizens, patients and those who work on the front line. I look forward to working with people on this.

See this speech in context