Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I move the following Estimate:

Vote 38 - Health (Revised).

That a sum not exceeding €13,649,033,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 2016, for the salaries and expenses of the Office of the Minister for Health and certain other services administered by that Office, including grants to the Health Service Executive and miscellaneous grants.

I welcome the opportunity to address the House on the Revised Estimate for 2016 for my Department - Vote 38. It comes in the context of the Government’s determination to put the fruits of economic success to work for the people by improving the services that really matter and make a difference to their lives. I am privileged to have become Minister for Health at a time when we are in a period of reinvestment in the health service which gives me the opportunity to address some immediate issues facing patients, as well as meeting programme for Government commitments on which I want to deliver in my first 100 days in office. They include a winter initiative to manage overcrowding in emergency departments, an integral part of which is the provision of increased resources for home care services.

It is also of particular importance that the Revised Estimate places the health service on a sustainable financial footing. I welcome the statement by the director general of the Health Service Executive that the additional funding has stabilised the finances for 2016 and allows a realistic target to be achieved, with the emphasis he placed on the need for effective financial management. Additional funding of €300 million was provided in budget 2016 and this, with the Supplementary Estimate of €600 million remaining in the health sector base moving into 2016, resulted in an increase of €900 million on the 2015 budget, albeit that some of this had to be used to address once-off measures from the previous year. While the funding secured in the budget was welcome, it was becoming increasingly clear that the HSE was facing financial challenges in 2016, including the national service plan, as approved. The late approval of the 2016 Estimates has allowed the Government an opportunity to reconsider the health Estimate in the light of the emerging financial pressures and the economic position in which the country finds itself.

I am very pleased to announce that the Government is asking the Oireachtas to allocatea further €500 million in Exchequer funding for the health sector in 2016. This brings the gross current budget for the health sector in 2016 to €13.695 billion. This is equivalent to an increase of €1.4 billion compared to the original 2015 allocation of €12.295 billion and €736 million more than the final revised allocation for 2015. In percentage terms, this represents a 6% increase on the final revised budget for 2015 and an 11% increase on the original voted budget for 2015. This very welcome additional funding will stabilise the health sector financially and allow the HSE to set realistic and achievable targets for service areas, while still requiring it and service providers to demonstrate effective management control. It is an indication of the Government's commitment to reinvestment in the health service.

While I am confident that we are in a far more stable financial position than we have been for some time, 2016 and beyond still contain real challenges. We have an increased and aging population in this country, an increase in chronic conditions and new and expensive medicines and treatments. Our progress in diagnosis and screening for cancers and chronic illness means more people require treatments. Health services throughout the world are struggling with rising costs and Ireland is no exception. We must recognise the additional resource demands that come as a result of these new pressures.

I acknowledge these pressures and I am particularly pleased that the Dáil recently passed a motion to set up the Committee on the Future of Healthcare to develop a single long-term vision for health care and the direction of health policy in Ireland. I firmly believe that the Irish health service will benefit greatly from a single unifying vision that we can all get behind and that can help to drive reform and development of the system over the next decade. In particular, it is important that we work towards achieving universal health care. The motion establishing the committee notes the importance of achieving a single-tier health service in which access to services is based on need. The committee is due to provide a report to the Oireachtas within six months of its initial meeting. As Minister, I wish to assure the House that I will provide full support to assist this committee as necessary and as it requires. I am grateful to my colleagues, the Minister for Finance, Deputy Noonan, and the Minister for Public Expenditure and Reform, Deputy Donohoe, 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 is as set out in the HSE 2016 national service plan along with some additional programme for Government commitments, which I will outline later. The service issues which will be addressed under the Revised Estimate, as outlined in the service plan, include funding to reduce delayed discharges and emergency department overcrowding through providing additional funding for community beds and long-term residential care. It also provides for continuing the investment to improve the standard of care in residential services for persons with a disability through providing enhanced staffing levels and improving the quality and standard of their surroundings.

In the primary care arena the full-year effect of the under six and over 70 free general practitioner care is provided for, along with the extension of GP care without fees for all children under 12 years of age in the latter part of this year. The further roll-out of BreastCheck, enhanced provision of speech and language therapy, developments to our maternity services in line with the maternity strategy and further additional funding for mental health, which will be outlined by my colleague, the Minister of State, Deputy McEntee, were also provided for in the Estimate.

In the budget and this Revised Estimate the additional funding required to maintain existing levels of service in the acute sector is provided. Funding is also provided for ongoing strategic developments in areas such as paediatric scoliosis, strokes, the living donor programme and organ donor services, acute coronary care, bilateral cochlear implants and cancer services.

Earlier this year the Government launched the first national maternity strategy, a significant milestone in terms of the development of national maternity policy. Additional funding has been provided for maternity service developments in 2016, all of which will be allocated in line with the strategy.

The programme for Government emphasises the need for sustained commitment to improving waiting times for patients, with a particular focus on those patients waiting longest. It commits to €15 million funding for the national treatment purchase fund for an initiative targeted at those waiting longest from a continuing investment of €50 million per year to reduce waiting lists. The Department is currently engaging with the NTPF and the HSE in planning a dedicated 2016 waiting list initiative focused on endoscopy. The NTPF clearly has an important role to play and next week I will be meeting those responsible to discuss further waiting list initiatives.

Delayed discharges and waiting lists for acute services can arise when sufficient supports are not available for our older citizens in the community. Our population is ageing rapidly, with advances in health care leading to a dramatic rise in our older population. There is now a stronger emphasis on home care and other community services that provide a greater range of options to avoid admission to acute hospitals, support early discharge, and, where appropriate, to rehabilitate and re-able patients after periods of particular difficulty.

The HSE provides a range of community-based services aimed at ensuring older people receive safe, timely and appropriate care and treatment at the lowest level of complexity and as close to home as possible. However, demand for these services is rising as more people are supported in their homes rather than in hospitals or nursing homes, and I am delighted that the Government has been able to respond to this demand by providing an additional €40 million for home care in 2016 in this Revised Estimate.

For the future, A Programme for a Partnership Government commits to increasing funding for home care packages and home help year on year.

Of the additional €40 million we are announcing today, €20 million will be allocated to ensure that the 10.4 million home help hours, 15,450 home care packages, 130 intensive home care packages and 313 transitional care beds provided in 2015 are maintained; €10 million will ensure that the rate of service allocation can be maintained during the summer months; and €10 million has been ring-fenced for home care as part of the new winter initiative. There will, however, always be a cohort of older people who require a quality long-term residential care option. This must continue to be available to anyone who needs it.

The Government, together with the statutory and non-statutory agencies which provide services to people with disabilities, have been working towards empowering people with disabilities to live independent lives, provide them with greater independence in accessing the services they choose and enhancing their ability to tailor the supports they require to meet their needs and plan their lives. This year funding of €1.59 billion in total is being provided for health and personal social services for wide and complex range of services and supports for people with disabilities, including the additional €31 million which was secured for disability services as part of this Revised Estimate today, details of which were outlined by the Minister of State, Deputy Finian McGrath, last week.

The additional funding will cover costs incurred from compliance with national residential standards, services provided to meet the changing needs of people with disabilities and, importantly, the provision of emergency residential places. Of this additional funding, €3 million is earmarked for new initiatives, including an additional provision for services to meet the need of school leavers with disabilities and the anticipated cost of a number of emergency residential placements arising this year.

There is an onus on us all to use this substantial resource more effectively and efficiently. Most importantly, we must ensure that we are achieving real and significant improvements in the lives of people with disabilities.

Enhancing primary care and integration of care between primary and secondary are priorities for the new Government. Significant progress has already been made. GP care without fees has been successfully introduced for children under the age of six and all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees, without having to undergo a means test. The service for those aged under six includes age-based preventive checks focused on health and well-being and a cycle of care for children with asthma. Other service developments include: the introduction of a diabetes cycle of care for adult patients with type 2 diabetes; an enhanced support framework for rural GPs; and a revised list of special items of service under the contract to encourage the provision of more services in the primary care setting.

There will be further investment in primary care, an essential element of which must be a comprehensive new GP contract, including an extension of GP care without fees for all children aged 11 years and under, including the asthma cycle of care. Other measures proposed are expanded GP access to diagnostic services and allowing more GPs around the country to offer minor surgery procedures.

There are two areas in particular to which I would like to refer in the context of these Revised Estimates and they are home care services and mental health, areas under the control and remit of the Minister of State, Deputy McEntee. Members will be aware that in the context of the approval of the national service plan, it was agreed that €20 million in time-related savings would be utilised to support services. I am pleased to say that as a result of the increased provision for health, we can provide the required funding for home care without relying on these time-related savings and can therefore restore the full ring-fenced mental health budget.

The Minister of State, Deputy McEntee, and my Department will work with the HSE to ensure that our mental health services get the maximum benefit from this funding, including, where appropriate, its use to support the development and refurbishment of the necessary facilities to house our new staff and provide more therapeutic surroundings for our service users.

In addition to the services set out in the national service plan, I am also pleased to announce that there is also scope for us to provide for the implementation of programme for Government commitments for the first 100 days. In particular, the additional funding being debated in the Dáil today allows us to provide €40 million in funding for a winter initiative to help address overcrowding in emergency departments. This initiative is currently in the early planning stages by both the Department and HSE. I have met the ED task force and asked for its input and there will be a specific ED task force meeting on this initiative. It will seek to support actions which improve patient flow through acute hospitals, as well as enhancing primary care and social care services.

As an integral part of this initiative, I will increase resources for home care services. As a result, we are not only maintaining home care and transitional care services at 2015 levels but are increasing them. The programme for Government acknowledges the need to improve services to our older citizens. The provision of additional home care services and transitional care will assist more older people to leave our acute hospitals when they are clinically ready to do so and this will allow patients awaiting admission in our emergency departments to be admitted.

Both my Department and the HSE recognise that the need for ongoing strengthened accountability and good governance within the HSE and voluntary bodies remains of critical importance. The HSE has reviewed its accountability framework after its first year of operation in 2015 and is involved in the ongoing implementation of the recommendations of that review.

This is focused on strengthening the operation, effectiveness and application of the accountability framework throughout the organisation to date, and will identify further changes to improve the process.

The allocation to address the budget overrun in the HSE must and will be underpinned by improved governance and accountability. My officials and the HSE will be working on the development of new and strengthened measures in this regard over the next two weeks. Health service management will be accountable for performing within the budget set by these additional resources. The Government believes the greatest need for improved accountability and control is in the acute hospital sector. For this reason, the programme for Government contains a commitment to establishing a performance management unit, which will work with individual hospitals where there are difficulties to achieve improvements. The establishment of this unit will contribute to a stronger focus on operational control and accountability in acute hospitals. I also see an enhanced role for the Oireachtas and Oireachtas committees. Those who are responsible for spending taxpayers' money on vital public services must be accountable.

When we talk about the need for improved performance, it is important for us to acknowledge the progress that is being made and the work people are doing to deliver improvements. The Department of Health is publishing the second annual report of the national health care quality reporting system today. This report, which presents health information related to immunisation uptake, cancer screening and survival, and the management of chronic diseases including asthma, chronic obstructive pulmonary disease, diabetes, stroke and heart failure, shows that clear progress is being made. It also sets out areas where there is room for more improvement.

The Government is committed to the development of a modern and patient-centred health service. While there is undoubtedly a strong case for increased health funding in the years ahead, it is also important to acknowledge that at a time of growing demand, more funding alone will not resolve the difficulties our services face. There must also be a focus on building a more effective health and social care service. Our experience during the boom years of the Celtic tiger, when satisfactory returns did not always accrue from considerable increases in health spending, is a stark testament to that.

I would like to take the opportunity presented by this debate on the allocation of additional resources to the health service, with the consent of the Oireachtas, to pay tribute to the health care staff who have taken us through some very difficult years. While issues have undoubtedly arisen, there have always been positive elements in our health service that are too often overlooked in this House. It was due to the hard work, commitment and dedication of the staff of the health service that it survived the most challenging period in its history. While we still face challenges, there is every reason to be optimistic and to believe things are now more manageable. We have a chance to embark together on a journey towards a better place for patients and front-line staff.

I thank the Members for their consideration of this Revised Estimate. I ask the House to consent to the provision of these much-needed additional resources to our health service. We are now in a period of reinvestment in the Irish public health service. I look forward to working with all Members of the Oireachtas in this regard.

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