Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I move:

That Dáil Éireann shall consider the Interim Report of the Committee on the Future of Healthcare, copies of which were laid before Dáil Éireann on 4th August, 2016.

It is a great pleasure to present the interim report of the Committee on the Future of Healthcare. This committee had its origins in a motion passed by the Dáil on 1 June last. It was a historic motion. While health is a matter of concern to every Member of the House, and they represent the concern of the community, I am not sure if at any stage we, as representatives of the public, have come together to decide on the best type of health system the country can have to meet the needs of the people. In many ways, our health system has developed in an ad hocmanner since the foundation of the State. We have never taken an objective view of its strengths and weaknesses and where it should go in the future.

The purpose of the motion agreed by the Dáil on 1 June was to recognise the fact that there are serious difficulties in the health service. Given the spend on the system, a total of €19 billion, it is certainly not providing the type of modern accessible service we should aspire to have. A big element of that is the nature of the service and the fact that it is a two-tier service that is very expensive for everybody involved, be it the 46% of people who are paying for expensive health insurance or the more than 40% of people who are public patients and are left waiting for long periods to access services. That is the backdrop. We are all conscious of the shortcomings in the health service. I believe there is a genuine shared aspiration to do something worthwhile to make our health service fit for purpose and to take the key strategic decisions which will enable us to move from the current somewhat dysfunctional two-tier health service, with all of its problems, to having a modern, accessible, single-tier health service. That is the desire of every Member of the House and it reflects the desire of the public which has expressed its views very clearly not just in the last election but also in several opinion polls over the years and through contacts with public representatives. People strongly feel that a good functioning health service is key to a modern republic. That is what we must achieve for this country.

That was one of the key provisions of the motion passed by the House. It sought to develop a consensus at political level on the future of the health service and the funding model, based on population health needs and the need to establish a universal, single-tier health service where patients are treated on the basis of health need rather than ability to pay. The motion also recognised that the best health outcomes and best value for money can be achieved by reorienting the model of care towards primary and community care, where the majority of people's health needs can be met. We determined that the Oireachtas would work to establish a ten-year plan for the health service, based on political consensus, that can deliver all of those changes to achieve a modern reformed health service.

The committee was established on foot of that motion, with 14 members drawn from all parties and groups in the House. From the start there was unity of purpose among the members and a clear determination and commitment to work together as best they could to put together a strategy for a ten-year plan for the health service, recognising all of the challenges involved but also recognising the importance, once and for all, of coming together at political level, setting past political differences aside, looking at the evidence relating to best practice, identifying the problems and roadblocks to modernising the service and making it more accessible and considering in an honest and genuine way the best type of funding model that would deliver a single-tier, accessible, equitable and modern health service. I pay tribute to the 14 members of the committee. I am pleasantly surprised by the level of commitment displayed, the attendance at meetings, the work that members had to do aside from the weekly meetings in terms of reading the volumes of material the committee received and their real engagement in the complex issues involved in moving from the current system to a new and better system. I appreciate the commitment and enthusiasm of the members in that regard.

The committee was established on 1 June and held its first meeting on 23 June. We met weekly at the end of June and through July. Initially, we sought to have private meetings at which we were given detailed briefings from some of the main players. We received very good briefings from the Department of Health and I acknowledge the full co-operation and support of the Minister and his senior officials for the work we have undertaken. We received a briefing from the HSE. We are also conscious of the huge amount of research that has been done already, the policy papers that have been drawn up and the examinations of different aspects of the health service, both at international and national levels. Indeed, we are very much of the view that this area has been researched in minute detail over many years. What we must do now is take decisions at political level and move into the implementation phase of what needs to be done to reform the health service. A vast amount of research has been done already.

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We received briefings on much of that research from the ESRI and the Department of Public Health and Primary Care, Trinity College Dublin.

We were also very conscious of the project management role that is necessary. It is not just a case of producing a report. It is about implementation. How do we ensure we deal with those cultural issues within our health service that prevent us from moving ahead, modernising and streamlining the service and making it more responsive to patients' needs? Dr. Eddie Molloy has done a lot of work in the area of implementation and we are very conscious of the work he has done in the public and private sectors. We invited him in for a briefing session, which was extremely worthwhile. He got a spontaneous round of applause at the end of his briefing, which is a first in my experience at a committee. Members were very impressed by his knowledge of this area and his stressing of the importance of cultural change and commitment to implementation.

That is the work we did prior to the summer and it is referred to in the interim report. We began a public consultation process in July. We issued invitations for submissions from members of the public, service users, patient groups, people working in the health service, different professional groups and so on. The closing date was the end of August. We were very encouraged by the fact that we got some 160 submissions, which were very detailed and thoughtful. We also received requests from many people to meet the committee. Those submissions are being evaluated and summarised. The secretariat of the committee is working through them preparing them for the committee and making recommendations to us on which of those groups or individuals we should invite in to make oral submissions. We have taken a number of those decisions so far. After the August break, we went straight back into weekly meetings. Two groups of individuals or service users or representative groups come in and present to us every Wednesday morning. This has been really worthwhile. It has produced a huge level of thought-provoking activity in the committee and has challenged us all possibly to revisit some set views or preconceived notions we may have had. It has challenged us to learn from the evidence presented to us and in particular to learn from best practice elsewhere.

We have identified 11 different work streams at an early stage. They involve the future vision and strategic challenges involved in what we are doing, the funding model on which a lot of work has been done by the ESRI to date, the related areas of primary care, integrated care and chronic disease management which are key, access to care, quality and safety, resource allocation which is emerging as a very big issue, organisational reform, workforce planning and the key issue of implementation and monitoring. I think I am speaking for all members when I say that we are determined that when we produce our final report, it will not be just another report on the health service. An implementation plan will be part and parcel of that. I hope the current Minister and future Ministers over the next ten years will subscribe to it and take it very seriously and that it will be the programme of work for future Ministers for Health.

In respect of the various groups that appeared before us before the summer, which is referred to in the interim report, our priority was to ensure the voice of patients and service users was heard. There are very loud voices in health, including very loud commercial interests. In some cases, one could even talk about vested interests. Too often, they are the voices that dominate. We said from the beginning that this is about serving the patient and that we were determined to put the patient front and centre of all that we do. That was the reason why our first public hearing involved the Health Reform Alliance which represented a number of different groups of service user representative bodies and which made an excellent presentation to us.

We have been meeting every Wednesday with groups since then. There is no doubt that to date, very common themes have been coming through. There is an extraordinary level of agreement across the board regardless of whether it involves service users, patient groups, professionals working in the area or researchers. There is a significant amount of agreement. I will very briefly run through those areas. They are the importance of the patient voice, inequality of access and the fact that we have a two-tier system, the geographical lottery that applies because of the unequal distribution of resources, moving from the hospital-centric model we have currently to putting far greater emphasis on health and social care within the community, the traditional under-resourcing of primary care where there are huge gaps not only in GP services and practice nurses but in other critical allied professionals who do such an important job at community and primary care level, access to diagnostics for GPs in particular where there is a sense that they are locked into a system where diagnostics are only available in hospitals, the lack of direct access for GPs and the logjams that creates, the question of multiple morbidities and ensuring that the next contract for GPs recognises the important role of chronic disease management - key to that is recognising the fact most people with chronic illnesses have multiple chronic illnesses and the need for a model of care that addresses to be reflected in the contract, staff shortages and the recruitment and retention of staff across the board which is a major challenge with morale emerging as a key issue because people do not feel valued in the service, and organisational structures which is an issue that is emerging as a significant problem relating to the organisation of hospital groups and the fact that we have six hospital groups and nine community health organisations that are not aligned and the difficulty that causes in terms of integration.

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