Simon Harris (Wicklow, Fine Gael) | Oireachtas source

When I spoke in the Dáil on 1 June last about the Government motion to set up the all-party committee, I said that I regarded this as one of the key health initiatives of the new Oireachtas. Four months on, I am even more convinced of the need for a long-term consensus on the direction of health policy. We can make, and I contend that we are making, improvements to our health system but the task that faces us is one that requires substantial and sustainable efforts underpinned by a long-term common purpose.

At the outset, I acknowledge the work being carried cut by the committee. It is so encouraging to hear the positive update, in particular the leadership role taken by Deputy Shortall both in the establishment of the committee and now as its Chair. I am genuinely excited about this project. I think we are on the verge of potentially achieving something really lasting in terms of our health service. Much work is already underway, as set out by Deputy Shortall and as set out in the interim report. I understand and am pleased to hear that there has been a large response to the committee's call for submissions. I have had the opportunity to read a number of submissions that have been sent directly to me and to meet with a number of groups that made submissions. The volume of submissions does say something about the huge level of interest in this fundamental societal issue.

The committee has set itself a very ambitious work programme. This includes work packages on the funding model, integrated care, resource allocation, access to care, primary care, chronic disease management, organisational reform and workforce planning, among others. I appreciate the breadth of this agenda and I do not think anyone in this House underestimates the challenging agenda that the committee has taken on. I reiterate my pledge to continue to support and assist the work of the committee in any way I can.

The central objective of the new Government, as reflected in the programme for a partnership Government, is to use the strengthening economy to make life better for the Irish people. As Minister for Health, that means improving the public services that people depend on and that really matter to families and communities across the country. We all know that the health service faces many challenges.

Moreover, the programme acknowledges that we now have an ageing population which, thankfully, is living longer and whose needs will become greater and more diverse. As well as an ageing population, we also have the highest birth rate in Europe. Most immediately, there are problems for patients trying to access services, whether from emergency departments or waiting lists, severe pressures on very dedicated staff and increasing demand and pressure on resources.

As citizens, all of us at some point in our lives will need to access health services. Therefore, we all have a common interest in finding a common way forward for improving and developing our health services. During debates of this nature, it is important to note that the health service has been changing and it would be only right to acknowledge where improvements have happened. For example, life expectancy in Ireland has increased by 2.5 years since 2004, to a place where it is now above the EU average.

There has been a decrease in the average length of stay in our 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. I spent the summer visiting hospitals and other local health care facilities around the country and I was again struck by the many positive things that are happening but are rarely seen. The television programme "Keeping Ireland Alive" has gone some way to shine a light on the real story of health services in Ireland. It is a remarkable combination of skill, professionalism and care, often in extraordinary difficult circumstances.

There are long-standing challenges that need to be addressed. Deputy Shortall outlined some of them. They include health inequalities and the geographical lottery. The Government and Oireachtas are clear in their objectives. We are committed to a goal of universal health care and working with others in the Oireachtas, in particular the Committee on the Future of Healthcare, to achieve the single tier health service that best suits Ireland.

The phrase "best suits Ireland" is key. We need to take account of the Irish context. In the past, we have considered the idea of lifting a model from another country. We do not need to do that do that. Rather, we need to do what is best for Ireland. While we can examine how others do things, we cannot simply transplant something that works somewhere else to here, nor does the health system in any country operate in isolation from the rest of society. Housing, education and employment are major parts of the universal health care equation. Therefore, this requires a whole-of-Government "health in all policies" approach and this is echoed in the healthy Ireland framework.

The committee has been established to allow us to reach consensus on an overarching vision and fundamental principles for health system. There are three significant areas that need to be examined in this regard, all of which have been identified by the committee in its work programme. They are: the model of care; universal health coverage; and the funding model. Before we consider the financial implications of health care or how we manage it, we should first consider what kind of care we should provide and what the best model of care for the future is.

We can, and should, all support 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 patients' needs and to expand chronic disease management in general practice. GPs want to do more and are able to do more but they need to be empowered to do so. That has to be the purpose of the GP contract negotiation due to begin this year.

We need to continue to embed social care and mental health and disability services within the community where appropriate and to support people to live as independently as possible. My view was echoed by the Chairman of the committee. There is a disconnect between the acute and the community and it is causing a problem. In terms of delayed discharges, there is a focus on acute hospitals and what we are doing about the pressures in them. Often, the solution lies in the community but a person in an acute hospital does not have the levers to release the solution in the community. That lack of integration is causing a real problem and adding to our delayed discharges in a very real sense.

The campaign of prevention and health promotion also needs to be continued and stepped up. I do not wish to be the Minister for ill; I am the Minister for Health. We all acknowledge that better integration across our health service is key to achieving a better patient experience, improving health outcomes and unlocking efficiencies within the system. In developing models of person-centred, co-ordinated care, we can draw on the work of national clinical programmes, in particular the piloted integrated care programmes.

Through the work of the committee, I hope we will be able to clearly articulate our desired model of care, the implications of moving towards it and how it can be achieved. I agree that we do not need a report to sit on a shelf. Rather, we need a model that we can get on with actually implementing.

The second area I have referred to relates to universal health care. As an overall goal to improve our health services, universal health care involves four main objectives, as set out by the World Health Organization, 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 spending as a result of seeking health care. The WHO 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. This is especially true in Ireland, where we know there are many challenges across the health system.

The Government is committed to a health service where all people can access the health services they need in an integrated and timely way, of sufficient quality to be effective, while ensuring that the use of these services does not expose them to personal financial hardship. Among the key building blocks for universal health care that are currently being advanced are the following important initiatives: the strengthening of primary care and improved management of chronic diseases; the creation of hospital groups and community health care organisations; implementing Healthy Ireland; the introduction of more efficient payment systems such as activity-based funding; the introduction of a wide-ranging package of patient safety reforms, which is a very important agenda; strengthening the ICT capacity within our health service; and the maintenance of a vibrant and sustainable health insurance market.

Work is progressing on these various reforms. As well as representing major building blocks for universal health care, they comprise important initiatives in their own right with the potential to drive performance improvement and deliver significant benefits in terms of timely access to high-quality 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. Through the committee, I hope we will be able to more clearly define our ambitions for universal health care and the means by which it can be achieved.

One of most important features of any country’s health service is how it is funded, 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 committee. Making changes to funding levels and financing methods takes time and requires careful management, not least to avoid disruption to vital existing services. That is one reason it is important to take a long-term view, such as a ten-year plan, of how the health service can be developed.

I am not making major structural reforms in this area while the committee does its work, as we have to be serious about building consensus on how to fund a shared vision of universal health care. As a new Minister, my first step was to put the health service on a sustainable financial footing through an additional €500 million in funding. I have also met the HSE and all hospital group CEOs to stress that I want to see results for patients and management controls to stay within budget. This additional funding allowed new commitments to be delivered, such as an additional €40 million for home help services and €31 million for people with disabilities, restoration of the ring-fenced mental health budget and funding for the recently-launched winter initiative to address emergency department overcrowding.

While the committee deliberates on some long-term issues, life goes on and so does the health service. We have pressing challenges we must continue to work towards. My focus is on delivering practical, achievable improvements for patients and meeting key programme for Government commitments. The Ministers of State, Deputies Finian McGrath, Corcoran Kennedy, Catherine Byrne and McEntee and I have been putting in place a number of initiatives designed to create further improvements for our people.

I was glad to be able to launch an initial waiting list action plan this year and began reactivation of the NTPF with the endoscopy initiative 2016 to treat an extra 3,000 people, and reduce waiting lists and times in this area. I have confirmed plans to deliver more than 10,000 medical cards for children with disabilities whose parents are in receipt of domiciliary care allowance. The HSE published details of the winter initiative 2016-2017 which will increase the availability of community care, facilitate timely discharge from hospital and increase hospital capacity using an integrated care approach. I am especially pleased that we can do something under this plan to reduce waiting lists for orthopaedic, spinal and scoliosis patients.

The Minister of State, Deputy Finian McGrath, is establishing the task force on personalised budgets to empower people with disabilities to live independent lives. We have to move away from the unaccountable block grant system of delivering our disability services.

The Minister of State with responsibility for mental heath and older people, Deputy Helen McEntee, has established the national task force on youth mental health to improve the mental health and well-being of children and young people in Ireland. Crucially, the national patient safety office will be established in my Department this year. We are also co-operating and co-ordinating with other Departments to deliver key health commitments. A recent example is the Health Innovation Hub Ireland which I launched earlier this week in Cork and which is the first national innovation hub in the area of health in this State. It is a key element of the action plan for jobs 2016 and the programme for Government as well as being good for our health services. The action plan on housing and homelessness includes additional healthcare support services for people who are homeless, enhanced in-reach primary care services and additional funding to support the voluntary and community sector to make sure we are putting in place those wrap-around services that people who have been homeless need when they are housed. The Minister of State with responsibility for communities and the national drugs strategy, Deputy Catherine Byrne, has launched a public consultation on the new national drugs strategy which will be action based and published in January. Last week, the Minister of State with responsibility for health promotion, Deputy Corcoran Kennedy, and I launched A Healthy Weight for Ireland - Obesity Policy and Action Plan 2016-2025 which announced the intention to establish a healthy Ireland fund to allow for further joined-up working between Government Departments. Obesity is a ticking time bomb with regard to the health and well-being of our people. There is much more to do. However, these are important improvements already under way on which we can and must build.

Establishing the Committee on the Future of Healthcare was one of the first programme for Government commitments to be actioned and was one of the first motions before the House. I am very grateful to Members on all sides of the House who worked with me to allow the committee to be established without delay. It is important too that the process does not just create another report to go on the shelf - to echo the words of Deputy Shortall - but that it does actually lead to something tangible that we can all get behind, regardless of future governments or future election outcomes. Universal health care is not just something to implement, it 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. In this regard, I look forward to the committee’s findings and recommendations, and the evidence on which these are based. The work of the committee will mean that members of the public, patients and those working in the health services can have a sense of certainty that there is a long-term strategy and vision agreed by political consensus, and I hope a societal consensus, about our direction of travel for a universal health service that will not change no matter what the make-up of the next Dáil. This is, I believe, an essential element that has been missing in reform efforts up to now and I look forward to working with people on this. We now have an unprecedented opportunity to achieve something that has never been achieved before in Irish health policy, namely, a long term political consensus on fundamental guiding principles. As a nation, when we have set our mind to it, we have achieved great things such as the peace process and meeting economic challenges through the decades. We now need to decide, collectively, to work together to achieve that consensus and to meet that challenge in health. As Minister I will do my very best to work with all Members to make that consensus real.

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