Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy Shortall for her contribution to this debate. She has once again spoken with passion and determination in pursuit of better health services for the citizens of our country, and I would also like to state that her contribution as Chair of this committee has been enormous, and I acknowledge that today.

I also commend all members of the committee, from all political parties and none, for the time and effort they have dedicated to this process. There are many people, both in this House and outside, who remain sceptical about the political make-up of the current Dáil and about what we can achieve together. The way this committee went about its business, and the near unanimity in support for its report, provides a solid rebuttal to those critics. Members engaged in an open, respectful and positive approach to discussions, and understood the prize of achieving a consensus position for patients and for all citizens. It behoves us all to continue in this spirit, and to do our utmost to act on the vision and the strategic direction set out by the committee in the Sláintecare report.

I will not dwell for long on the challenges facing our health system. They have been recounted here and elsewhere with increasing frustration in recent years. We have a fractured system, an outdated model of care that is unfit for purpose, chronic access issues, and growing sustainability concerns as we face into a period of significant population ageing. These problems have persisted for some years now, and have unfortunately led to a real lack of public confidence in elements of our health service, particularly relating to the issue of access. That is not to say that there are not positives. Health outcomes continue to improve, and services are continuously adapting to provide more effective care. Every day, people in this country experience excellent care at the hands of extremely dedicated and qualified health care professionals.

Over the last year, I have had the opportunity to visit health care facilities right across this country. I know the difficult working conditions that people face. I have seen first-hand the commitment and professionalism of staff and management that underpin our services, and most importantly, I understand the genuine hope and ambition that still exists across the system, despite the bad days, to deliver health services that we can all be proud of. The committee's report demonstrates that this hope and ambition is shared in Leinster House.

I have no doubt that the publication of the Sláintecare report will come to mark a critical milestone in the history of our health service, and can provide us with the solid framework and guidance for health services development over the next decade. It is clear in its resolve that considerable change and transformation are required. I fully agree with this. The former US President, Bill Clinton, said "The price of doing the same old thing is far higher than the price of change."

The report sets out a clear set of principles developed through political consensus. We should not overlook the importance of these eight fundamental principals outlined by Deputy Shortall. It is not possible to map out in advance all of the decisions that will be required over the next ten years. Some specific details may inevitably need to be revisited based on experience, as Deputy Shortall said about implementing any plan. However, the principles set out in the report provide a basis for getting the important calls right throughout the implementation process. They also provide clarity in challenging resistance based upon vested interest.

I also believe that the ten-year timeframe is a key strength of the report, which needs to be viewed in that prism. In some of the commentary I have heard on this report, people have talked about it as if it all needs to be implemented right this moment. It is a ten-year plan. We need to be realistic about the timelines required to plan and implement large-scale system change in services as important as health care. It may be possible to make ad hocchanges over shorter timeframes, but it is not realistic to introduce meaningful changes on a sustainable basis without proper planning, the building of support, clear accountability for implementation, and the monitoring and evaluation of outcomes.

The report strongly advocates for a new model of integrated care, centred on comprehensive primary and community care services. We all know that this must be the direction to travel. Our hospital system simply will not cope with the likely levels of demand in the coming years if we continue with our current model of care. More importantly, health outcomes and patient experience can be much improved by developing greater services in the community and by bringing about deeper and more seamless integration across the health and social care system, as set out in the Sláintecare report.

Proposals to develop capacity in both HSE primary care services and in contractor-provided services such as general practitioner and community pharmacy services, increased provision of diagnostic capacity, a greater role in the management of chronic conditions, and measures to support GP practice in rural and deprived urban areas, all dovetail well with actions set out in the programme for Government, and will be fundamental to supporting the desired shift to primary care.

A range of enablers and initiatives supporting integrated care are also given strong endorsement in the report, including the Healthy Ireland strategy, eHealth, integrated workforce planning, clinical governance, enhanced community nursing, integrated care programmes, and current strategies in the areas of maternity care and mental health. The support for these initiatives can add greater impetus to their successful delivery.

I will pick eHealth as an example. Just as in all sectors of society, the role of information technology in health cannot be overstated. We simply cannot achieve the responsive, integrated, effective system that we all desire without significant investment in information systems. We can all agree that we were coming from a particularly low base when the eHealth strategy was first put in place. This is a prime example of a challenge that, at the time, may have seemed too daunting to even contemplate with regard to systemic change. Now we can begin to see what can be achieved when a clear strategy is put in place and an effective implementation plan and roadmap is defined.

I will also single out the committee's conclusion that our health structures are in need of change. I spoke on this issue in my appearance before the committee. While I do not believe that structural change will be the panacea for improvement in our health services - far from it - I firmly believe that our current structure is not serving patients or staff in our health service in the best way.

I welcome the fundamentals set out by the committee that should underpin structural reorganisation, including the re-establishment of a HSE board, and the reconfiguration of the HSE to involve a leaner national agency, retaining national level functions complemented by a more devolved, responsive and integrated entity at regional level. I intend to move ahead with the establishment of a HSE board, and will publish the necessary legislation this year.

As we evolve our structures, our overriding ambition should be for policy, entitlements and standards to be set nationally, but for these to be delivered locally to the greatest extent possible. We need to bring decision-making closer to the point of care delivery, and provide a counterweight to the unnecessary over-centralisation which impedes service responsiveness.

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The report is also clear in its call for the establishment of a universal single-tier system where access to care is on the basis of need and not ability to pay. Let me be clear, that is a view I share and it is a view that my party has also endorsed in terms of both the terms of reference and the work of our members on the committee. Of course, this is in accordance with the terms of reference for the committee. To deliver on this aim, two fundamental policy changes are proposed by the committee: (1) the introduction of universal entitlement to healthcare services underpinned in legislation, and at no or at low cost; and (2) the removal of private activity from public hospitals. These are fundamental changes. There is currently an inherent unfairness in our system when it comes to accessing care. Ability to pay does have an influence today on access, and for many, accessing care comes at too high a price. This needs to be addressed.

The committee's report represents a very important step in the reform of our health services. It provides us with a vision and strategic direction that parties, and indeed Independents, across the House have signed up to.

However, it is only a first step. As recognised by the committee report, "mechanisms for implementation are as important as the report's recommendations". It is appropriate that we now allow time to reflect and deliberate on the findings of the committee and consider how best the vision and spirit of the report can be realised. I understand the desire of many to move quickly on the recommendations and to demonstrate real momentum and this is a desire that I share, but we need to balance this with the potential consequences of rushed or incomplete implementation plans. It is critical that we get this right. I agree with the need for a whole-of-Government approach and the role of the Department of the Taoiseach and the Taoiseach as outlined in the report, but I also need to balance that with the responsibilities that I have, as Minister for Health, and indeed that future holders of this office will have, in terms of our own duties to the House, to the Oireachtas, to the Cabinet and indeed under the Ministers and Secretaries Acts, but I believe we can tease that through, as I have already discussed with many members of the committee.

As Minister, it is my duty to consider the challenges we are likely to face in delivering the scale of reform envisaged in the report. At the outset, I would like to stress that I consider these as challenges with solutions, as opposed to immovable barriers, but they require consideration.

The first obvious challenge, and one that is recognised throughout the report in fairness to the report, is that of current capacity. To be blunt, out starting point is not good. Since taking up the position of Minister over a year ago, I have been clear that we need more capacity, both physical and staffing. This is a problem that is being experienced right across the health service and it is one that will not be remedied overnight.

A capacity review is under way which will report later in the year. It will give us a definitive assessment of capacity requirements across the system and will provide a platform for planning and delivering health services in the years ahead. There is also a concerted effort under way to recruit and retain staff. By the way, I believe this report, in having a ten year plan, helps in that aim to recruit and retain staff in the Irish health service. Recruitment and retention is not without its challenges but the development of a more attractive working environment will go hand in hand with the roll-out of system improvements.

However, we must be realistic about our current capacity situation when we are considering timeframes for delivering on the report's ambitions. It will take time to put in place infrastructure and a pipeline of trained healthcare professionals. Entitlement expansion and waiting list guarantees will be meaningless unless we match them with increased capacity - that is something on which we can all agree. It will be important to introduce sufficient increase in the supply of healthcare as we stimulate demand and utilisation through changes in entitlement or charging if we are to avoid exacerbating access issues for those most in need or reducing quality for everyone. We should also introduce changes in entitlement on a phased basis so that we can monitor and address the impact. We also need to be conscious of the ever evolving economic and fiscal environment and the range of demands across all public services for funding increases. It is a point we all agree on. Whilst the report provides costings, I doubt there is a political consensus on funding. I am sure that will be an issue that we will debate on many an occasion in this House.

In saying all that, I do not want to concentrate solutions overly on capacity increases. We are all agreed that additional capacity and extra funding cannot be the only answer. Fundamental changes in our model of care, as I mentioned earlier, must be a central plank of long-term reform plans. The report also points to fundamental policy changes in entitlements and in the mix of public and private activity within our hospital system and in GP services. We are all aware of the realities in delivering reform in these areas. This process will require more than will and leadership from within the political sphere. It demands leadership and flexibility across the health service and within the health professions, and I appeal to all health professionals in that regard. Changes in contracts will not be easily achieved and this cannot be at any price to the taxpayer. It would be naive to consider that there will not be resistance to change in these and other areas. The Chairman acknowledged that when she referenced vested interests.

Successive Governments have long advocated for a shift towards primary care. It is something upon which there has been genuine broad agreement for some time but we must ask ourselves why it has not been successfully delivered to date and what measures can be taken to realise and capitalise fully on the potential primary care has to offer. These will be important considerations for implementation. To achieve integrated care requires much more flexible, organisational and professional practices than has been the norm to date.

The report quite rightly addresses the learning from the reorganisation of our cancer services but the reform of hospital services in cancer and other areas based upon quality and sustainability considerations has not always won support locally or in the House. There is a duty on every Member of this House to acknowledge - I include my party in this - that when it has come to reforming health services and when it has come to making changes everyone is in favour of it until it is in his or her own constituency. The committee rightly references in the Sláintecare report the success in relation to cancer services but reform of hospital services involves all of us making decisions on the basis of quality clinical advice and sustainability, not on the basis of political point scoring. I hope we can build upon the political consensus achieved in this report when it comes to addressing these and other difficult issues in health over the next decade.

In pointing to these challenges, I do not intend to be defeatist - far from it. I firmly believe that the time is opportune to deliver the kind of change that we all know is needed and that is indicated and outlined in the Sláintecare report. We now have a cross-party report which enjoys widespread political, and I would suggest widespread societal, support. There is a desire evident at all levels, both within the political system and across the health service, to work together to deliver lasting improvements in our health services.

This is a desire shared by the Government. The Taoiseach was very clear in his speech to this Chamber last week that delivering real improvements in our health services is a key priority of this Government. He has tasked me with preparing a detailed response to the report, including proposed measures and timelines. It is my intention now to discharge my duties as Minister for Health in that regard following this Dáil debate. I hope to bring forward not just proposals as to how we might gear up for implementation taking account of existing statutory responsibilities, but also some immediate decisions that we might be able to proceed to implement to show momentum.

I have already had the opportunity to hear initial views from some Members of the Oireachtas and from various stakeholders, and I look forward to hearing contributions from across the House today. Following this, I hope to bring detailed analysis and proposals to Government.

I remain positive that we can make a real difference to the lives of individual patients and the health system as a whole and I have no doubt that this report will be an essential reference point for all Governments and parties in the fundamental reform of our health services over the next decade.

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