Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:“acknowledges:

— the historic cross-party consensus that has been achieved by the Committee on the Future of Healthcare and that the ‘Sláintecare Report’ now provides an agreed vision and framework for achieving healthcare reform over a ten-year period;

— that the demand for nearly all health and social care services is growing as a result of overall population growth and an ageing of our population (60 per cent growth projected in the 65 plus population over the period 2016 – 2031) as demonstrated by analysis from the Economic and Social Research Institute (ESRI) last year and the Department of Health’s, Health Service Capacity Review 2018;

— the challenges that many patients, service users and their families are experiencing in accessing timely care, and the difficulties being faced by healthcare professionals who are doing their utmost to provide safe, quality care to as many people as possible;

— that the Health Service Capacity Review 2018, recognised the need for both investment in additional capacity and healthcare staff, and a programme of whole-system reform over the next decade to modernise and improve our health services to meet current and future healthcare needs;

— that the Government has committed a record level of €10.9 billion in the National Development Plan 2018-2027 to the health sector over the coming decade;

— that the Government has increased funding for health services each year since 2013, totalling a 19 per cent increase over the period, and that the Programme for a Partnership Government commits to sustain these increases;

— that robust performance management and accountability arrangements are an essential component of any healthcare system; and

— that delivering real and sustained improvement in our health services continues to be a priority for the Government; and

supports continued cross-party cooperation and consensus on the vision and direction of travel for health policy outlined in the ‘Sláintecare Report’, including the following commitments:

— put in place a programme of reform arising from the ‘Sláintecare Report’, this follows actions already taken to advance recommendations in the report:

— a Sláintecare Programme Office will be established and the recruitment of an Executive Director is almost complete;

— an independent expert group is undertaking an impact assessment of separating private practice from the public hospital system; and

— draft legislation will be brought forward this year to establish a governing board for the Health Service Executive (HSE);

— publish the Sláintecare implementation plan in the coming weeks which will set out a clear roadmap for delivering on the Sláintecare vision of a universal single-tier public health service based on need, not on the ability to pay;

— invest in additional capacity in line with the National Development Plan 2018-2027, which includes provision for 2,600 acute hospital beds including three new elective facilities, 4,500 community care beds, diagnostic hubs in the community and the rollout out of eHealth infrastructure across the health system, and work is underway to identify the number and location of additional beds that can be opened and staffed in 2018 and into 2019;

— continue to develop comprehensive primary and community care services with a number of investments and initiatives being pursued including:

— continued roll-out of primary care centres, with 114 now fully operational across the country, six of which opened in the first quarter of this year with a further fourteen scheduled to open this year;

— additional funding of €25 million for primary care services, including an expansion of Community Intervention Teams which will help to prevent unnecessary hospital admissions and facilitate early discharge of patients;

— the engagement process to develop a new, modernised contract for general practice has commenced which will have a population health focus, providing in particular for health promotion and disease prevention and for the structured care of chronic disease;

— the number of General Practitioner (GP) training places has been increased from 120 in 2009, to the current 194 places available in 2018; and

— the commitment of Government to develop a new statutory scheme for the financing and regulation of homecare services, to enable our elderly population to live within their community;

— provide improved care and services to our most vulnerable in society as a central component of overall health policy and delivery, and initiatives include:

— legislation will be brought forward this year to provide GP Visit cards to those in receipt of Carer’s Allowance or Carer’s Benefit, benefitting approximately 14,000 persons;

— increase in the number of discretionary medical cards in circulation, from 52,000 in mid-2014 to 135,728 on 1st April, 2018;

— over 182,000 respite nights and over 42,500 respite day sessions will be provided this year, with an additional €10 million provided by Government to establish twelve extra new respite houses;

— in line with national policy and international best practice, there are now less than 2,400 people living in a congregated setting, with 170 more people expected to move to community living in 2018;

— a taskforce has identified how personalised budgets can be introduced in disability services and its recommendations are under consideration; and

— in light of significant additional funding provided, the Government is committed to continuing to fully implement and refresh ‘A Vision for Change’, including building capacity into Child and Adolescent Mental Health Services, the provision of counselling and psychological services in primary care, including the recruitment of 114 assistant psychologists, and fully populating community psychiatric teams;

— prioritise a range of initiatives during 2018, aimed at reducing waiting times in emergency departments and elective waiting lists, including:

— as part of Budget 2018, an additional €70 million was provided to respond to winter pressures, this included €3.5 million for additional transitional care beds and €18 million for additional homecare packages;

— over 200 new beds have been opened this winter to help alleviate the pressure our hospitals faced this winter;

— €55 million has been allocated to the National Treatment Purchase Fund targeted at reducing waiting times for the longest waiting patients, the Inpatient/Day Case Action Plan 2018 published in April, provides for treatment of 20,000 patients, and an Outpatient Department Action Plan will be published later this year;

— an additional €9 million has been provided to paediatric orthopaedics, including scoliosis, to deliver on the commitment of a four-month waiting list target for surgery for clinically suitable patients, following an increase in the total number of surgeries delivered in 2017 to 321 from 220 in 2016; and

— continuing to manage an increasing volume of emergency department attendances, with an increase in overall attendances in the first three months of this year of 3.7 per cent as compared with the same period in 2017, including a 5.9 per cent rise in attendances of people over 75;

— continue a series of focused campaigns to attract frontline staff in order to meet patient care requirements, including:

— an additional 942 nurses and midwives were recruited in 2017, including student nurses, and all nurse graduates have been offered permanent contracts to work in the Irish Public Health Service in 2018;

— the Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland was launched in April 2018, which sets out for the first time a methodology for calculating the staffing requirement and skill mix needed in our specialist medical and surgical wards in adult hospitals;

— the number of Non-Consultant Hospital Doctors has increased by 289 in the twelve months to the end of March 2018, and the number of consultants has increased by 110 in the same period; and

— the Public Service Pay Commission is currently examining issues relating to the recruitment and retention of staff in the health sector, and their report is expected in June; and

— to continue to develop and expand our aeromedical services and implement the recently published trauma policy.”

I wish to begin by thanking the Deputies in the Rural Independent Group for tabling this motion, raising a number of very important matters and providing us with the opportunity to discuss them on the floor of Dáil Éireann. The events of the last week demonstrate how important and how personal healthcare is to every individual in this country. The issues we have been grappling with on cervical screening and maternity services in Portiuncula show just how devastating the effects can be when there are failures within our health services. It is incumbent on all of us, as elected public representatives, to work together to bring about real change in our health services and real improvements in healthcare for everyone in this country.

Since taking up the role of Minister, I have been appreciative of the willingness of Deputies across the House to work together on health issues. This is one of the potential achievements of new politics and minority government. I refer to the fact that Government and Opposition Deputies sat on a cross-party basis to try to put together a plan for our health service. It is often forgotten in the narrative that Government Deputies also sat on the Sláintecare committee and that my party supports the Sláintecare recommendations as well. This really came to the fore in the workings of the Committee on the Future of Healthcare, where all parties stepped up to the plate and worked together to develop a roadmap for change in our health services, and I pay tribute to all involved.

It was evident again last week as we considered the serious failings in CervicalCheck. We have been united as an Oireachtas in our shock and dismay at what has happened to Vicky Phelan and her family, to other women across this country and to Mr. Stephen Teap and his late wife, Irene. I thank the Deputies who met me last week to discuss the establishment of an inquiry and who made submissions, which I sought to address in the proposals I brought to Government this morning. Today, Government agreed to the establishment of a scoping inquiry to examine the facts and get answers quickly for Irish women, while also identifying the issues that will require a full statutory investigation. Dr. Gabriel Scally, who has been appointed to carry out the scoping inquiry, has widespread experience in undertaking reviews of this kind. He has had a distinguished career as a senior public health doctor and adviser with the UK Department of Health as well as the NHS and is currently president of the epidemiology and public health section of the Royal Society of Medicine and a professor of public health at both the University of the West of England and the University of Bristol. He has also worked to unearth very many significant service and clinical failures in parts of the UK and Northern Ireland. I have no doubt but that he brings huge experience to the issue, and he has really hit the ground running starting his inquiry today. He will be joined by Dr. Karin Denton, a consultant cytopathologist who has huge expertise in cervical screening within the NHS. I thank Dr. Scally for arriving in Ireland today, for immediately beginning his work and for committing to report back by the end of next month setting out his findings and to provide a progress update at the start of next month.

For many, CervicalCheck is just one in a long list of failings in our health services, and I understand that point of view. Too often we are here talking about lack of services, poor performance or, in the worst cases, breaches of trust and duty. In the face of these failings, it can be difficult to talk about any positives. However, we must remember that, in the vast majority of cases, staff across our health service are doing their utmost to provide high-quality care. They are treating more patients than ever before, they are providing much-needed care, support and compassion to people when they need it most and they are doing this in an ever-increasingly busier environment.

We all know the pressures and challenges that face the health service. We all know people who are not getting the care they need as quickly as they should get it. We all know healthcare professionals who are frustrated and burnt out from working in a system that is not working all that well. Our system is already challenged, and the changes in demography, technology and the nature of illness that will happen in the coming years will place ever-increasing strains on it. Funding alone will not be enough to address this. There is no silver bullet or magic wand we can wave to get us the kind of health service we all want. The scale of the challenges we face means that fundamental change is needed, and this can only be delivered by an ambitious, coherent and sustained programme of reform that has broad support.

I am on record here and elsewhere in expressing my belief that the Sláintecare report and the cross-party support it enjoys present us with a unique opportunity to embed long-lasting reform. Sláintecare has the potential to fundamentally change the way we deliver healthcare in this country, to allow us to provide high-quality, safe and fair healthcare for all our citizens. I have listened to health service users, patients, staff of the health service at all levels and Members of this House and I know the challenges that lie ahead in driving through large-scale reform. We will only succeed with this ambitious programme if everyone - and that includes all of us here - are united on the overall goal and pulling in the same direction.

In the 12 months since the publication of the Sláintecare report, the Government has already taken significant steps to commence the programme of reform that it envisaged. We have already committed to the establishment of a Sláintecare programme office, and the recruitment process for the executive director of that office is in its final stages. This has been a very thorough and comprehensive process, led independently by the Public Appointments Service and involving a national and international executive search. I hope to be able to make an announcement on the new director for this programme office very soon, a key priority of Sláintecare. We have also prioritised the Committee on the Future of Healthcare's recommendation to remove private practice from public acute hospitals. Let me say on the record of this House again that I believe this must happen. We are an outlier among other countries in this regard. This is a far-reaching, complex reform but absolutely fundamental if we want to achieve a fairer, more equitable health service. I have established, in line with the Sláintecare report, an independent review group, chaired by Dr. Donal de Buitléir, to examine the impact of this measure. The group will conclude its work later this year, which will provide a valuable roadmap on how this can be achieved. That is another key recommendation of Sláintecare implemented.

The Sláintecare report made a series of important recommendations in respect of accountability, clinical governance and patient safety which resonate even more strongly now. I have already signalled my intention to bring forward a Bill to legislate for the establishment of a governing board for the HSE. I am pleased to confirm to the House that I will bring a memorandum to Government next week with the general scheme of a Bill, which will then be published next week. I ask for the co-operation of all parties and groupings in this House - and I know it exists - in getting this legislation through the Oireachtas as quickly as possible this year so a new board of the HSE can take up office, effective January 2019. I know we all agree that we need more robust and transparent structures of accountability across our health service, and the appointment of a strong board with the appropriate skills set is essential to achieving this. I ask that we work in a bipartisan fashion to work out how best to populate this board. It is really important we have the right skills set. If ever we were in any doubt about the need to improve accountability structures, recent weeks have shown the importance of that need.

My Department has also commenced work on the committee's recommendations in respect of changes to the HSE structure itself. An important component of this will be the development of regional structures to support the delivery of integrated care, a key Sláintecare recommendation. This is an issue I raised with the committee myself during deliberations and it is something I fully support. Let me be very clear: my view on this is that the HSE as currently constructed is overly centralised, far too bureaucratic and does not have sufficiently devolved systems of governance and accountability.

We need to create a leaner central body complemented by regional organisations which will provide the framework within which much clearer, transparent and more robust accountability and performance arrangements can be developed. The structure has become far too complex and far too bureaucratic. It was set up in an inappropriate fashion but we are going to fix it and do so in line with Sláintecare roadmap.

On accountability, I spoke to Róisín and Mark Molloy, who have been incredible patient advocates arising from the terrible tragedy they experienced with baby Mark in Portlaoise hospital, about accountability legislation. They asked me to examine what other jurisdictions have done and I am undertaking that work now.

The first step in reforming structures is to better align our current regional structures, that is, hospital groups and community healthcare organisations. A public consultation on this is currently under way, I welcome the submissions of all and my Department will bring forward proposals later in the year. I have previously pointed out that I do not think that reform alone can solve all our problems. Given the scale of population change that is expected over the next decade, additional funding will also be necessary. This will build on the significant increases already delivered in recent years, with public funding on health increasing by 19% since 2013. In particular, the Government is committed to advancing a €10.9 billion capital programme over the next decade to improve our healthcare facilities and increase capacity across services. This is 165% higher than it was for the last ten years and will support major priority projects as well as enabling the roll-out of new additional capacity. The bizarre failed policies of the past of reducing hospital beds is over. We are now going to deliver in full the provisions in the capacity review, 2,600 acute hospitals beds, three new elective facilities - one each in Dublin, Galway and Cork, and 4,500 community care beds, and diagnostic hubs in the community. This is all funded. It takes several years to build hospital wings and new elective facilities and to put diagnostics into the community but we are beginning to plan for that.

Crucially, we are also delivering on a key Sláintecare recommendation in committing €1.6 billion to delivering enhanced eHealth and ICT capability which the Sláintecare report identified as an important enabler of reform. I fully appreciate that extra staff will be required and I very much welcome the Framework for Safe Nurse Staffing and Skill Mix in hospitals. I made an announcement on that at the Irish Nurses and Midwives Organisation, INMO, conference last Friday in Cork, while the pay commission is also looking at issues on recruitment and retention to the health service. It is due to report next month, and the Government will be guided by that.

I have secured Government approval to move forward with contract negotiations with general practitioners. I am pleased to inform the House that that engagement has commenced. It is clearly under way and meetings have taken place. We have many millions more that we want to spend in general practice but it takes two sides to negotiate and I also have requests on behalf of the Irish people and of patients.

We are developing a new homecare scheme for older citizens and people with disabilities. It is under development and in the meantime we are committed to providing an additional 754,000 home support hours this year.

I am running out of time but we will have an opportunity at tomorrow's joint committee on health to further tease through some of these issues.

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