Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

Question 26: To ask the Minister for Health and Children her policy position on the allocation of resources to publicly funded hospitals; her views on whether there is a need to change the way in which money is allocated on the basis of historical patterns rather than work done, efficiency and response to the needs of the cohort for which the hospital provides service; if she will ensure that an assessment is carried out on Our Lady's Children's Hospital, Crumlin, so that the extra demands on its services as the primary tertiary children's hospital here are adequately funded; and if she will make a statement on the matter. [26457/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The purpose of health policy is to achieve the best health status and health outcomes for the whole population. We are succeeding in Ireland in many respects. Life expectancy is now at the highest level it has ever been. Infant mortality is one of the lowest in the world. Survival from many cancers is improving. Death rates from cardiac disease are falling.

We are now allocating €16 billion in current funding across three health Votes. Even if there was scope to increase this, it would be vital that we allocate resources so that the clear focus and the economic incentives created are about achieving the best health status and health outcomes for people, within affordable limits. Many health care systems are seeking to achieve this. It is not about changing the funding basis from tax-based funding to insurance-based funding. It is about how resources are allocated. There is certainly every reason we should avoid changing to a system dominated by fee-per-item payments to doctors and hospitals, where simply more activities, such as tests, investigations, surgeries, get more money for the providers. This system has a cost dynamic that can bankrupt either insurers or the State or both, and worst of all, can result in worse health outcomes for patients. However, I do want to move away from the tradition in our country of allocating resources to public hospitals on the basis of incrementally adjusted historic block budgets.

I want to allocate resources to support the best outcomes for patients, in a way that would avoid unnecessary hospitalisation, reduce the lengths of stay in hospital, manage chronic conditions in the community, and reward better preventive primary care. This is what we mean when we talk about making money follow the patient. For this reason, I established an expert group on resource allocation and financing in the health sector in April this year to do the complex, detailed work required. This group is being chaired by Professor Frances Ruane, director of the ESRI. It includes many independent experts who will bring their experience and judgment to bear on how to achieve the objectives I have set in practical ways. The group is to report to me and the Minister for Finance by April 2010.

In the meantime, I fully support the work being done by the HSE in conjunction with the three Dublin children's hospitals. The real challenge in paediatrics is to maximise the efficient use of all our health care capacity, both in Dublin and across the country. The paediatric services in Crumlin, Temple Street and Tallaght need to be increasingly working in a co-ordinated, shared and efficient fashion to prepare for the eventual merging of the three institutions in 2014 into one national paediatric hospital. In the meantime, the HSE is actively pursuing ways in which services across the three hospitals can best be co-ordinated, in order to avoid unnecessary duplication and to achieve savings that can be put back into patient care.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

I welcome the fact that the Minister accepts that we need to move away from the historical pattern of providing a small increase or decrease to hospitals every year, irrespective of the demands put on them. In measuring outcome, surely Our Lady's Children's Hospital in Crumlin must measure up well. The Minister is talking about taking action that will give children a better outcome for the future. In many cases, pain and suffering will be avoided because of early intervention. Yet through no fault of their own, as the birth rate has gone up, the rate of serious illness among children that can be treated has also gone up, and the demands on the hospital have gone up. In the last four years, day activity has gone up by 30%, outpatient activity has gone up by 23%, and theatre procedures have gone up by 34%.

While the Minister may be right in stating that savings can be made through co-operation among the three hospitals, there needs to be intervention among children in order to address the fact that waiting lists are growing due to increased demand for the most important sector of our population, namely, children with serious illnesses.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The Deputy is correct and we have substantially increased the budget in Crumlin by 39% since 2004. However, I believe that many initiatives can be taken and are being taken by the hospital, such as the decision by the board last week not to have any further ward closures this summer. That is to be welcomed, and it was done without any additional money. There is no system in the world with an unlimited source on which we can continually draw.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

I am not saying that.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

Everybody must be allocated a budget. The reduction in the allocation to Crumlin was less than many other places. Professor Drumm will be addressing the health committee next week on the children's hospitals, specifically regarding the issues on Crumlin. He is familiar with them, having been a clinician there for many years. There is a 17,000 day overtime bill in Crumlin. By the end of this year, we hope to move to a single surgical department between the three children's hospitals, with seven surgeons. That will greatly cut down on on-call overtime and so on. We hope to move to a single, clinical critical care department between Temple Street and Crumlin. Professor Des Bowen from Canada has been brought in to help with this. All of these initiatives can greatly reduce overheads in the hospital and direct more activity to patient care.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

That is all very well for the future, but children are currently waiting for unacceptable lengths of time with very serious conditions such as scoliosis, which is generally not dealt with by the National Treatment Purchase Fund. Will the Minister find some measure in the meantime which accepts the kind of models on value for money, but which also accepts that the demands on the children's hospital in Crumlin have greatly increased in recent years?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I accept that, but the resources allocated to Crumlin have also increased. There was an 18% increase in medical staff and there are also more day cases, which is much less expensive for a hospital than overnight stays. We are hoping to arrive at a situation in Ireland where about 85% of surgery will be done on a day-case basis. We are at about 62% at the moment. Professor Drumm will address all of these issues. I do not believe seriously-ill children cannot be treated within the budget framework for Crumlin hospital in 2009.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

One size fits all does not work in this case.