James Reilly (Dublin North, Fine Gael)

We inherited that legacy and we shall deal with it. Not for the first time, a Fine Gael and Labour Party Government will clean up the mess left behind by a Fianna Fáil-led Government.

A hospital must fix the problems in its emergency department by addressing their cause. What causes them are the actual numbers coming to the emergency department and the lack of primary care facilities. That is an issue we are addressing. We are putting in place a strategy on which we will deliver, unlike the strategy of 2001 which was left on a shelf.

Equally, one must change the way a hospital operates in order that more patients can be admitted quickly. In order to do this one must provide services in the community to allow patients who have finished the acute phase of their treatment to continue their journey back to full health, if that be the case, or in longer term care, if that is what is required. There is a range or host of possibilities between short-term convalescence, longer term convalescence and other initiatives. If a diagnosis of pneumonia is made, for example, when the patient will need intravenous antibiotics, the first dose can be given in hospital and the patient can then go home where he or she can be visited by a competent nurse to administer the antibiotics while the patient is monitored by his or her general practitioner. There is also home help and home care packages available. All of these possibilities must be addressed.

When the Government came to power, I promised to set up a special delivery unit. The reason I was so keen to do this was that I had seen what had been achieved in Northern Ireland where there was an information system that allowed full visibility throughout the health service. One could see Mr. Murphy's waiting list in Ulster Hospital with the touch of a button on a computer, or Mr. Walsh's list in Belfast. If one was a two month list and the other was a two week list, the man with the two week list was left alone while the man with the two month list received a visit to find out what the problem was. This was not used as a big stick with which to beat people but rather as a tool to help them to address the problems they were experiencing. Was the reason for the delay the fact that the man concerned was undertaking too many reviews, or was it that he was so popular that everybody wanted to see him? In such a case perhaps some patients could be moved to another list. The key point is that the Minister is in constant touch with the special delivery unit which reports to him weekly and sometimes daily. This has had two effects, as I noted at the time. First, people know there is help available and, second, that there will be consequences if they do not change their habits.

My adviser was told that it would cost €10 million and take 18 months to introduce such a system here. The special delivery unit, under Dr. Martin Connor, a doctor of philosophy, not medicine, in conjunction with some excellent people from the HSE and the National Treatment Purchase Fund, has managed to put in place a system in 98 days for less than €250,000. It is not yet complete, but they are getting there quickly. Of course, the final bill will be higher, but the point is that the team has managed to do in a very short time what it was said would take much longer and cost much more to do. We are now in a situation that allows full visibility across the system. We can see how many are waiting for access to inpatient services and for how long they have been waiting in emergency departments at any given moment. This does not yet apply to all emergency departments, but is to be found in 27. We can now monitor what is happening and intervene. Similarly, we can now see Mr. Murphy's waiting list. For the first time, instead of driving around in the dark, we are driving with full beams. We can see what is happening, plan and react much more quickly. Instead of finding out months or a year later that there is a problem, we know now and can address it.

We are also putting in place a similar type of IT system for financial matters in order that we can monitor a hospital's financial performance at two and four week periods. This obviously gives us more monitoring ability because many more parameters can be measured. We will be able to see very quickly when a hospital is moving away from budget and intervene, something it was not possible to do in the past. Generally, what happened was that in the middle of February things would begin to look a little funny and one waited to see how they looked in March. In May one realised that half the year was almost gone and budgets had gone seriously astray. That will not happen again.

Many Senators have issues concerning their local hospitals. Eight are problematic, while another seven are considered high risk. They are receiving intensive support. I will take questions as Senators raise them, if they have a particular interest in a given hospital.

I wish to discuss, briefly, the position of smaller hospitals and the pervading fear that they will be downgraded and, ultimately, put out of business and lost to their communities. Nothing could be further from the truth. We are obliged to preside over the safe provision of services — that is an absolute — and will do so. Where we can make a hospital safe, we will do so, but where we cannot, or if there is a facility within the hospital that is not safe, we will not preside over it. In the midst of all the negativity, however, I wish to point to some positive facts about smaller hospitals. The Government is developing a framework for such hospitals, the first draft of which has already been delivered. The Cabinet Sub-committee on health met to discuss this strategy and is due to meet again in the next week or so in order to give further consideration to it.

An example of a small hospital that has flourished is Louth County Hospital. In 2009 there were no care of the elderly cases at this hospital, in 2010 there were 162 and to date this year there have been 388. In 2009 there were 535 episodes of venesection for haemochromatosis which requires removing units of blood at a time, in 2010 there were 800 and to date this year there have been 1,783. There was no colposcopy service at Louth County Hospital in 2009 but in 2010 some 3,083 cases were dealt with there. The number of surgical cases at the hospital has risen from 3,416 to 3,659 in recent years. The number of radiological examinations increased from 534 in 2009 to 1,519 in 2010 to over 3,000 this year. The number of outpatient sessions has increased from 933 to 974.

These are the types of services which can be provided safely, conveniently and in a far more cost-effective way in smaller hospitals than in their larger counterparts. I accept that there has been a great deal of controversy with regard to what has happened in smaller hospitals. I warrant, however, that there will be a great deal of controversy when we transfer from the bigger hospitals the type of procedures which more rightly should be carried out at smaller facilities. People should make no mistake — we will move those procedures. I have stated on previous occasions that obliging people to attend in larger hospitals for a varicose vein ligation procedure or the repair of an inguinal hernia is similar to sending one's ten year old Volkswagen to the Ferrari testing centre. There is no doubt that a great job will be done but this is hardly a good or efficient way to use resources.

I do not want to take up too much of the time because I am aware that Senators have many questions to pose. However, I wish to state that we are determined to make our health services better. We know that we can do this and we have gathered around us the expertise to allow us to proceed. The clinical care programmes were already in existence when I entered office. They are now flourishing and are playing a major role in addressing many of the inefficiencies that exist in the system. It is worth noting, particularly in light of past controversies, that it will not be possible to do things as they were done in the past, especially as our way of operating has not delivered. I will give some credit where it is due. The previous Government threw a great deal of money at the health service. It is clear, however, that money alone will not solve the problems. What is required is change, particularly in respect of the way care is delivered.

The underlying principle of our policy is that a patient should be treated at the lowest level of complexity in a setting that is safe, efficient and as near to his or her home as possible. We intend to ensure that this principle will be adhered to. We have already begun our journey on this road by allowing patients the option of having flu vaccinations administered in pharmacies. This gives them greater choice and increased access due to the fact that pharmacies have long opening hours. Similarly, we want to bring those with chronic illnesses out of hospitals and back into the community, where they can be treated in a far more cost-effective and convenient manner.

I recently visited Mallow primary care centre, at which over 2,000 people with diabetes are being treated at 20% of what it would cost to treat them in hospital. The results achieved by the centre are excellent and I understand that in four years not one patient has been obliged to undergo an amputation procedure. Patients' blood sugar levels are monitored at the centre and the level of control is excellent. In addition, attending there is far more convenient for patients. Some of the larger hospitals in Dublin have 8,000 or 9,000 people with diabetes attending their outpatient departments. Why are these individuals attending hospitals when they could attend their GPs and be cared for, in the main, by practice nurses?

These are the matters to which we are giving consideration. We are determined to make the changes to which I refer. I accept that these will require alterations to the way in which consultants, NCHDs, nurses and GPs work. The country is in a difficult position — although in light of the progress that has been made, the position is not as difficult as was the case when the Government entered office — and it is incumbent on all of us to put our shoulders to the wheel. It is particularly incumbent on those who are leaders in institutions such as hospitals, etc., to put their shoulders to the wheel, to lead by example and to show others the way. We are all in this together. As stated, no part of the health service exists in isolation, no man is an island and no body in society can state that it does not have its own share of responsibility to bear in the context of rectifying the situation in which we find ourselves.

I thank Senators for their time and look forward to answering their questions.