James Reilly (Dublin North, Fine Gael)

Given the day that is in it, the metaphors regarding honeymoons and marriage may be appropriate. However, I will leave that well alone. I thank Senators for their contributions and will endeavour to answer their questions as best I can. I do not have every answer, but the information will be conveyed to Members. Where it is not available today, I will seek it out and get back to them in writing. I am reminded of my time in opposition when I was wont to fire a barrage of questions at the Minister at the Oireachtas committee. Members will understand if I inadvertently omit any question that was asked.

I thank Senator Darragh O'Brien, who has had to leave the Chamber, for his questions. He referred to the reduction of €750 million in real terms in the health budget, the loss of 4,000 staff and our undertaking to protect the front line. Protecting the front line is what we have undertaken to do, in so far as we can. It is about front line services as much as front line numbers. The Senator said there was no mention in my opening statement of the issue of consultants' private fees. I have made the point numerous times that it might give us a warm political feeling to give consultants a whack over the head and take €50 million from them, but the question is whether that will lead to more patients being treated more quickly.

I draw Members' attention to the various initiatives we have taken through the clinical programme, supported by the special delivery unit. For example, the assessment of the medical admissions unit in Cork has, in a six-month period, saved 11,000 bed days by avoiding admissions for patients who would otherwise have ended up in hospital. That would translate to 22,000 bed days in a year and a saving of somewhere between €15 million and €17 million. That is the type of progress being made in just one hospital. The productive theatre initiative is being carried out in five units, representing only 2.5% of all theatres, and has saved €2.5 million in one year. Transposing that across the system would give potential savings of €100 million. In addition, the money follows the patient initiative in regard to orthopaedic procedures, whereby patients are admitted on the day of surgery rather than the night before, has led to savings of €6 million thus far.

There is more than one way to achieve our goal. To clarify, my target is not savings but ensuring more patients are treated more quickly. If I can achieve that by way of negotiations with consultants on changes to work practices, that would be a good day's work. My main concern is the cost of private beds and private fees. I am concerned that there is a willingness on the part of VHI and others to accept a 9% cost inflator year on year. I do not accept that. VHI has shown a willingness to deal with the matter through its engagement of Milliman to help it examine its cost base. Furthermore, having had a meeting with the three insurers and having established the health insurance consultative forum, which will meet again later this week, I made clear that cost is a major issue and that they must examine why they pay what they pay for different procedures.

I am certainly seeking serious discounting of consultant fees where they are carrying out procedures in hospitals that could and should be carried out in primary care. What is at issue is not whether those procedures are carried out by consultants or GPs but the fact that they are attracting utterly unnecessary hospital side room fees. In regard to the cost of care in private hospitals, VHI has taken on board that our clinical programmes have been quite successful in reducing costs in public hospitals. VHI is now engaging with Barry White, the Health Service Executive's national director of clinical strategy, to see how similar cost reductions can be achieved in private hospitals.

Senator Colm Burke referred to competition in private health care. I have made very clear to VHI that it is not its role to determine its market. If there is a private facility available that is open and competitive, then VHI should be covering it. Certain people on the board of VHI may have a different view, but there are four new appointments to be made in the coming week. Those appointees will carry my message loud and clear that the objective is to secure more, not less, competition for the benefit of patients.

Senator O'Brien claimed that waiting times under the National Treatment Purchase Fund, NTPF, have increased from three months. That is a little disingenuous. The reality is that many people waited six months or more before they even got on to the NTPF. I can prove it if the Senator needs me to. We had patients waiting up to three years for treatment. Is it more equitable to have everybody treated within a year or to have a select group treated within three months while others wait for years? Nobody should wait longer than a year for treatment, a target we have achieved throughout the country, with the exception of Galway. The specific reasons for that have been addressed with a new management now in place. It has control over the university hospital, Merlin Park, Roscommon and Portiuncula hospitals as a group, with clear riding instructions in terms of what is required of the smaller hospitals. That will cause some friction, but it is an argument we are determined to win.

On nursing home care, I have made clear that the policy of this Government is to maintain a public provision capacity for nursing home care and community nursing units. However, I have made equally clear that we cannot have a situation where it is costing anywhere between 50% to 100% more to provide that care through the public health system as opposed to the private system. People will say there has been cherry-picking by private nursing homes and so on, and we are addressing that in a clear fashion. The NTPF has been asked to draw up, in conjunction with clinicians, a score card incorporating boxes that must be ticked in terms of the services available in a nursing home. When provision is agreed in terms of the price the nursing home will receive to care for a patient, if it does not tick all of these boxes, a discount will be applied. There is some evidence that nursing homes in the private sector do not provide the same complexity and high dependency of care as their counterparts in the public sector. This is only anecdotal and not across the board by any means.

Community nursing units are not being downgraded. Some may very well have to close, but we should try to keep as many as possible open and where they are not necessarily economically viable alternatives should be considered in terms of local fund-raising, being taken into a local trust and so on. I am wide open to all such options. What I cannot do is tell a person that his or her mother cannot get the care required because another patient is in a facility that costs twice as much as it should. There is an equity issue here. I have made clear in the past that it is not always about money. It is also about changing work practices and rosters.

Several Senators referred to delays in processing medical card applications and disputed the Health Service Executive's claim that its primary care reimbursement service, PCRS, is turning around new applications within 15 working days provided all the necessary information is submitted. I had a meeting with Mr. Paddy Burke, director of the PCRS, only two weeks ago, at which we reached agreement on several matters. First, anybody who responds to the PCRS's contact will keep his or her medical card until the review is complete. Heretofore, applicants' cards were being withheld until all correspondence was complete. This change takes a large number of people out of the equation. Second, there is now cross-referencing with the Department of Social Protection to ensure that anybody on social welfare keeps their card. Third, as I said in the House last week, there are people who have not responded and have not had any activity on their card in the past two years. It is reasonable that a card is revoked when there is no response to a third attempt at contact. Otherwise Mr. Burke would be in front of the Committee of Public Accounts trying to explain why he is still paying GPs to service cards for people who have not used them for two years and have not responded to his inquiries on three separate occasions. It is safe to assume that those people have probably left the country and, as such, we should not waste public money in providing medical cards for them.

I fully accept that there was not sufficient regard given in the past to the need to process medical card applications in a timely fashion. Mr. Burke has apologised for that and the position has improved. However, in case anybody should take false succour from that, including the staff of the PCRS, a delegation from the Oireachtas Joint Committee on Health and Children will visit the facility in Finglas before the end of the month. There should be no doubt about the tremendous interest in this House in ensuring minimum inconvenience for people applying for or renewing medical cards.

Senator Colm Burke raised the issue of retirees returning to work in the health service. He is absolutely right that we must maintain flexibility within the system so that we can maintain services. If we find ourselves with a highly specialised vacancy, such as a CNA II in a paediatric intensive care unit, for example, we need to be sensible. To clarify, it is not my intention that retirees will return to the service in droves. Not all of the positions will be filled because they will not be necessary. However, those which are necessary to fill will be given to new people. We want to give young people a chance at a job instead of bringing back people who have already had their lump sum and pension. That is not what this is about. It would be very much the exception that somebody who has retired will be back in their old job. We are doing something that has not been done anywhere else in the western world, as far as I am aware, namely, seeking to improve quality and service against a backdrop of seriously declining budgets. I commend all of those involved.

Senator David Cullinane referred to a reduction in the number of theatres and beds in Waterford. I already mentioned the productive theatre initiative. It is not about the number of theatres but how one uses them and how many patients are treated. The number in Waterford has reduced from eight to five, but I am assured that the productivity of the remainder can be improved under this initiative to ensure that patients receive the service they require. The same applies in regard to reductions in bed numbers.

Regarding drug treatments, I do not accept that any patient would be left without treatment because of a delay in accessing drugs. Drugs will be secured if patients need them in urgently. It would be very strange if it were otherwise.