Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister to the House and thank him for introducing this legislation. We need to consider where we are in health care and think about the very negative message given out on health care. We need to consider why we need reform and need to create efficiencies.

Currently, 27% of all Government spending is on health care. This means 27 cent of every euro paid in income tax goes towards health care services. The ¤13.588 billion provided for in this area in last year's budget was greater than the total amount collected in income tax. This means all other taxes collected were utilised to operate the remaining 14 Departments. There are huge inefficiencies in terms of health spend, in particular in the cost of drugs. In 2000, the cost of drugs in the health care sector was ¤576 million. By 2010, this had increased to more than ¤1.9 billion, which is a 230% increase, with little or no control during the intervening time over who or what was paid for drugs. In comparison with other countries, Ireland is one of the most expensive not alone in Europe, but in the world in terms of the cost of drugs. In terms of governance of the health sector, how did this happen and who is responsible for it? This Bill seeks to bring control of this sector back within the remit of the Department of Health.

The reform which took place in 2004 was supposed to bring about necessary changes. However, the cost overruns occurred after 2004 when the Health Service Executive was established. This will continue unless necessary reforms are put in place. The Brennan and Prospectus reports of 2003 recommended the establishment of one national entity to manage health services. Following the establishment of the HSE, the Minister frequently referred Deputies' parliamentary questions on health services for answer by the HSE, as a result of which a huge number of issues arose.

At the time of the 2003 report of the national task force on medical staffing there were 1,731 approved permanent consultants posts within the health boards. The task force predicted in that report that owing to the European working time directive there would be a need to appoint more consultants and that by August 2009 there would be in the region of 3,100 permanent consultants appointed. It was also stated that, by 2012, we would have 3,600 permanent consultants. Currently, there are 2,500 consultants in the system, which is 1,100 short of the target.

Last week Opposition spokespersons complained about waiting lists for appointments with senior consultants. However, these have occurred because policy, in terms of appointment of the planned number of consultants as set out in the 2003 report, was not implemented. The Opposition is not entitled to be critical of waiting lists given they are the result of the failure of the previous Administration to appoint the number of consultants promised. It is difficult now to address this issue owing to a tightening of budgetary provision.

This legislation puts in place a new structure of governance and seeks to provide for that promised in the programme for Government, namely, that money should follow the patient. This is just another step in that process. As outlined by the Minister, the legislation introduces a temporary transitional structure, which is but one of the steps needed to be taken in this area. While the Bill abolishes the board of the HSE, it does not change the legal status of the HSE. It also, as outlined in detail by the Minister, provides for accountability and establishment of the directorates.

Section 5 amends section 10 of the 2004 Act and allows the Minister to issue directions to the HSE on implementation of ministerial and Government policy. In other words, it gives back the power to the Minister to issue directions. Section 6 determines the priorities to which the HSE must have regard in preparing its service plan. The Bill also establishes performance targets for the HSE. It is important clear targets in this regard are set out. It is also important the terms of any plan and the targets set in each area are implemented.

Section 12 introduces changes to how the service plan is prepared and amends section 31 of the 2004 Act. The HSE must take into account the priorities and targets set by the Minister. It is important if we want to move forward with reform that the plan prepared each year takes into account the Government's long-term programme. The Minister has dealt with the various amendments to the 2004 Act that are required to be put in place.

A particular issue about which I am concerned - this relates to the task force report of 2003 in regard to reform of the health service - is front-line staff. In this regard I would like to outline to the Minister one issue which I believe needs to be tackled, namely, the appointment of locum consultants following the retirement of consultants. A number of instances in this regard have been brought to my attention. In one case, a consultant retired and an interview was held in November, following which the interview board agreed on the candidate to be appointed. As of today, the locum consultant remains in place and the selected candidate has not been informed of his or her selection for appointment. This is disappointing from the point of view that the HSE would incur no additional cost as a result of replacing a locum consultant with a permanent consultant. Perhaps the Minister would address this issue. We do not want a return to the situation whereby we are relying more on junior doctors. If the policy as I have just outlined continues, that is what will happen.

Another issue of concern is that of junior doctors. It is important I raise this matter with the Minister, as I have done consistently since becoming a Member of this House. One of the problems with which the Minister had to deal when he took up office approximately two years was the lack of planning in regard to the appointment of junior doctors. In April 2011, the Minister had to, on short notice, ensure recruitment of a huge number of junior doctors. In this regard, a number of people from India and Pakistan were recruited and given two year contracts. Those contracts will expire in June 2013. I want to ensure the necessary procedures are being put in place to ensure replacement of those doctors in June-July 2013. The planning for this needs to be in place now.

I am raising it because of a survey of final year medical graduates I carried out in April, May and June. Over 50% of those interviewed said they will not be working in Ireland after June 2013. Only 35% intended staying in the Irish hospital service in 2013. That is a concern and we must start planning for it because we are eight or nine months from 30 June.

The Bill brings the power back into the Department, while working with very good staff in the HSE. It is easy to criticise HSE staff but there are good and dedicated people in the HSE. It is important the cost of drugs is dealt with in a comprehensive manner. We are paying far in excess of what is required. It is one area where we can replace services.

We must work hard on the reconfiguration of services, which is being dealt with professionally in Cork. We used to have three or four hospitals doing a bit of everything at huge cost whereas reconfiguration assigns certain categories of treatment to certain hospitals so there is no duplication. It is a welcome development and the Minister has been very much involved in it. We need to do this throughout the country to ensure we are getting value for the money we put into hospitals and to provide the best possible level of care.

Despite media comment on the health care area, much progress has been made on outpatient care. The media will not cover the fact that the number of outpatient appointments has increased from 2 million to 3.5 million per year in the past ten years. The number of day case procedures has increased dramatically and there are more day case procedures now than ever before. This increase has taken place because of reform and reorganisation in health services. These changes can make the service more efficient but it is a question of how we manage it.

A HSE financial management issue raised recently concerns the small number of people dealing with financial management who have financial qualifications. The legislation refers to setting up an audit structure. That is very important. As financial management is about getting value for money, we need people with expertise. I am not convinced we have a sufficient number of people in the HSE to deal with financial management. I ask the Minister to give priority to this point over the coming 12 months. We need to get value for money but this requires people with the necessary financial qualifications to ensure we get the maximum out of every euro we spend in order that the patient is the beneficiary. The theme of the Minister is that the patient comes first and it is pertinent that the taxpayer also gets value for money. The level of cover for the patient should not be diminished. I look forward to working with the Minister in the implementation of the Bill.