James Reilly (Dublin North, Fine Gael) | Oireachtas source

I thank the Chair and will be grateful for his protection.

Now we do not just measure the number of patients on trolleys at 8 a.m. with the INMO, we measure the number again at 2 p.m. and again at 8 p.m. in order that we can now predict a pattern and know at 8 p.m. the night before if we will be in trouble the next morning and can take corrective action. That is why, although many people had their hearts in their mouths when I said it, there will never be 569 people again on trolleys. I can never say that absolutely because there could be a catastrophe that might result in that but in the ordinary run of things that does not happen. Today there are 100 fewer people on trolleys than this time last year.

We now have put in place a system that can predict. For example, we have put in place a system for inpatient procedures whereby people are prioritised, once the urgent and cancer cases are looked after, on the basis of the duration of time they have been waiting. Moreover, in respect of outpatient figures, it is utterly disingenuous to state they have increased since last April. They were never counted before in this country and the figures never were available. Last April, we only had to hand half the figures and while we now have nearly all of them, they still are not complete. The current figure is 340,000, which ultimately may rise to 360,000.

However, I wish to assure Members about a matter that must be put into perspective. I have been told the outpatient services see approximately 200,000 people each month. If one is to believe some figures that have been given to me today to the effect that 3.5 million people were seen last year as outpatients, that monthly figure obviously is higher at 300,000 people. It is a problem that, when one first looks at it, is quite shocking. However, it can be addressed and the Government is determined to address it. I have stated in the past and repeat that I will put my neck on the block whereby my aim is that by the end of next year, 2013, no one will be waiting longer than a year for an outpatient appointment. Some 16,800 people have been waiting longer than four years for an outpatient appointment. This is an absolute disgrace and a cause of considerable concern to me.

Senator Colm Burke mentioned an instance of the non-appointment of a consultant. If he provides me with the details, I certainly will investigate it. The issue concerning non-consultant hospital doctor, NCHD, planning is ongoing. The Senator is dead right that many excellent people work in the HSE and I have always made that point. However, I always have complained about the lack of proper management, transparency, accountability and fairness. One must start at the beginning in that one must have transparency and one then can have accountability. When one has accountability, one may get fairness. Senator Burke mentioned the cost of drugs and this issue must be addressed. I am happy to state we are well advanced with our negotiations with the Irish Pharmaceutical Healthcare Association, IPHA, and hope to conclude them by the end of this week. I hate to say they will conclude because one never knows what could happen in negotiations. However, we are making good progress and I am quite confident that I will have good news on that deal in the short term. Another issue that arises with regard to the cost of drugs is drug reference pricing and the cost of generic drugs in this country. One need only go up the road to Newry, where one can buy some drugs generically at one tenth of the price we pay down here. Drug reference pricing will address this issue and as Members are aware the Health (Pricing and Supply of Medical Goods) Bill 2012 received support in this House just before the summer break, from where it will pass into the Dáil and become law very quickly. I already have mentioned how significant numbers in respect of financial expertise will be put into the system and I will have a definitive announcement in this regard in a couple of weeks time.

Senator Gilroy made the valid point that before the HSE was formed, there were approximately 13 grade eight staff in the system but by the time the Government came to power, there were more than 700 such posts. An explosion is not the word for it. I thank Senator Crown for his supportive comments. I can tell him I have no intention of being captured by the bureaucracy. I could not agree with him more regarding the employment of consultants by Comhairle na nOspidéal. I wish to devolve down to the managers of the hospital groups control over their budgets and control over recruitment of doctors and nurses. This must be their decision. There is very little point in giving them responsibility unless they are given authority and they know what they need by consulting on the ground where they are delivering care. I must refer to the example of Mr. Bill Maher in Galway. When he took over the hospital, had they not started to attack the waiting list, there would have been 9,901 people waiting for longer than one year for treatment. When I last spoke to him two weeks ago, that figure was down to 720 and he stated it would be 500 by last Thursday. This is a hell of an achievement and shows what can be done. However, Bill Maher did not do that on his own. He acknowledges he did this with the co-operation of the clinical directors, the nursing directors, the front line staff and everyone with a focus to put the patient first and to be fair.

Senator Crown spoke about the current funding system and I agree it is utterly bonkers and made that point in opposition. I refer to the idea that one gives a block budget to a hospital and that when the money is all gone, everything stops and the only people who suffer are the patients. Furthermore, there is a perverse incentive to leave lying on a bed a patient who has finished his or her acute phase of treatment because he or she only costs one grand a day, as opposed to taking in an acutely ill patient who could cost five grand a day. On a fixed budget, one simply does not do it. However, under a money-follows-the-patient system, one will do it because if there is no patient, one will not get paid. The new arrangements with consultants will mean they are available 24 hours a day, seven days a week, 365 days a year on five-day rosters, including night work. This means there will be a senior clinician in the hospital at all times. Senior clinicians are known to make more decisions more quickly with fewer tests. Consequently, this will save money and will put people through the system much more quickly. When I referred to the clinical programmes last year saving 70,000 days at a putative saving of ¤63 million, the point is not about the ¤63 million but about how more patients were treated more quickly and that is what it must be about, namely, the patient.

I do not want Senator Crown to preside over a system in which any man or woman working therein is afraid to speak out. However, neither will I preside over a system in which people can use their professional status to give a skewed version of what is happening to speak to their own vested interest. While I will encourage people to speak out, I will have others who would be prepared to speak against them from the same area of expertise. If they are telling the truth, the truth will be seen by the people but if they are telling a little yarn simply to further their own agenda, so be it as that will be found out too. I believe that to be fair and I hope Members agree. I want doctors to talk to doctors and nurses to talk to nurses. Senator Crown spoke of new management and clinical leaders and I believe that is of critical importance. It is hugely important to have clinical leaders with management responsibility and authority. As I stated previously, the success of the special delivery unit, SDU, is based on the fact that for the first time, those on the front line believe they are being listened to. Their ideas are assessed and if they look good, and make sense from a financial point of view, they are implemented and if they do not, they are not. In the case where there is a doubt about the idea, one should go back and revisit it. The Dutch model has been much talked about. I always have made clear that we take certain things from the Dutch model. However, we take ideas from Denmark on patient safety, from the United Kingdom on the trust model for hospital groups and from Northern Ireland the example of the SDU.

I take, in particular, the point Senator Crown made, also made by Senator Barrett, about doctors over-doctoring VHI. VHI now has new leadership in the form of a new chairman and a new chief executive officer with a remit to reduce costs and to bring in proper audit. I am sure all Members have heard anecdotal stories about people who were billed for procedures they had never had carried out or certainly were not aware they had carried out but for which the company would pay anyway. In addition, they have a remit for something that never was undertaken previously in VHI, namely, clinical audit. A cardiologist will ask the relevant cardiologist the reason he or she did something and if it was not necessary or clinically indicated, the company will not pay for it.