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

I welcome the opportunity to speak on this motion and in support of the Government amendment. The central objective of the Government's reform programme is to deliver a fair, efficient, single-tier health service supported by a strong primary care system and underpinned by universal health insurance. The latter will mean people are treated on their need; not what they can afford. The programme for Government sets out a clear pathway for the future development and strengthening of the services, notwithstanding the enormous financial challenges the Government inherited. Despite the challenges posed by reducing resources, it has already made significant advances in improving services and delivering on the commitments it made in the programme for Government. I will provide examples to give Members a flavour of how much things are changing. Earlier today, I stated there had been an improvement of 22% in the number of people who are obliged to wait on trolleys. I have just received the latest figures, which indicate a reduction of 23.8%. This is real and measurable and the people concerned are real.

I acknowledge there are still too many people lying on trolleys and we must and will do more. I mentioned earlier the reduction, from an all-time high of 569 patients on trolleys only last year in January 2011 to a figure of 139 on 7 September 2012, which is a 75% reduction. Overall surgical waiting list numbers have decreased in the last year by 7%, while each time band has seen a substantial reduction with those waiting more than 12 months down by 85%, those waiting over nine months down by 63% and those waiting more than three months down by 18%. In addition, I note there are 800 fewer children on waiting lists. There has been the establishment for the first time of a national office of clinical audit, NOCA, for surgery, critical care and orthopaedics. For the first time, the country now has 24 hour a day, seven days a week thrombolysis coverage, which means that all hospitals that receive stroke patients and treat them have a stroke unit. The statistics currently available indicate this is saving one life a week, as well as saving three other citizens from entering long-term care.

The average length of stay has reduced from 8.7 days to 7.9 days. The rate of readmission from heart failure has been reduced from 27% to 6.3%. A national education programme for asthma is now operational in primary and secondary care. Four 24 hour a day, seven days a week percutaneous coronary intervention, PCI, centres are in place to enable the percutaneous insertion of stents for acute heart attacks. This development is real and now means that someone who experiences a coronary occlusion - who previously would have had a heart attack and died - can be saved. Not alone can such a person be saved but instead of being a cardiac cripple lying in a bed for eight weeks, he or she will leave hospital after 48 hours. These are real achievements that affect the lives of citizens.

In the area of mental health, three significant programmes are being designed in areas such as self-harm and eating disorders. Moreover, an integrated care model for diabetes and other chronic diseases is being put in place. In emergency medicine, all 28 continuous improvement implementation teams are in place. Moreover, 30% more patients are being seen in dermatology and rheumatology clinics and national audiology screening of 99% of children within four weeks of birth is in place. There is much more, including the productive theatre initiative, the money-follows-the-patient initiatives, the change such clinical programmes have brought and the money this has saved in respect of bed-days saved. The savings amount to 70,000 bed-days, or ¤63 million, and there will be more this year. As part of the reform programme the Health Service Executive (Governance) Bill 2012 has been published and was debated in this Chamber earlier today. This provides for the abolition of the Health Service Executive, HSE, board and its replacement with a new directorate and governance structures. A director general-designate has been appointed and already is taking action to change and reform the system.

The Government's primary care strategy is one of the key pillars of the reform programme in health. The key objective of this strategy is to develop services in the community that will give people direct access to integrated multidisciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists and other health care disciplines. A modern, well-equipped primary care infrastructure is central to the effective functioning of primary care teams. The infrastructure development, through a combination of public and private investment, will facilitate the delivery of multidisciplinary primary health care and represents a tangible re-focusing of the health service to deliver care in the most appropriate and lowest cost setting. It is the intention of Government to develop as many centres as possible by one of three separate methods, namely, direct investment, that is, Exchequer-funded HSE construction, by way of leasing arrangements and through public private partnerships. The Minister for Public Expenditure and Reform, Deputy Howlin, announced the Government's ¤2.25 billion infrastructure stimulus package on 17 July. This will provide investment in a range of important new projects. The infrastructure stimulus package announced by the Government involved projects that would meet key infrastructural needs in line with the priorities identified in the Government's investment framework. They would form the first phase of a new programme of public private partnerships, PPPs, designed to stimulate economic growth and create employment. A total of 35 potential locations for primary care centres have been published. Of these, approximately 20 will be commissioned subject to agreement between the local GPs and the HSE on active local GP involvement in the centres - because otherwise one merely would be building empty palaces - and site suitability and availability. It is envisaged the locations will be offered to the market in two separate bundles. The current position is that the HSE is engaging with the National Development Finance Agency as required to progress the primary care centre public private partnership programme. The HSE is currently analysing the available sites in each location and engaging with the GPs in each location to determine their interest in participating in the primary care centre development.

I believe it is important to report on the progress achieved to date in the area of primary care. In order to achieve savings in health spending while also reforming and improving the health service, it is imperative that we develop new models of care. Primary care should be able to meet 90% to 95% of people's health needs and through modern and strengthened primary care, we can achieve much better health outcomes and much better value for money. I look forward to working with the Minister of State, Deputy Alex White, in ensuring we achieve this. In January, the universal primary care project, UPC, team was established to drive the implementation of the primary care reform. The projects overseen by the UPC team include policy, planning, costing and legislative preparation for the extension of free GP care and the preparation of legislation for this key reform is at an advanced stage. It also oversees the development of implementation plans for chronic disease management in primary care and preparation for a new GP contract to reflect the programme for Government commitments to universal free GP care and intensive chronic disease management. All this change, however, must take place in the context of a very difficult budgetary environment.

The HSE budget has been reduced by ¤2.5 billion over the last three years. The number of health service staff has fallen from a peak of 111,000 in 2007 to fewer than 103,000 now. As all Members are aware, the country still faces serious challenges in respect of the public finances. Further measures to address the deficit were submitted to the troika in July including accelerated cash collection from private insurance income, use of capital funding for revenue on a once-off basis, savings in 2012 from agreement with the pharmaceutical industry, additional once-off funding arising from an agreement with the Medical Defence Union and once-off transfers of funding from the Department's Vote.

Proposals for the achievement of additional savings of ¤130 million were announced by the HSE in August. Almost 50% of the savings are to be achieved from more focused cash and stock management initiatives, savings in medical equipment - non-capital, furniture, education, training, office expenses, travel and subsistence and advertising. The remaining 50% will be achieved through efficiencies in disability services, home help hours, home care packages, agency and overtime payments.

As Senators are aware, Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. The demand for home supports will increase in the light of changing demographics, needs and wider system pressures. This has obviously been a challenging year for the health services overall, including maintaining services in line with evolving resource pressures. Decisions in regard to the provision of home help hours will continue to be based on a review of individual needs, and no current recipient of the service who has an assessed need for this will be left without a service.

Ongoing reductions are being applied to HSE-funded disability services generally as part of the general Estimates reductions, with savings generated focusing mostly on consolidation and rationalisation of back office costs to protect front-line service delivery as much as possible. The HSE is continuing to examine options for savings from other sources to limit further the impact on front-line services.

In addition to undertaking measures to address the immediate position, the Department has been undertaking strategic measures to address the ongoing financial issues in the HSE. A review of the financial management systems in the Health Service Executive was commissioned in May. The review team came up with a number of recommendations to improve the financial management process within the HSE, and PA Consulting was engaged to draw up urgent measures to be put in place in regard to the HSE's financial management and processes having regard to the findings and recommendations of this review. It was also requested to stress test the HSE's July cost containment plans, analyse the effects of the plans on scheduled and unscheduled care and identify potential structural cost savings in the acute hospital sector. The consultants' report is due to be submitted to my Department shortly.

I would like to address some of the issues raised and comments made. Senator MacSharry spoke about me being downright irresponsible. I have to put it to him that there could be no greater example of downright irresponsibility than the throwing away of our financial sovereignty. The only stroke here is from the masters of strokes themselves who want to spin a good yarn to distract from the real issue which is the mess left by the previous Government which we must clean up, and in health, that mess is as big as anywhere.

There is also a contention that we have the same captain and we are just moving deckchairs on the Titanic. We have already had a long discussion in the House about a new director designate for the HSE.