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

As I was not at the committee I do not know what members were told. I can say this, as a Minister for Health and as one who practised medicine for 25 years, there is no way that I will remove clinical decision-making from the clinician. I will have counterbalances whereby other clinicians can challenge that decision-making but I certainly will not have somebody with a biro dictating what health care people get.

The Senator mentioned skin lesions and dermatology. In the drive towards primary care centres and more primary care teams, I see no reason these people would be referred away from primary care. They should have skin lesions removed in general practice - I did it myself. I identified three melanomas over a period of years. That should be encouraged rather than discouraged and should be done locally. If there is a lesion that proves to be of a serious nature clearly one has a valid reason for seeking an urgent appointment when one has got the histology back to prove the point.

In regard to matching of resources, the cystic fibrosis unit at St. Vincent's Hospital is not a matter for today's debate. I hear the concerns. There was an arrangement and I want to see it honoured. I want people who suffer from cystic fibrosis to have the same life expectancy as their cousins 40 miles up the road. A number of things have been done to address that issue, a key part of which is the unit at St. Vincent's Hospital. While the unit may attract clientele from other parts of the country because it is seen as a centre of excellence, nonetheless those beds must be available. I will certainly look into the issue to ensure that is happening. I had understood the matter had been resolved.

Senator Quinn mentioned the costs in the system. The costs are too high. I put it on the record here and elsewhere that we are focused on cutting the cost of service, not cutting the service. Of course, that relates to rosters and how people work and the new LRC arrangement with consultants which is being enforced and put in place is critically important. We now have consultants available five days out of any seven, not just Monday to Friday, and at night. This will lead to much quicker decision-making and a faster throughput for patients. As leaders in the health service, it gives a lead to the others who work in the service that they too must change their ways. The Senator mentioned the system in Singapore which is very different. I am not sure if we looked into it we would find huge disparities there. I subscribe to prevention being better than cure and early intervention being better than late intervention.

Senator Healy Eames raised the matter of shared decision making. That issue is being looked at, particularly in relation to new drugs. Dr. Barry White who has stood down as clinical director, and has been replaced by an excellent lady, Dr. Áine Carroll, is a haematologist and encouraged the Irish Haemophilia Society to enjoin with him and the HSE in dealing with the pharmaceutical industry in respect of the provision of drugs and have saved several million euro in recent years. That is just as an example. I am for more patient empowerment, more patient involvement and more advocacy group involvement. That is why the patient safety authority is so important. I am moving away from the Bill itself.