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

I thank all the Senators for their contributions while accepting that some are taking advantage of my presence to raise matters unrelated to the issue under discussion. In response to Senator MacSharry, I will certainly ask the Department to examine the situation. When will licensing be introduced? I have discussed the issue on a number of occasions with the chief medical officer. There is a huge amount of legislation going through the Department at present. Licensing is quite complex. I am very concerned that we do not have a licensing system for private hospitals in particular and our citizens need to be protected. There are other means of intervening and that has happened in the past when there has been trouble and problems but I would much prefer a much more straightforward licensing system and certainly I hope that will be done in the next 18 months.

To whom will the hospital groups report? Each hospital group will have its board. Each hospital will have to report to its board and those boards will have to report to the Department and the health care agency that replaces the HSE. The Senator was particularly concerned about Sligo and Letterkenny hospitals within the context of the Galway group. I can understand that given where he comes from and his constituency but one of the reasons these groups have found so much acceptance and have landed so well with the people is that they have seen them in operation and they have seen Galway deliver. When Mr. Bill Maher took up position? There were 9,901 people waiting nine months or longer for an inpatient service. By last September everyone of them was treated. At the time there were regularly 40 to 50 people on trolleys with an average of 27 on trolleys; the average is now seven people on trolleys. That is still too many and we will do more to address the issue.

In relation to Roscommon hospital, there is grave concern over the change from an emergency department to an urgent care centre and what that would mean for the future security of that hospital. That issue has been more than addressed. I said in my address that it is a key performance indicator for the new management and a bar they have to cross in terms of proving their fitness to go to trust status that they have devolved resources out to the smaller hospitals. Specifically for Roscommon hospital, that means a rheumatology service, a phlebotomy clinic and plastic surgery which it never had previously. Louth hospital has a coloscopy clinic and a range of other services it did not have previously. There is a menu of about 40 procedures that can be carried out with absolute safety in smaller hospitals. It is up to each group with parity of esteem to come to a decision on what services each hospital should provide.

I want to make a general point which cuts across what many people spoke about, namely, the principle of the money follows the patient. Money follows the patient is coming in on a shadow basis this year and on a full basis next year. It will drive the group and its CEO to ensure the service is provided at the most cost-effective place and that will be the smaller hospitals because they have less overheads. Perhaps I can give examples. There are people from Connemara who are happy to go to Roscommon hospital for their procedures because they can get them done quicker in a nice pleasant environment where there is not the same sense of chaotic activity that sometimes can be the case in a larger model 3 or model 4 hospital.

When I visited Ennis hospital where I opened the 50 bed unit, I met a young lady from Limerick who was there for a procedure and was delighted to be there.

As people start to experience the new services they will be very happy to travel.

I want to get through the issues quickly, if I can. Delivery of service is a key performance indicator and drives the CEO of the group to make sure that services are delivered in the most cost-effective place. Obviously the lower the overheads then the more cost-effective a place is. The transfer of resources is an issue.

Senator MacSharry mentioned the health service relationship between the north-west region and the North of Ireland. Real and tangible things are happening in the region. The Government has invested €19 million in radiotherapy services at Altnagelvin Hospital. Advanced progress has been made regarding the discussion on a helicopter service. There is no helicopter service in the North but there is one in the South. If we expanded the service to Donegal, parts of Sligo, etc., then the North could justify having a helicopter service and we could move our service down as far as the most southerly tip of the country. We are exploring the initiative and a range of other issues with our northern counterparts.

We will sign up to a paediatric all-island cardiac surgery service. A single team of surgeons, comprising people from Belfast and Dublin, will operate at both sites. The more complex work will be carried out at Our Lady's Hospital, Crumlin, and the less complex work will be carried out in Belfast. The service will be available to people in Donegal, Sligo and along the Border. It will be much more convenient for people in the region to bring their children to Belfast rather than Dublin. We have real co-operation and synergy with our northern counterparts that benefits the health of people living on both sides of the Border. However, we all know that health and illness do not respect borders and politics. Once we have the helicopter service in place it will allow access to cardiac stenting 24-7 for people in the north west. The region does not have the service at present.

It would be wrong of me to allow Senators to leave here with the impression that Professor Higgins, or any other medic, suggested that the future of the health service was contingent on us building better roads. That is clearly not the case. The clinical programmes and the different way that we conduct business is proof of that.

Several Senators raised the issue of recruitment. The hospital groups have gone a long way to address the matter and other issues. Let me explain. Doctors and other staff like it shown on their curriculum vitae that they have worked at a teaching hospital. We do not have many teaching hospitals. The hospitals have grave difficulty attracting and retaining the best clinical staff due to their location and not being a teaching hospital. Now that each hospital group has a strong academic partner and an academic officer will be on the executive management of a board, a strong association can be made with research and innovation.

I will take this opportunity to send a message. As I travelled around the country I implored all of my people who work in the health service to do the same. Too often, government and others, have considered health to be a drain on resources. Health is a resource and a healthy workforce means a healthy economy. The scale and size of hospital groups along with their strong academic partner means that they will become very attractive to international and national partners for research in terms of medicine, new medical devices and new methods for delivering care. Dr. Susan O'Reilly, director of the national cancer control programme, HSE, has stated that an improved management and organisation can also improve outcomes for patients by up to 10%. We have a wonderful opportunity here on a host of levels. Health is a resource that can deliver in terms of the economy and that is how it must be viewed. I shall return to the matter at the end of the debate.