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

I thank the Leader for the extra time. I have addressed Senator Keane's concern about a shift of power, money and resources to the centre. As I have said, the initiative is a key performance indicator but I accept that everybody here shares her concern. Professor Higgins has made it very clear that the resources is one of the major parameters to judge whether a hospital group is suitable to change to trust status. The money follows the patient is a further measure that drives the initiative.

Senator Crown is troubled by the new administrative management arrangements and I shall discuss them in a moment. However, there will be competition for national and regional management services. Cost comparisons will be made between trusts. For example, how much will it cost to treat a patient with a hernia at a trust hospital. There is no reason for procedures to be more expensive for the Dublin east group than the south-south west group.

Quality of service is critically important and the new patient safety authority will be very important in this regard. The authority will provide patients with somewhere where their complaint will be listened to and it will act as a patient advocate. As I have said often, it has been my experience as a doctor that nine times out of ten people want an acknowledgement that something went wrong, an apology for it going wrong and an assurance that it will not happen again because things will be changed. With the current system everyone pulls down the shutters leaving patients utterly frustrated and having to resort to litigation. The issue then takes on a life of its own. That is very wrong. A third of compensation for medical legal claims goes to the legal profession. I have nothing against the legal profession but the money should go to the people who have been harmed.

Senator Crown raised an issue about using the term "trust". Let us examine what happens with trusts based in the UK, even though that may make the Senator a bit nervous. We have looked to the North of Ireland for information on special delivery units, to Denmark and Canada for patient safety and to Holland and Germany for how to deliver health care using a multiple insurer model. I heard what the Senator said about the Mid-Staffordshire hospital and health district. That is why it is so important that key performance and quality indicators are not just box ticking exercises. They must be real measurable markers for better outcomes for patients.

I agree with the point the Senator made about leadership. We need leadership in medicine and we are getting it through the new clinical programmes. We need leadership in nursing and we are getting that as well. A new chief nursing officer has been appointed an assistant general secretary, the highest level in the Department. The appointment is long overdue. There have been chief nursing officers before but not at the new level. Over 37,000 nurses work in the health service and they must be represented at the top table as the health service evolves and reforms.

I must talk about managers here because Ireland has not had the required skillset. Administrators, many of whom are excellent people, have been promoted into management positions without being given the training or skillset to do the job. Let us compare that with doctors and consultants. It costs about €1 million to progress from pre-med to consultant level. A person is supported during the time in terms of studying and continuing professional development. Even when a person becomes a consultant development is still catered for and encouraged by the tax system. What is given to managers? They are just left there. They do not receive that type of support but we need it. Equally, six hospital groups will provide us with the level of management expertise that we need and it will grow a new management beneath. Last year the SDU provided funding to support and train managers. Thirty people have availed of the initiative and 30 more people will be aided this year. However, we need to do more. We will continue to examine the programme. As I have pointed out, the management and organisation of the health service is critically important in terms of outcomes for patients.

Senator Crown expressed his concern about the health information Bill. The legislation is critically important in terms of developing the health service, public health initiatives and screening, etc. I am quite prepared to listen to his concern about the legislation.

Senator Moloney talked about improvements at Kerry General Hospital. That reminds me of something. I cannot address the health issue here without mentioning the real and measurable improvements that have taken place despite the loss of 10,000 staff and the €16 billion budget for the health service being reduced by €3 billion. We have also managed to reduce the number of people who must endure long waiting times on trolleys by 24%. There are still too many people on trolleys but we are working on the problem. We met the one-year target in the first year. In other words, nobody will wait longer than a year for inpatient treatment. We met the nine month target last year and we will meet the eight month target this year. The waiting times are still too long but we are working on the problem.

We have reduced by 95% the number of people who are waiting longer than 13 weeks for an endoscopy and the number of children who must wait for 20 weeks or longer for an inpatient procedure has also been reduced by 95%. These are real, measurable and provable. I am not afraid and nor is my Department of the truth or of putting it out there. This is the reason that for the first time, the current Administration has measured the number of people who are waiting for an outpatient procedure. As Senator Moloney mentioned, it is not that 386,000 people are waiting for an outpatient appointment that is the true scandal here. The true scandal is that more than 16,000 people have been waiting for longer than four years. That is utterly unacceptable and I have given an undertaking that this problem will be tackled in the same way as were the other problems, which is that when the urgent cases and cancer cases have been dealt with first, the longest waiters will be dealt with thereafter and no one should be waiting for longer than one year by the end of 2013. I accept this is still too long but we must start and continue from a starting point that is realistic and we will continue to do that.

Senator Moloney was also concerned about the recruitment of non-consultant hospital doctors, NCHDs, and the number of consultants being appointed - I believe Senator Mary Ann O'Brien also raised that issue - and the issue of long-stay care. The nursing home supports scheme is visible and because it is a pot of money, people head for resources. We have discussed this issue in the Department and elsewhere and we must have more choice available to people before they enter long-term care. It should not be a case of hospital, home help and long-term care. While we need home help and home care packages, we also need supported sheltered housing and tiered support. I know of particular facilities in the south east, where some people come, stay the day and then go home at night, while others arrive and stay the night and then go home during the day. We must address people's needs and not dictate the service on the basis of what is available. Moreover, we must inform ourselves of what are people's needs and we are doing that. We will have a much greater and broader range of services - with funding. However, as we only have a limited amount of funding, that funding must come back from long-stay care to pay for these other, more cost-effective and, I believe, better facilities. I know of no one who wishes to be in long-term care a day before it is necessary to be there.

Senator Mary Ann O'Brien was concerned about the reduction of salary for consultants about which I wish to make the following point. The new consultant starting salary level is €116,000 to €121,000. While it is all very well to compare this with the salaries that obtain in the United States of America or somewhere like that, why not simply look up the road to the North of Ireland or across the pond to the United Kingdom, where the starting salary for a consultant is £80,000, which is less than €100,000? As a doctor, an Irishman, an Irish citizen and a republican, I believe it is not simply money that binds our people to our country and I believe we pay well. I also believe we have a huge problem regarding the cost of insurance in Ireland. For example, we are paying the same sort of money for procedures that used to take two hours but which now take 20 minutes. I will give Members a classic example without mentioning any names. It concerns a particular individual, who complained that he could do only nine procedures all week in the public system but could get ten done on a Saturday. However, he neglected to mention that he gets €800 a pop, which comes to €400,000 per year for a one-day week. Consequently, there are serious issues to be addressed in respect of the problems around this matter. I am not in the game of haranguing consultants because they do phenomenal work. They are extremely well trained, work extraordinarily hard to get to where they are and must be remunerated properly. However, this must be done in a transparent way that is fair because if one spends a lot of money on one thing, it means one has less money for something else. In the past, some doctors would prescribe drugs the cost of which was not their concern. However, that cannot be the way any more because there is only a single pot of money. If one prescribes something that is hugely expensive on one side, one will deprive several people on the other side of some other service, perhaps a life saving one.

As for the issues pertaining to recruitment and career paths, much of this has to do with the nonsense of giving people six-month contracts. In the main, these are young married men and women with families but who have no certainty. They spend six months in one place but do not know where they will be six months later. They should be given three or four-year contracts and I wish to discuss that with the organisations concerned that represent them and with those who are involved. Equally, however, it also relates to the lack of respect that has been shown to NCHDs. Moreover, some of that lack of respect has come from senior doctors. I refer to scenarios in which people are advised that while their contracts provide they work on a nine-to-five basis, which is what they get paid for, they had better be in attendance by 7 a.m. and had better be prepared to stay until 7 p.m. if needed, because otherwise they will not get a reference. I know this has happened. Doctors are people and will not wear that. While they will take the hit for the six months for which they are caught, thereafter they will be gone. Many of these factors are influencing this problem, as does the issue of the clear career path. One should be able to come into a hospital and if one does one's work and if one qualifies through the exams, one should then come out as a specialist - end of story. While one may not get a consultant job, one is a specialist and is recognised as such. At present, however, that does not happen. One does not tend to be a specialist until one is given a consultant post. I want all these issues to be addressed and I want the people to be treated with respect. Moreover, one of course should encourage people to go abroad to finish their training. My point is not that I expect a consultant who has worked for ten years abroad as a professor of cardiology to return here and start on a salary of €121,000. While that is not the case, it is not a bad starting point for a doctor who has just finished his or her training and is now a specialist. I think it compares favourably with many countries in Europe.

I agree with Senator Cummins's comments and have covered the issues regarding the recruitment problem, salary and career path. As for the universal health insurance building blocks, the Senator is absolutely correct but I do not think time will allow me to go into the subject in the manner he would wish. I undertake to revert to him on it.