Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister to the House. This Bill is another step in the reform programme, as the Minister has outlined. It clearly sets out the manner in which we are bringing the budget back under the control of the Department of Health under the Minister. This is the right decision in moving forward in how we manage our health service. In view of what has occurred in the health service over the past 15 years and how we let many things go unplanned, this has resulted in a huge cost issue. This Bill deals with the requirement for the amendment of the legislation but it also provides that there will be proper procedures in place to ensure that the people who work within the HSE structure are accountable directly to the Minister and to the Department. Section 8 is important in that it amends section 31 of Act, which provides for the executive to prepare and submit a service plan to the Minister for his or her approval. The section providing for the amendment requires the HSE to submit the service plan 21 days after receiving notification of its net determination from the Minister. There are timelines set out in respect of the service plan and it is a matter of working over the following 12 months within that service plan and delivering the health care that is required. With regard to the health care budget, we have a major problem in understanding that the money we spend on health care is not Government money but taxpayers' money, and currently it is costing the Irish taxpayer, on average, approximately €254 million per week.

That is a huge amount of money and, obviously, will have to be carefully managed. In the period 2000 to 2010, no matter what occurred, we appear to have accepted what was submitted by the old health boards and later the HSE. In all those years the HSE has not stayed within budget. The budget must be looked at in the context of the amount of money that is being spent. The HSE has a budget of €13.2 billion to maintain services for a very large number of people. People think about accident and emergency services only if they have to attend them, yet attendances exceed a million per annum. In the past three years, day case procedures have increased from 650,000 to more than 850,000 per annum. That is a huge increase in the services provided.

We focus a great deal on expenditure in the HSE but not nearly enough on the delivery of health services. It is easy to complain when one item of medical care goes wrong. Everyone believes that no mistakes should be made, but given the volume of work, a very good health care service is being delivered. While we may have criticisms, and it is right that we continue to seek perfection, that is not easy to achieve, but much progress is being made in getting value for money. In recent years the budget has been reduced by more than €3 billion, yet the number of day case procedures has increased from 650,000 to more than 850,000 in this short period.

It is interesting to note that more than 130 submissions have been made in respect of the White Paper on universal health care. It is important to examine those submissions and take on board any constructive criticism to ensure a comprehensive plan is delivered with regard to how we manage health services into the future. We can look at other countries and the mistakes made there to ensure we do not make the same mistakes.

An area I have focused on in recent years is how to move forward with the recruitment of medical personnel and how to manage those working in administration in the HSE. I am concerned that positions for administrative staff are being filled internally without being advertised. Initially the positions are filled temporarily because the vacancy has arisen, whether it is at grade 5, grade 6 or grade 7. I ask whether that is the best way of building a comprehensive administrative section in the HSE. I do not believe it is. The issue needs to be examined carefully to ensure the right people are appointed to the right places and to ensure we do not have a scenario whereby somebody ends up in a position for which he or she is not suitably qualified. Likewise, we should not allow that to happen in respect of medical personnel. The Minister's decision to set up a working group, chaired by Professor Brian MacCraith, to carry out a strategic review of medical training and career structure is welcome. Its two reports were published in December 2013 and April 2014. When set up, the hospital groups need to be fast-tracked.

Of the 4,900 non-consultant hospital doctors, NCHDs, more than 54% are not Irish graduates, and the percentage is increasing. Also, a large number of our medical consultants are not Irish graduates. As taxpayers, we are spending large amounts of money on medical education and it is important that there is a return on that expenditure. We must ensure that those we assist through college with medical qualifications are involved in the future development of our health service.

Overall, I welcome the Bill. It is an important step. It deals with an issue on which much work has been done in the past three years, but much remains to be done to reach the target of universal health care. I thank the Minister for introducing the Bill.