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

I thank the Senators for their comments and questions and I will address some of the issues they raised. Perhaps I will start with Senator Ó Clochartaigh, who referred to fewer long-term care beds being available for lay discharges, as if such were the only solution for someone who did not necessarily need long-term care in a nursing home as we understand it, but more home care packages and a tiered approach to supported accommodation, which is something we are developing with a number of NGOs.

The Senator discussed the psychiatric nursing situation in Galway. We are implementing A Vision for Change, which is something with which all sides of the House agree. The Lower House did not divide on this issue last night. That strategy requires a change in the model of care, but at the core of everything we are doing is the fact that the basis of any measurement must be better outcomes for patients. It does not matter how nice a scheme is or how well built a building is. If the net result is not better outcomes for patients, it is all for naught.

The Senator also mentioned the issue of the number of children who are still being admitted to adult facilities. This is something that is not acceptable and we have been working hard on it. Although the number has reduced year on year, it is still happening. We want to reach a point at which no person under 18 years of age is admitted to an adult psychiatric unit.

Senator MacSharry stated that the review of maternity services had not yet started, but it has. A literature review of best international practice has been commissioned and is due to be completed by the end of this month. The HSE's review of services across all maternity units is due to be completed shortly and will feed into the process as well. That will inform the maternity services strategy, which should be finalised by the end of the year.

I agree with many of Senator Barrett's points. I accept that he has had to leave but, on the subject of admitting past mistakes, I have told him that we all make mistakes. In fact, the old saying that the man who never made a mistake never made anything at all is quite true.

Regarding changes in legislation on consultative forums, this Bill deals solely with the Vote arrangements and is not an appropriate vehicle for making consultative reforms. However, there is no doubt that there is a deficit in the democratic process arising out of the formation of the HSE. This must be addressed by giving the forums a real input. I decried the passing of the health boards. I was a member of one, although I was not involved in politics at the time. I wore a different hat entirely, but I was concerned about the loss of the democratic input.

The designation of the Minister for Public Expenditure and Reform will be changed by legislation.

Issues were raised concerning finances. Senator Gilroy comprehensively dealt with the fact that, for 14 of the past 17 years, the HSE and the Department of Health have incurred overruns. This is a difficulty with a demand-led service.

Senator MacSharry raised a number of other issues, but I agree with him about the HSE having been a disaster, but one of Fianna Fáil and its current leader's creation. I do not blame the people who work in the structure but those who put a structure in place that has resulted in significant frustration for those who work on the front line, have been trained to deliver excellence and are only too willing and able to do so. They have been frustrated by a monolithic structure of command and control that has removed the innovative ability of the front line to think on its feet. The arrival of the special delivery unit, SDU, which engaged with the front line in a meaningful way, has allowed for a resurgence of that innovation. Despite the loss of €3.3 billion, or more than 20%, from our budget, a reduction of 14,000, or more than 10%, in our staff, and an 8% growth in population since 2008, we have been able not only to maintain the service but to improve it in a verifiable, open and transparent way. The numbers from the Irish Nurses and Midwives Organisation, INMO, show this. Trolley counts were down 34% in the first three years and a further 7% this year, despite all of the challenges that we face. I pay tribute to and express my gratitude and that of the Government for the people working in the health service and the great job they do on a daily basis.

To err is to be human. As the airline industry does, we want to build proper systems that protect patients from the inevitability of errors. However, there is a major difference between the airline industry and health services. An airline can cancel a flight, but we cannot cancel an operation when a patient is on the table without him or her dying.

Several Senators raised the issue of manpower. I am pleased to report that I met Professor Brian MacCraith just before attending the Seanad. His third and final report is ready and we will publish it on Monday. It represents a great deal of work done by him and his team. I pay tribute to them, as this issue has been lying around for 30 years across successive Administrations. Like everything else in our health service, manpower has been allowed to evolve chaotically. We are setting a clear career path for young doctors and allowing a clear understanding of where demand will be when they enter training programmes. Proper training programmes will now be more reflective of international norms, without making doctors wait 12 years to become specialists when it only takes six years elsewhere. To those who claim this is too short a time, I say it is not. Even after 12 years, no one expects a brand new consultant to be as experienced as someone who has been there for 20 years. This is self-evident in any walk of life. People's progression will be supported. We need more mentoring of young doctors so that they can be advised on the paths they might take instead of being left to wonder how to make progress.

I thank Senators for taking part in this debate. I re-emphasise the Government's commitment to the health reform programme as set out in the programme for Government. The Bill will implement one of the commitments contained in that programme. While it is largely technical legislation and, as Senator Crown stated, only a small step on a long road, it is still part of a process that is designed to give people the health service they not only deserve but have paid for. It will be a single-tier service in which people will be treated on the basis of medical need, not on the basis of what they can pay, and, if I may say this to the Senators across the floor, one under which all Irish citizens will be happy to be treated in this country and will not need to go abroad.