Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I am pleased to address Members of the Seanad on the HSE's National Service Plan 2015. I know that Members may also wish to discuss emergency department overcrowding and influenza. I am happy to update Members on both of these matters also. As the HSE service plan is now in operation, it is time that I update the House on the contents of the plan and my priorities for the health service this year. As this House is aware, the health service faces important challenges in 2015. We are dealing with immediate difficulties due to overcrowding in some emergency departments and more longer-term challenges, for example, our ageing population and an increasing incidence of chronic disease. I wish to outline how I intend to address both of these immediate and longer-term challenges.

All Members will recognise that the health service has been through seven very difficult years of retrenchment as a direct consequence of the financial crisis that the State had to address. In the period 2008-11, €1.5 billion was taken out of the health budget. This occurred under the last Government led by Fianna Fáil. Under the current Government, health spending has remained flat with a modest increase provided for in 2015. Nonetheless we are still trying to run a quality, modern health service with fewer staff, less money and more demands than we had seven years ago. Budget 2015 represented the first welcome step in reversing this prolonged spending freeze by increasing the funding available to the HSE - the first increase in seven years. As a result, the HSE has €635 million more to spend this year than it had budgeted for in 2014. This €635 million is made up of Exchequer funding of €305 million and projected one-off revenues of €330 million.

This funding increase is part of a two-year process to stabilise and improve health funding. The spending ceiling for health in 2016 has already been increased upwards by a further €174 million. Health funding for the first time since 2008 is going in the right direction. A minimum savings target of €130 million has been set in areas such as procurement, drug costs and agency costs in 2015. In a welcome development, any further savings that can be delivered over and above this target will go back into the delivery of the health and social care services and will not be used to reduce the deficit or the debt and that is important. The more realistic budget parameters of 2015 allow the HSE service plan to include a number of targeted enhancements to health and social care services by providing generally for existing levels of services. The service plan also progresses key elements of the health service reform programme.

Before I talk about the specifics of the 2015 service plan, I would like to update the House on the current position in overcrowding in our emergency departments and the number of patients who are waiting on trolleys.

I would again like to stress that my Department, the Health Service Executive and I regard the current situation as unacceptable. I am very much aware of the distress and hardship it causes for patients and their families. Many different factors contribute to overcrowding and trolley waits. Factors vary from hospital to hospital and this needs to be reflected in the measures taken by hospitals in response to the current difficulties they face. In all cases, however, effective local leadership, management and communication are of key importance in addressing overcrowding in emergency departments. Staff unions and management all have a role to play, as does the Government. I firmly believe that all of us involved in health service provision need to co-operate and work together to find solutions to this long-standing problem.

In response the immediate situation, hospitals are taking exceptional measures to reduce overcrowding and have invoked hospital escalation plans. These include the opening of additional overflow areas, curtailing non-emergency surgery, providing additional diagnostics, that is, easier access to scans and other tests, strengthening discharge planning and twice daily ward rounds. There has also been increased collaboration between hospitals and hospital groups to enable access to additional capacity, for example, opening a ward in Navan to relieve Drogheda.

These and other measures have resulted in improvements to the number of patients waiting on trolleys. I do not think I have today's figures in front of me. I think I printed off the wrong attachment. At 2 p.m. today, the number was 237 on trolleys, 143 of whom were there for more than nine hours. We expect the number to fall below 200 later on in the day but, inevitably, that will go up overnight. It will then go down during the day tomorrow. Those are not the figures I was looking for but I suppose they give Senators an idea of where we are. They are similar to this time last year and previous years so I suppose where we are is regarded as normal by Irish standards but should not be regarded as normal in my view. What we need to achieve this year is a new normal which is a much lower level of patients on trolleys than we have had in recent years.

Also impacting on emergency department overcrowding is the issue of delayed discharges of patients who no longer require acute care in hospitals. In late 2014, I provided additional funding to begin to address this issue. This has continued into 2015 with a further €25 million provided in the budget to fund additional fair deal, short stay and community nursing beds and home care packages. These measures are beginning to have an effect with the number of delayed discharges now at around 750 whereas it had been approximately 850 in September. I intend to keep this matter under careful and continual review in the weeks and months ahead.

Looking to the future, it is clear we need to come up with long-term sustainable solutions to emergency department overcrowding. The emergency department task force I convened before Christmas met again last week and had a very productive meeting, co-chaired by Tony O'Connell, the outgoing national hospitals director, and Liam Doran, who is general secretary of the Irish Nurses and Midwives Organisation. The essential elements of an action plan were discussed in detail. As intended, the action plan will be finalised by the end of January. It will set out immediate, medium and long-term solutions across the continuum of care to address emergency department issues, with a view to achieving a significant reduction in trolley waits over the course of 2015. The task force is scheduled to meet again in early February.

While on the matter, I do not want to lose sight of the contribution over time that better public health and well-being can make by helping to reduce demand for acute health services. The same applies to better primary care and social care - primary care so that people do not have to go into hospital as often and social care so that they can get out quicker. This year's service plan provides for the improvement of the health and well-being of the population as a whole through the continued implementation of the Healthy Ireland programme.

Many of the immediate problems with which the health services are currently grappling are caused by underlying structural issues which I am determined to tackle. While there is undoubtedly a strong case for increased funding in health in the years ahead, it is also important to acknowledge that as a demand-led sector, health will quickly absorb any funding provided. If we have learned anything from the Celtic tiger years, it is that providing more resources without reform simply does not work.

The continuation of the programme of health service reform is of critical importance. With this in mind, the HSE's 2015 service plan gives priority to progressing the Government's reform agenda. The 2015 service plan provides for the establishment of community healthcare organisations which will improve the way in which primary care is delivered in the community. This will enable better and easier access to services for patients, closer to home and in which patients can have confidence. Likewise, the reorganisation of public hospitals into hospital groups is designed to deliver improved outcomes for patients. Each group of hospitals will work together to provide acute care for patients in their area integrating with community and primary care. The objective is to maximise the amount of care delivered locally while ensuring that specialist and complex care is safely provided in specialist centres and larger hospitals. The priority in 2015 will be to get the seven hospital groups up and running and to agree a strategic plan for each one.

The HSE will further implement activity based funding on a phased basis this year. Under this funding model, hospitals are paid for the quantum and quality of services they deliver. This, I believe, will drive efficiency and, hopefully, increase transparency.

I also want to highlight the work of the national clinical programmes as an example of clinical leadership. They have already greatly improved services in many specialised areas, such as stroke and cardiac services. The service plan foresees the development of the national clinical programmes into five integrated care programmes, dealing with patient flow, older persons, chronic disease, children's health and maternal health, and will improve the integration of services, access and outcomes for patients generally.

As I mentioned earlier, the 2015 service plan, provides for the delivery of an existing level of services, with targeted enhancements in some areas. One of the service enhancements is the commencement of the extension of the BreastCheck screening programme to women aged 65 to 69 years of age. Screening of these women will commence towards the end of 2015 and will be expanded on a phased basis. The additional eligible population is approximately 100,000 and when fully implemented 540,000 women will be included.

The 2015 service plan also provides for the implementation of the first two phases of a universal GP service, making available a GP service without fees to all children under six years and everyone over 70 years. The aim is to have universal GP care without fees for children under six years implemented in the first few months of this year, subject to the conclusion of discussions with the Irish Medical Organisation and the successful completion of a fee-setting process. Signing up, of course, will be optional for GPs. The over 70s will be facilitated under the existing contract once the relevant legislation has been passed by the Oireachtas. With the co-operation of the House we hope to have that done in the first quarter of this year. By the end of 2015, almost half of the population will have access to their general practitioner, without charges, for the first time. That is a major and concrete step on the road to universal healthcare.

The service plan also provides an additional €30 million to fund new hepatitis C drugs in 2015. This has the potential to bring major benefits for patients with serious illness as a result of hepatitis C. We are ahead of many other countries in making these medicines available. As with other countries, Ireland must ensure that access to high-cost treatments such as these is managed. We must prioritise access for patients who can benefit most, while also ensuring that the financing model is sustainable and affordable. Our aim is to provide access for as many patients as possible given the resources provided by taxpayers. An early access programme for over 100 patients with the greatest need for these new drugs is already in place.

Budget 2015 provides an additional €35 million in ring-fenced funding for mental health, bringing to €125 million the total investment by the Government in mental health services since 2012. The additional funding will enable the HSE to continue to develop and modernise our mental health services in line with A Vision for Change. This includes the ongoing development and reconfiguration of general adult teams, including psychiatry of later life, and also child and adolescent community mental health teams, along with other specialist mental health services. This will be delivered through further recruitment and investment in agencies and services in order to achieve consistent provision of quality services across all areas. The funding will also permit urgent specialist needs to be addressed, including services for those with mental illness and an intellectual disability, suicide prevention services, psychiatric liaison services, and addressing the gap for low secure acute care and rehabilitation services to service users with complex needs.

A number of measures will be taken in 2015 to further develop primary care services and allow more people to receive a wide range of quality services in their own community. An additional €14 million is being provided in 2015 for primary care developments, including the extension of the pilot ultrasound GP access so that GPs can get ultrasounds for patients, particularly in the southern part of the country, without having to refer them to hospital and also the provision of a minor surgery services pilot in about 30 GPs practices and primary care centres, thus enabling 30 GPs around the country to perform minor operations which are normally done in hospitals. There will also be extension of GP out-of-hours services, within existing resources, to areas currently not covered, particularly urban areas, and more spending on community orthodontic and ophthalmic services. Some €1 million in additional funding is being provided for each of those in an effort to significantly reduce or eliminate the children's ophthalmic services waiting list in Dublin and also reduce waiting times for orthodontic treatment around the country. Additional funding of €2 million is also being provided to improve maternity services, although how that is to be deployed has to be determined.

Patient safety will, of course, remain an overriding priority across the health service in 2015 and this is reflected in the plan. The HSE has redesigned its national quality and patient safety function and has established a quality and patient safety enablement programme. The overall goal of this programme is to improve the quality of services with measurable benefits for patients and service users. Priority areas that were identified in last year's service plan will continue to be the focus of attention and include medication safety, healthcare associated infections and the implementation of the national early warning score. In addition, the process for identifying, reporting on and following up on serious reportable events, SREs, has been strengthened.

The Health Identifiers Act 2014 provides the legislative framework for a national system of unique identifiers for patients and health service providers for use across the health service, both public and private. Individual health identifiers are primarily a patient safety tool and are designed to ensure that the right information is associated with the right patient at the right point of care. It is rather like a PPS number for health. In addition, identifiers will help make our health service more efficient and will support health reform initiatives, including the activity based funding model I spoke of earlier. Health identifiers are a fundamental building block in support of the e-Health agenda. The HSE will develop and implement the individual health identifier on a phased basis starting in 2015.

Every employer's greatest resource is its workforce and, with this in mind, a priority highlighted in the service plan is the development by the HSE of a workforce plan to ensure that staff are motivated and retain good levels of job satisfaction while delivering effective and compassionate care. The HSE will have more autonomy and discretion to manage staffing levels within its overall pay framework in 2015. This should greatly assist in reducing reliance on agency staff which is very costly and is one of the key priorities for the HSE in 2015.

With greater autonomy and greater capacity to utilise any further savings achieved within the health service comes an even greater responsibility for cost containment and cost avoidance. The HSE has, therefore, put in place a considerably enhanced governance and accountability framework for 2015. This is set out in detail in the service plan. The framework provides the means by which the HSE, hospital groups and community health organisations and other units, will be held to account throughout the year for their efficiency and control across the balanced scorecard of access to services, patient safety, finance and human resources.

There are enormous demands and cost pressures on our health service. Healthcare demand continues to rise due to our growing and ageing population, the increasing incidence of chronic conditions and advances in medical technologies and treatments. Health systems all around the world are struggling with this issue of rising costs. Against this backdrop, I am aware of the limitations as to what can be achieved with the funding available for this

year. Clearly, we do not have sufficient funds to address all areas of concern or all the priorities we would like to address across the health sector immediately. However, what we have been able to do in this year's HSE service plan is to make a start, an important start, towards the restoration of stability to the health service and its budget. The modest increase in resources being provided in 2015 and reflected in the service plan is the first step in a two-year process to stabilise the health budget. My focus is now on assisting and supporting the HSE management and staff in achieving the service delivery and patient safety and quality targets set out in its service plan.