Tuesday, 21 June 2016
I congratulate the Leas-Chathaoirleach on his elevation to even higher office.
I am delighted to speak in the Seanad about my priorities for health and advancing the programme for partnership Government commitments in the first 100 days. I will be here for most of this debate which will allow me hear the priorities of Senators. My colleague, the Minister of State, Deputy Marcella Corcoran Kennedy, who is leading the public health promotion section of the Department, will join the debate later and will also be interested in the views expressed by Members.
Establishing the committee on the future of health care was one of the first commitments of the programme for Government. I am grateful for the cross-party and grouping co-operation which allowed it to be established without delay. The Leader of the House has already raised with me the eagerness of Seanad Members to make a contribution to the formulation of this ten-year vision. This is a contribution I would welcome. While it is out of my hands in the sense that it is a matter for the Oireachtas, I hope and trust a mechanism can be found to facilitate the involvement and engagement of Senators in creating a ten-year vision for health care.
This presents us with an historic opportunity to achieve something which has never happened before in health policy, namely a long-term consensus on its fundamental principles. When one talks about ten-year strategies and committees, one can see people rolling their eyes, saying, “Another committee, another strategy”. However, this has never been done before. We have never before set ourselves the challenge of getting every political party and Independent grouping to sign up to a programme setting out where we want the public health service to be in the next ten years, regardless of what happens in elections and politics. If we can reach this consensus together, it will give the public, health service staff and management the certainty that the direction of travel will not change, even if the Government does. When I speak to people on the front line of the health service, they tell me they are not fed up of reform but, instead, fed up of a little bit of reform here and there while never finishing the process. Part of the reason for this is because there has not been consensus. Health Ministers come and go, tweak the system but we never allow enough time for a certain direction of travel to be undertaken.
I recognise some concerns already expressed since the committee was established. First, people have pointed out the six-month timeframe is ambitious, which I accept. However, it is up to the committee members to make it work. Second, a key requirement to make the committee succeed is to achieve political, and indeed, societal consensus on the future of health care. I could not agree more with this objective. It will be a significant first if we can achieve it. Finally, when talking about committees and reports, it is important the process just does not create another report to go on a shelf but actually leads to something tangible which we can all get behind, regardless of future governments or elections.Again, I am fully in agreement with that view, and the Department will provide every support to the committee in its important work. I intend to second somebody from the Department of Health to provide support to the committee in carrying out its work.
The central objective of the new Government, as reflected in the programme for partnership Government, is to use our now strengthening economy to make life better for people. During the general election I very clearly heard people stating it is grand the economy is back on track and that it might be improving in some ways but asking what we will do about a range of public services. One of those which all of us involved in various electoral contests heard very clearly was the importance of reinvesting in the health service. The Government's objective, and my objective as Minister for Health, must be about improving the public health service on which people depend. It is a health service which really matters to families and communities and on which we and our families will depend at some stage in our lives.
We all know the health service faces many challenges. However, I am pleased to state as Minister for Health that I am in the fortunate position, because of the work of the people, to preside over a period of reinvestment in the health service. We saw this last week with the revised Estimate of €500 million for the health service. This will help stabilise health service finances in 2016, and the HSE has already stated it will put the health service on a sustainable footing. It also gives me an opportunity to address some immediate pressures facing patients as well as meeting programme for Government commitments in the first 100 days.
These commitments include enabling me to put in place a winter initiative to manage emergency department overcrowding. Work is under way on this initiative and I met the emergency department task force, which is jointly chaired by the Irish Nurses and Midwives Organisation and the head of the HSE. At the meeting I asked for input and ideas. I asked what worked and did not work last year in hospitals and what new measures we can try. I am very pleased that the funding I have secured for the winter initiative is more than the budget for the winter initiative last year. This year we have €40 million for a winter initiative compared with €33 million last year. I extend the invitation to Senators for ideas, input and any suggestions they think will help make our emergency departments more manageable, particularly during the winter period when we see a spike in attendances. I would very much like to hear them.
It is very important to me that the initiative focuses not just on acute hospitals but also on effective integration between primary care, social care and acute hospital services. We must stop talking about the issues and challenges facing our hospitals as though they are just problems in our hospitals. I note Senator Dolan's commitment with regard to disability work. Part of the issue is when people who do not necessarily need to be in hospital, or would not have needed to be in hospital, find themselves in an emergency department because they could not access a service in primary care or social care. Had they been able to access this, they may not have needed to turn up in an emergency department at the weekend, or had the support been in place in primary care or social care, they could have left the acute hospital when they were ready to do so, rather than finding themselves in the uncomfortable position of occupying a hospital bed when they would much rather be at home in their community with their family. We cannot just talk about acute hospitals on their own. This is why we do not have a Minister of State for primary care, because the Minister for Health is not just the Minister for acute hospitals but also the Minister for all the health service, which very much involves primary care and social care.
Another integral part of the initiative I am able to announce as a result of the extra funding is increasing resources for home care services. As a result of an extra €40 million for home care above and beyond what was planned in the budget, we are not only able to maintain home care and transitional care services at 2015 levels, but also, for the first time in quite a period, we are able to increase them. The programme for Government acknowledges the need to improve our services to older citizens, and the provision of additional home care services and transitional care services will assist more older people to leave acute hospitals when they are clinically ready to do so. This will allow patients awaiting admission in emergency departments to be admitted in a more efficient manner. This initiative will also help older people and people with disabilities to remain independent at home and to continue to have active lives in their communities for as long as possible.
I hope the Seanad notes that in terms of the future direction of health care in the ten-year strategy, one of the specific terms of references is how to ensure the effective delivery of primary care. Deputy Kelleher in the other House likes to remind me of the very valid point that when Dr. Rory O'Hanlon was Minister for Health in 1987, when I was one, he used to talk about the delivery of primary care. We are still talking about it. My colleague, Senator Reilly, started this process. We must realise the primary care is not just about buildings in the community; it is about being able to avail of more services in the community. This is why I think it is an important body of work to do.
To do this, we must recognise that we need to build up general practitioner, GP, capacity to respond to patients' needs and to respond to the expansion of chronic disease management in general practice. Recently, I met the NAGP and the IMO to discuss this. Our GPs deserve and need a new contract. We have not had a brand new contract in 44 years. Patients in Ireland value their relationship with their GP and the State also needs to value this relationship. As with any contract negotiation, the State needs to decide what it needs and what extra, additional or changed services it requires as part of a new contract.
I am very pleased that as part of the additional funding I have secured, I will be able to restore all the funding to the mental health budget. As Senators know, due to time related savings, which is a very bureaucratic phrase, some of the money meant to be spent in the mental health area this year was not going to be spent and would go into the base for next year. The additional funding I have secured for our health service means I am in a position to restore the €12 million that had been diverted from mental health services. We will, under the Minister of State, Deputy Helen McEntee, be in a position to spend on mental health services the full €35 million which was ring-fenced for them. The Minister of State will develop a plan this year.
We will also be able to invest further in disability services. My colleague, the Minister of State, Deputy McGrath, is working on this area. We have an additional €3 million for school leavers. An important area is where people with a disability, who are turning 17 or 18 and are leaving school will go next. As a country, we have not dealt with this well and we need to do it much better. The extra €3 million will provide assistance. As part of the additional funding for disability, there will be more money for emergency placements and for bringing disability facilities and residential services up to HIQA and national standards, which is important.
I wish to speak briefly about the need to improve waiting lists and waiting times, with a particular focus on those waiting the longest. It is fair to say that as a direct result of the years of economic recession, we are seeing unacceptably high waiting lists in this country. We will be reactivating or revving up the National Treatment Purchase Fund, NTPF. The programme for Government commits to providing €15 million funding to the NTPF for an initiative targeted at those waiting the longest. That funding will come from a continuing investment of €50 million per year to reduce waiting lists. I met representatives of the NTPF yesterday and asked them what they can do with €15 million, how many patients it will take off a list, how the organisation will decide who to take off lists and what it could do with more than €15 million. We are having a discussion about how best the Department of Health can spend the €50 million that has been pledged in the programme for Government in terms of waiting list initiatives. This year, we are planning a specific dedicated waiting list initiative through the NTPF, focused on endoscopy. I expect this to mean the service will be in a position to carry out at least 1,200 endoscopy procedures and to clear the lists of those waiting 12 months or longer. This is an important issue and it needs to be addressed. I expect to be in a position formally to bring the Seanad details of this quite soon.
I acknowledge the health service has been changing, and it would be wrong not to acknowledge where success has happened. We must challenge ourselves. At what point did we decide it was acceptable for the political and media norm to be that we only ever talk about the health service in the negative? This does a huge disservice not just to the Government of the day but to the 105,000 people who work in the health service. Every day good things happen in the health service. It is rightly our job to challenge things that do not go well and to highlight problems - absolutely - but I want to acknowledge the good work carried out in difficult circumstances by front-line staff in recent years. Life expectancy in Ireland has increased by two and a half years since 2004 and is now above the EU average. We have seen a decrease in the average length of stay in hospitals and significant progress in reducing tobacco consumption. It is fair to say that Senator Reilly in his time as Minister for Health continued the good work of previous Governments in driving this agenda, which has Ireland leading Europe in terms of tackling tobacco consumption. Progress has been made in many health areas, including how we deal with cancer patients and cardiac situations, and it is important to recognise this progress, along with recognising those who work so hard on the front line.
There is clearly much more to do, but I believe there exists an opportunity to make realistic and achievable improvements in patient care and therefore make a difference to people's lives. As well as the shorter-term initiatives I have outlined, I am determined that we progress major investment projects, such as the national children's hospital and a new national maternity hospital. I was in the House last week speaking about this. We must look at how we keep our population healthier through the national obesity strategy and the new national cancer strategy.
I want to be very clear. I stand here as Minister for Health knowing that I alone will not fix the health service and that while the Oireachtas is very diverse, it need not be divided on every issue.If we are honest with each other, there is a great deal we agree on across the Oireachtas in terms of the direction of travel for the public health service, although I acknowledge that we sometimes like to extenuate our differences for political reasons. However, there will always be issues on which we do not agree. If ever there was a unique opportunity to put in place a ten-year vision, it is now because we have a minority Government and we have no monopoly on wisdom or mandate. I am very much in the hands of both the Seanad and the Dáil in terms of how we can work collectively together and I look forward to working with Senators on all sides of the House.