Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am delighted to be back in the Seanad to have an opportunity to have a discussion about the health service and to outline some of my priorities for the health service during 2017. When I spoke to the Seanad in July of last year we had what I considered to be a frank and positive exchange on a number of issues. I look forward to an equally interesting exchange of ideas today.

On that occasion in July I spoke of my hopes for building a health service that makes us all proud as citizens. I believe that we have a unique opportunity to put in place a long-term vision for our health services. Eight months on, I have not lost that sense of hope. We continue to face challenges and I get frustrated like everyone else on behalf of patients waiting on trolleys or for an appointment. It makes me and it must make all of us more determined than ever to tackle the problems that we face.

When I was appointed it became abundantly clear to me that this was going to be a process that was going to take a number of years, and that what we needed was to try and build a political consensus on a direction of travel, so that when the Minister changes, the plan does not change. When I have visited hospitals and other facilities within our health service, what I have detected from many people working within the health service is frustration that every time the Minister changes or the Government changes, the policy and plan changes. It is almost like going back to the beginning and starting all over again. We need to genuinely try to embed long-term planning and building blocks for where we want to get to. In my visits to hospitals and health facilities, it has been valuable and important for me to see for myself what professionals, patients and families experience, and there are positives and negatives too.

I have witnessed the exceptional levels of commitment of health care professionals and had so many patients tell me of the great care they have been given and how the treatment they have received has improved their lives but equally I am not blind to the fact that we still face significant challenges. We all know someone who is accessing services, a family member, a friend, or a colleague. We all share the same goal. Each of us wants to have a health service where people feel valued, respected and well-cared for and a service where the patients are at the centre.

We are now back in an era of reinvestment in health care. The budget for 2017 delivered the highest ever health budget in the history of the State at €14.6 billion. This unprecedented investment will serve to make a real difference in the services that we can deliver. It is not just about the size of the budget. It must also be about where that money is spent, where that focus is and indeed the output and the outcome from the patient's perspective.

Today I would like to set out some of my priorities. I wish to acknowledge the distress for patients and their families and the impact on staff caused by cramped and overcrowded conditions in many of our hospital emergency departments. Behind every trolley number, and there is a tendency to count trolley numbers, there is a patient in need of effective, timely and compassionate care from our health service. We must all try harder across the health service and do more to improve the experience of every single one of those patients. I am very conscious of the unacceptably high number of patients on trolleys at the beginning of the year, but I am glad to report that while numbers remain far too high, they have reduced more recently and now remain consistently lower than each of the corresponding days of last year. In fact, the number of people on trolleys in January this year, although far too high, is lower than the number of people that were on trolleys in January last year. It is important to acknowledge, not politically, the intensive efforts of staff and management across the health service who have contributed greatly to stabilising the situation after the high number reached immediately after Christmas.

The rate of increase of flu throughout the country increased substantially in the weeks directly after Christmas and the strain of flu circulating at present has been affecting elderly people in the main. I know people ask, is there not flu every year? Of course there is but there are different strains of flu and different times that flu strikes. This was a particular strain of flu that we had last seen a prevalence of in Ireland in 2009, and it was a particular strain of flu that impacted older citizens, and we saw that with the very significant increase in older patients requiring our health services. Although recent figures from the Health Protection Surveillance Centre suggest that this outbreak of flu may be reaching its peak, thankfully, I would continue to urge all “at risk” individuals who have not, as of yet, received the flu vaccination to contact their general practitioner or pharmacist as soon as possible. It is still not too late to be vaccinated.

Some €40 million of additional funding was provided to the winter initiative 2016 to 2017 to help alleviate overcrowding and I would like to report to the House on the implementation of this initiative. One of the key objectives of this year’s plan is to reduce the numbers of people waiting to be discharged from hospitals by providing the specific supports and pathways to allow patients to move home or to an alternative suitable community setting which meets their needs. Achieving this objective frees up beds in the acute hospital system, thereby reducing overcrowding in emergency departments. However, it does much more than that. It is about the dignity of the patient, the person who is ready to go home, who does not want to be stuck in an acute hospital and who wants to go home and be in a more appropriate setting. I want to commend those teams across acute hospitals and social care that work together on a daily basis, because they have exceeded the target set in the winter initiative and reduced the number of delayed discharges in our hospitals to an all-time low, with 458 people recorded last week, down from 638 at the start of the winter initiative.

A number of other practical measures have also been implemented. We have seen over 7,500 patients avail of community intervention teams, meaning that these patients were able to avoid hospital or be discharged earlier from hospital. Of this number over 1,000 patients received treatment directly from funding provided by the winter initiative. We have seen almost 3,500 patients avail of aids and appliances, enabling them to be discharged from hospital. We have seen 670 additional home care packages and 330 additional transitional care beds. We have seen an additional 35 acute beds open before Christmas in the Mercy University Hospital in Cork, in Beaumont Hospital and in the hospital in Mullingar. On 5 January, I sought and received additional, enhanced measures from the HSE, and these measures focus particularly on augmenting the supports for primary and community care, targeting acute capacity, opening additional transitional care beds, and opening more beds in our acute hospitals.

Reducing waiting lists is a key priority in 2017. It is not necessarily the headline number, how many people are on a waiting list, that is a cause of concern to patients. It is how long they must wait. I am encouraged that we were finally able to make some progress in 2016. We made investments in a targeted way and as a result of that we saw the number of patients waiting over 18 months for a procedure halved. We saw the first fall in the overall numbers on waiting lists in around two years. Now we have put aside €20 million for the National Treatment Purchase Fund, NTPF, in the budget for 2017, and committed a further €50 million in 2018. That is €70 million for dedicated waiting lists initiatives, to get down the length of time that people are waiting. We used to be quite good at this before the economic crash, and we really need to get back to that as quickly as possible. I acknowledge the considerable work that has been done across our hospitals and in conjunction with the NTPF to reduce those lists.

Senator Kelleher and Senator Colm Burke have raised a specific issue in regard to Cork University Maternity Hospital, and I am sure that they may touch on that later. I am very concerned about that level. I do not understand how we have arrived at a situation where the waiting lists in Cork are twice as long as the next highest. It is not acceptable. Every hospital has gone through the same sort of challenges in terms of finances, but we need to get in under the bonnet of what has happened in Cork. I had a very good meeting with the consultants there a couple weeks ago, and I will be following it up with them. I have asked them, the new maternity strategy team in the HSE and the soon to be new clinical director for maternity services to report back to me on a range of suggestions they want to see implemented. I am looking forward to having a further meeting and engaging further with Members of the Oireachtas from Cork in regard to that.

We need to have a very honest debate about how we are going to break what has now become a vicious cycle. Every year for the last two decades, if not longer, the Minister for Health of the day has stood here, or in a spot similar to here, and talked about hospital overcrowding, trolleys and apologised, and meant it. Ministers have then done their best to improve it but they have never managed to break it. The reason we have never managed to break it is that we have failed to take a number of the fundamental steps that we are now going to take, and on which I want to hear the views of Senators in terms of what we need to do. Some of those on which I would like to touch are bed capacity, recruitment and retention, and making the decisive shift to primary care a reality, rather than just a catch-phrase.

In regard to capacity, my Department will undertake a capacity review in line with the commitment in the programme for Government. Systematic analysis of the capacity requirements of the health service is an obvious requirement of proper planning and management. Such reviews should ideally be undertaken on a periodic basis and have a medium-term to long-term focus. The last report was in 2007. There is no doubt that a review at this stage is appropriate given that we are all aware of population and demographic changes in the interim. I cannot understand how the last new acute hospital we built was in 1998. If the Minister for Education and Skills was standing here and said that the last school we built was in 1998, we would all understand why there would be a problem accessing school places. We have not built a new hospital since 1998, and yet demographic pressures have increased. The troika was not in town for all those years. This is a collective challenge that we are going to have to rise to. We need a capital investment, and we need an investment that will result in an increase in bed capacity. We need to do this properly and on the basis of evidence.We need to see where the beds are needed and how much more we can do in primary care. If we really implement and embed primary care, how many beds should be in the community rather than acute hospitals? How will we manage chronic diseases? These are all issues that need to be considered with regard to acute and non-acute beds. For this reason, I am anxious the review will have a wider scope than previous reviews and will examine key elements of primary and community care infrastructure, in addition to hospital beds. Initial work on the capacity review has focused on expanding the concept of a preferred model of care and how it can inform the assessment of future capacity requirements. Given the current pressures being experienced within our hospital services, the process must also have a short-term focus and determine how capital investment over the coming years can be best targeted. We need to have a clear crystalised ask for the mid-term capital review with regard to capacity.

I will take this opportunity to address the recruitment and retention of nurses and midwives. I, the Department and the HSE recognise the importance of recruiting and retaining nurses and midwives in the public health service. As I have said on a number of occasions, recruitment is one of the key building blocks we need to put in place to break the cycle. It is also recognised that the fall in numbers employed between 2008 and 2013, from 39,000 to 34,000, had to be addressed when the moratorium ended. There is a global shortage of nurses and midwives and it is a challenging environment in which to grow nursing and midwifery numbers. However, the number of nurses and midwives employed in the public health service has increased from 34,178 at the end of 2013, to 35,835 at the end of December 2016, an increase of 1,657 nurses.

I accept there is much more we need to do and initiatives are under way to improve staffing levels throughout the country. The HSE is offering permanent posts to 2016 degree programme holders, and full-time permanent contracts to those in temporary posts. So many nurses I have spoken to who went abroad left because they did not have the option of a job in the health service, or certainly not a job on a contract of longer than a number of months. This is no longer the case. The HSE is also focused on converting agency staff to permanent staff, while also accepting there will always be a need to have some element of agency. The HSE's national recruitment service is actively operating rolling nursing recruitment campaigns. The campaigns encompass general, mental health, intellectual disability and registered children's nurses, and also midwives. In addition, a relocation package of up to €1,500 continues to be available to nurses who return from overseas.

The HSE ran a three-day open recruitment event over the Christmas holiday period in Dr. Steevens' Hospital for nurses and midwives from all disciplines who are interested in working in the Irish public health service and 220 candidates attended the event. I also had the opportunity to attend. A total of 115 nursing and midwifery candidates were deemed successful and placed on a panel following interview. The files for successful candidates have been passed to the contracting unit. This is the first of a number of career and recruitment events for nurses throughout 2017, with the next one scheduled for 31 March 2017.

In September 2016, the HSE set up a project group to review nursing workforce planning, recruitment and retention. The main objectives of this project group include identifying current recruitment black spots in a co-ordinated way and developing measures to incentivise and attract nurses to these essential posts. I accept nursing recruitment and retention is a challenging issue. We are in discussions with the INMO. It is important in the interests of the health service that we have these discussions and outcomes from them because the health service needs stability in the interests of all of our patients and does not need any disruptions. We are engaged in discussions with the INMO. The talks adjourned last night and management will revert to the INMO later this week with details and further nursing and midwifery recruitment measures to be undertaken in 2017. The challenge this year and the objective is to recruit 1,000 additional permanent nursing posts in 2017. These posts are provided for in the HSE's service plan and HSE management is committed to engaging constructively with the INMO to address its concerns and to agree a range of initiatives that will support future recruitment.

I am firmly committed to making the decisive shift of the heath service to primary care a reality in order to deliver better care close to home in communities across the country. The programme for Government emphasises the need and focus on enhancing primary health care services, including the building up of GP capacity, increasing the number of therapists and other health professionals in primary care and continuing to expand the development of primary care infrastructure.

The Government is also committed to ensuring that patients throughout the country continue to have access to GP services, especially in remote rural areas and also in disadvantaged urban areas, and that general practice is sustainable in such areas. There have been significant developments in general practice services recently, with more services being made available to our citizens and additional support provided by the HSE. I have emphasised repeatedly the need for a new GP services contract which will help modernise our health service and develop a strengthened primary care sector. Health service management has already progressed a number of significant measures through engagement with GP representatives, including the following: free GP care for all children under six years and those aged over 70; a specific diabetes cycle of care for adult patients with type 2 diabetes; a new rural practice support framework; and a revised list of special items of service that can be provided by GPs. The effect of these measures has been an increase in State funding to general practice of approximately €100 million as well as, importantly, improving services and accessibility for patients.

Preparations for the next phase of discussions on a new GP contract are under way. I am keen to ensure that future contractual terms for GPs would enjoy the support of the broad community of GPs, and in this regard officials from the Department of Health and the HSE will engage with the relevant GP representative bodies on a wide range of matters which will need to be encompassed by the contract development process. The aim is to develop a new modern GP service contract which will incorporate a range of standard and enhanced services to be delivered. If we can get this right I believe we can unlock new potential in primary care. Our GPs want to do more, they tell me they can do more, we know they can do more and they are qualified to do more, but they need to be resourced and supported to do more. We cannot expect them to do more or patients to benefit from more when people operate on a 44 year old contract. The new GP contract is a major priority for me in 2017 and a major priority for the Department of Health and the HSE.

Many Senators will be interested in the Government's commitment to providing medical cards to children in receipt of domiciliary care allowance. The Department recently received permission to draft a new Bill to deliver on the commitment that all children in respect of whom a domiciliary care allowance payment is made will automatically qualify for a medical card, therefore will no longer be subject to the medical card means test at any point in the future while in receipt of domiciliary care allowance. The legislation is being prepared and will be brought before the Oireachtas as quickly as possible. With the help and assistance of Senators I would like to get it passed and issue the medical cards as early as possible this year. In addition to the preparation of the legislation, I have asked the HSE to commence the process of planning for the requirements of the scheme, how the cards will issue and how people can apply for them so the proposal can be implemented in a smooth and efficient manner. This will benefit approximately 10,000 children with certain disabilities and special needs who do not receive a medical card. It will also benefit 30,000 children in receipt of domiciliary care allowance who have a medical card but are subject to reviews. The reviews will no longer be necessary.

I have been asked for an update on the relocation of the National Maternity Hospital to St. Vincent's University Hospital campus and I am pleased to provide one because it is such an exciting flagship project for our maternity services. In fact, the whole area of maternity care is an area where we are making significant progress. Following from what I have described as a landmark year for maternity services in 2016, the agreement reached on a governance structure for the new National Maternity Hospital at St. Vincent's University Hospital has enabled the project, which was stalled, to recommence. The existing National Maternity Hospital has been located at Holles Street since 1894, and much of the existing building dates from that era. Its redevelopment has been a Government priority for some time, in fact it has been a priority for many Governments, and I am very pleased we will get on with it and it will proceed. A planning application will be launched early this year. I have seen the exciting designs for the new hospital, which will cater for up to 10,000 births per annum. The design team has produced a very high-quality design, which integrates the new maternity hospital into the existing St. Vincent's University Hospital building. I have no doubt that such a state-of-the-art development will raise the international profile of the entire St. Vincent's University Hospital campus. In this regard, the potential for cross-campus research and development is immense. Work to finalise the strategic infrastructure development application is under way and I expect the application will be made to An Bord Pleanála early this year.

The new maternity hospital will give physical expression to the new model of care proposed by the national maternity strategy and will ensure that women will receive their care in an environment where their need for dignity and privacy is respected. The level of care in the hospital is superb and it has a long and proud tradition, but the building is simply not fit for purpose. It does not provide women with the dignity and privacy they deserve and should expect, and it certainly is not acceptable for staff to have to work in the building either. We need to get on with this as quickly as possible.

We are very committed to progressing the development of our maternity services in general, and 2016 saw the publication of Ireland's first ever national maternity strategy. In some sense it is unbelievable we did not have one before 2016. The HSE's national standards for bereavement care following pregnancy loss and perinatal death were also published in recent months, as were HIQA's national standards for safer better maternity services. These three publications represent key building blocks to provide a consistently safe and high quality maternity service. In addition, the new national women and infants health programme will lead the management, organisation and delivery of maternity, gynaecology and neonatal services, strengthening such services by bringing together work that is currently undertaken across primary, community and acute care.

I should also mention that additional funding provided last year, and continued this year, has enabled us to build capacity in the maternity workforce, including the approval of an additional 100 midwives, including for the development of specialist bereavement teams.It also provided for the implementation of the maternal and newborn clinical management system, the new electronic health record system which I saw in action when I visited Cork University Maternity Hospital. Yesterday, in just 24 hours, the eHealth team visited every other maternity hospital in the country in an initiative to quickly establish the next steps in rolling out the electronic health record system across our maternity network.

In a related development, I want to see construction start on the National Children’s Hospital in 2017. The Government decision that the new children’s hospital should be co-located with St. James's Hospital on its campus in Dublin 8 was made in the best interests of children with clinical considerations paramount in the decision. Co-location with St. James's Hospital and, ultimately, tri-location with maternity services on the St. James's campus, will deliver the excellence in clinical care that our children deserve. St. James's Hospital has the broadest range of national specialties of all acute hospitals as well as a strong and well-established research and education infrastructure, making it the acute hospital that best meets the criteria to be the adult co-location partner.

While we must invest in our children’s health, we must also consider the needs of our older people. We know we live in a country where people are growing older. This year, we will see an additional 20,000 people over the age of 65 and another 3,000 people over the age of 85 so Government policy must be about providing care in the community for older people so that they can continue to live in their own homes. A political consensus is emerging on this issue. We have a statutory care scheme for nursing homes. We say that, as a country, we want older people to be able to live and grow old in their own homes, yet the only statutory scheme states that a person must go into a nursing home. We need to underpin home care through a statutory scheme. I know there are a number of ideas across this and the other House about how to do that and we will have a debate in the other House on it. The Minister of State with responsibility for mental health and older people has taken a significant step in launching a consultation scheme and listening to the views of older people and policy makers so that we get this right. It is really important that we get this right and that there are no unintended consequences. Bearing in mind the fact that thousands of people benefit from home care packages today, we do not want to accidentally impact on that. We need to get this public consultation process under way, get it concluded within months, allow people to have their views and get on with legislating in respect of it. Meanwhile, a review by the Health Research Board of the way in which home care services are funded and regulated in four comparable European countries, which was commissioned by the Department of Health last year, is to be published shortly. I hope this will inform all our thinking about future decisions about the structure and governance of home care services.

The programme for a partnership Government is committed to reducing the cost of medicines, including prescription charges, for medical card holders. In budget 2017, the Government announced that the prescription charge for medical card holders aged 70 and over will be reduced this year. This measure will benefit over 300,000 people. Legislation is required to introduce this reduction and this is being drafted. I will continue to examine opportunities to address the cost of the charge to patients having regard to the funding available.

This brings me to the particular issue we, in common with many other countries, are facing concerning the cost of medicines. Advances in medicines have played a key role in improving the overall health of the population. However, this comes at an ever-increasing price. For example, the medicines bill in Ireland has increased from €400 million in 1998 to over €2 billion in 2016. Securing access to innovative medicines for citizens at an affordable price is, therefore, a major challenge but one that is not easily solved. A number of key initiatives have been introduced in recent times, including agreements with industry, the most recent being signed in June last year, as well as the introduction of generic substitution and reference pricing. These initiatives have generated significant savings and reduced prices in Ireland to a more sustainable level. This is to be welcomed. Nonetheless, the medicines bill is forecast to rise significantly in the years ahead driven primarily by the increase in cost and usage of recently introduced medicines and the very strong pipeline of new medicines. Therefore, our financing model for medicines needs to be both sustainable and affordable. However, the pricing model proposed by industry must also be sustainable and affordable.

It is important that we challenge the pricing structure and practices adopted by the pharmaceutical industry where they are wrong so that patients can access innovative products. That is why I have reached out to my colleagues in other countries seeking international collaboration in this area. I attended an OECD health ministerial meeting in Paris last week. Countries around the globe are facing the same challenge but if we do not work together as countries, and certainly as EU member states, in the same way the drug companies collaborate with each other, we will be unable to meet this challenge so we must work together. We have huge buying power when we work with other countries. I was impressed with what the Benelux countries have done in coming together to buy drugs and we can learn a lot from that so I am in talks with a number of other EU and OECD health Ministers to see how we can share information and help each other so that citizens in all our countries can access drugs.

Turning back to my priorities for 2017, we will also see a new national cancer strategy. I am very excited about the publication of this, which will happen in the coming weeks. It is a strategy for the development of cancer services in this country for the next ten years. Much of the heavy lifting was done by my predecessors in getting the model of care right. We must now look at things like survivorship. Thankfully, people are living beyond cancer but how do we look after them after cancer? How do we look after all of their needs such as their psychological needs, their well-being and the needs of their families and help them get back into employment? The new national cancer strategy will endeavour to set out a roadmap in that regard.

We will also publish an implementation plan for the neurorehabilitation strategy, which is so important. It concerns how we look after people who need neurorehabilitation such as those who have suffered a stroke and those with multiple sclerosis or a range of neurological conditions. I thank all the stakeholders and interest groups that have worked with us in this regard. We need an implementation plan and it will be published this year and provide the roadmap for the delivery of the service. It is specifically mentioned in the service plan and is a priority.

I will also take the opportunity to mention some priorities being progressed by my ministerial colleagues at the Department of Health. Empowering people with disabilities to live independent lives and to have greater choice and control over the services and supports they need to make that goal a reality is a key priority and the Minister of State with responsibility for disability issues is progressing that commitment through the task force on personalised budgets. This involves actually empowering people with disabilities and not thinking that the State's responsibility stops when it writes a cheque and sends it to a service provider. It involves asking the people with disabilities what they want done with those resources and what they want for their lives. The Minister of State is leading on that issue.

The Minister of State with responsibility for health promotion is driving the health and well-being agenda. Work is progressing on the public health (alcohol) Bill, which is really important legislation that needs to be passed and enacted, and on implementing A Healthy Weight for Ireland: Obesity Policy and Action Plan 2016-2025. We are on course to be the most obese nation in the EU if we do not get on with delivering on this plan.

The Minister of State with responsibility for communities and the national drugs strategy is actively progressing a new national drugs strategy which will set out Government policy from 2017 onwards in the areas of drug awareness and prevention, treatment of substance misuse and addiction, promoting rehabilitation, reducing the supply of illicit drugs and piloting supervised injecting facilities. I expect progress on the legislation relating to injecting facilities in the coming weeks.

The Minister of State with responsibility for mental health and older people chairs the national task force on youth mental health. This group is considering how best to introduce and teach resilience, coping mechanisms and greater awareness to children and young people and how to access support services voluntarily at a young age.

I thank the Seanad for inviting me here again today and I look forward to hearing Members' thoughts and views on the direction the health service should take. I have tried to touch on a number of issues, health being a broad topic. I would be delighted to interact on any other issues.