Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Acting Chairman for the opportunity to address the Seanad on the issue of long waiting times for patients. I know Senators will contribute in the course of the debate and I thank them genuinely for maintaining a focus on this vital issue for our health service. I also acknowledge on the record of the House the constructive approach taken both in Sinn Féin's original motion before the House and in the Fianna Fáil amendment. Regardless of voting patterns in the House or however the House decides it wishes to deal with the motion, I wish to progress the matter and work with both parties on a number of issues referred to in their proposals. I also acknowledge, as did Senator Conway-Walsh, the brilliant facility we now have in Altnagelvin. It is a real, concrete, tangible example of what cross-Border co-operation looks like, and I was delighted to be there with the Minister of Health in the Stormont Executive, Ms O'Neill, last Monday. We have provided €19 million towards the cost of delivering the service in Altnagelvin, which will make a huge difference for the people of the north west in terms of access to radiotherapy services.

It is fair to say that, while this is a political Chamber, we are more united than divided on the way forward. Therefore, I, on behalf of Government, do not intend to oppose the motions before the House. Many of the suggestions made by both parties are in line with Government policy and work is already planned or in train to implement them. I have been clear that I believe improving our health service requires an all-party effort and I believe Senators are demonstrating they are of the same mind. I have previously said publicly and on the floor of Dáil Éireann that there is merit in the Sinn Féin suggestion and that I will meet Deputy Louise O'Reilly on the matter. However, before we introduce any new systems or structural change, we will have an all-party committee report in April, which is about each party outlining the system it wants. It was in this context, not in the context of a fobbing off, as Senator Devine suggested, that I made my comments to Deputy O'Reilly.

My feelings on RTE's "Living on the List" programme are well known at this stage. I can only add that the traumatic experiences of those patients left waiting in pain and anxiety and the shattering impact on those who love and care for them have only strengthened my determination that we must put first those who are waiting longest and reduce further long waiting times in 2017. I am unapologetic in my view that as well as this being a funding issue, there is an issue of management and accountability. Senator Mulherin has raised on a number of occasions the issues of management, roles, responsibilities, the purpose of those roles and how they are impacting or not impacting on various roles in front-line patient care. I have asked for a report on these issues and will revert to Senator Mulherin in this regard. The Sinn Féin motion calls on me to explore the feasibility of a new model to maximise capacity of the public hospital system by means of the following core elements: the introduction of a new and single integrated hospital waiting list management system; providing a core activity budget to public hospitals; the introduction of a new activity fund; and addressing the public-private mix in public hospitals.

I will first address Sinn Féin's proposal on core activity budgets. I assure the House that the Government fully supports the concept of activity budgets. A Programme for a Partnership Government, published in 2016, confirms this Government's continued commitment to the implementation of activity based funding, ABF. Implementation of such budgets has already commenced through the HSE's ABF programme. Since January of 2016, funding for inpatient and day-case activity in the 38 largest public hospitals has been on an ABF basis. Hospitals are now given fixed ABF allocations, funding is being earned back following delivery of agreed ABF activity targets and performance is being monitored on a monthly basis. The introduction of ABF will deliver a number of key benefits. It is intended to ensure a fairer system of resource allocation to drive efficiency and increase transparency in the provision of hospital services in terms of the cost and volume of activity. The provision of funding for inpatient and day-case services will continue to be on an ABF basis during 2017. My Department intends to work with the HSE to ensure that the model is expanded to encompass outpatient activity.

I have repeatedly made clear that increasing capacity in the public health service is a priority. That includes physical capacity, the staffing capacity to support that and harnessing untapped capacity already in the system. Ireland’s improving economic position has enabled the health service to achieve much-needed budget increases in each of the last two years. Additional funding provided during 2016 presented the opportunity to address some immediate issues facing patients, such as investment in a winter initiative. Under the current winter initiative, funding has been provided to open approximately 100 extra acute beds this year. Ninety of these are already open. During the past year, over 100 additional hospital consultants, almost 250 extra non-consultant hospital doctors and nearly 500 additional nurses and midwives have been employed by the HSE. In addition, my officials are working with the HSE to develop a national integrated strategic framework for health workforce planning, with the objective of recruiting and retaining the right mix of staff. I expect to receive a report and an implementation plan during 2017.

The motion also refers to a suggestion from Sinn Féin to establish a new fund to cover the cost of procedures for those patients transferring to a different public or participating private hospital. Budget 2017 includes an allocation of an additional €15 million to the National Treatment Purchase Fund, NTPF, to enable patients to receive treatment in other hospitals. These can also be public hospitals. In implementing this, the HSE and the NTPF will work together to maximise capacity in both the public and the private sector. Under this arrangement, lower-complexity day-case procedures will be outsourced to the private hospital sector in order to free-up and maximise capacity in the public hospital system to undertake more complex inpatient treatments.

Sinn Féin's motion makes reference to an end to the special treatment of private patients in public hospitals. The Committee on the Future of Healthcare is examining different funding models for the health service and will make recommendations, according to its terms of reference, on the funding models that are best suited to Ireland, having regard to the aim, to which all parties have signed up, of moving towards a single-tier health service. It has been the policy of many successive Governments to allow public hospitals to continue to cater for the needs of private patients, based on the benefits accruing to those hospitals from having a balanced mix of public and private practice. This is also reflected in the current contractual arrangements with many hospital consultants.

The last point of the Sinn Féin motion, which is the one most directly linked with the management of waiting lists - I believe it is the most important point - makes specific reference to the Portuguese integrated hospital waiting list management system. There is no doubt that IT can play a significant role in underpinning a more integrated approach to managing waiting lists which would achieve a more patient centred approach, while optimising resources. Last summer, I asked the HSE’s office of the chief information officer to respond to a digital challenge to propose technological solutions to reduce waiting lists. As part of this e-health digital challenge, the Portuguese waiting list IT system was reviewed. In essence, I would agree that greater integration of hospital waiting list management systems would be a step in the right direction. I, therefore, accept the proposal in the Sinn Féin motion to examine the feasibility of progressing to a more integrated approach to waiting list management at hospital group level and I commit to request the NTPF to lead a project team to report to me within six months on the issues to which the Sinn Féin motion gives rise in this regard.

One of the critical enablers of any integrated waiting list management system is the unique individual health identifier, IHI, which was given a legislative basis in the Health Identifiers Act 2014. The system of identifiers will be deployed across the public and private health care systems. The electronic health record became reality in December 2016 with the arrival of Ireland’s first digital babies in Cork. New babies born from December in Cork University Maternity Hospital will now all have electronic health records with the deployment of the IHI register in the health sector.

I will now turn to the Fianna Fáil amendment. I want to address the issue of the maintenance and publication by the NTPF of national waiting list data. The NTPF figure provide an up-to-date and verified picture of patients actively waiting for inpatient day case treatment and outpatient appointments. These official waiting lists are published online on a monthly basis. The NTPF receives over 2 million records per month from hospitals and distributes up to 2,000 reports per month. The NTPF does not currently collate hospital diagnostics waiting lists but work is ongoing in the NTPF on testing the feasibility of compiling such waiting lists. I accept the premise of the amendment in this regard. In 2014, the NTPF guidance to hospitals regarding waiting list management advised that hospitals needed to keep a record of patients pre-admission and awaiting planned procedures and the NTPF has been capturing these data since then. Last Thursday, I committed to asking the NTPF to work towards the publication of the pre-admit and planned procedures waiting lists. The NTPF will review and advise on clinically appropriate time bands for these two different categories of patients. Let me be very clear, in case there is any political charge, the published figures have not changed under my tenure, or any other tenure. In fact, it is the same data set published each and every month since the NTPF was set up by Deputy Micheál Martin in 2002. That is not a political point, he was following best international practice at that time. The idea that there was some change to massage or to hide figures is a charge that is simply not true. Last week, l also announced that the NTPF will audit the practices in each of the hospitals highlighted by the individual cases featured in the RTE documentary.

Finally on this issue, I note the reference by Fianna Fail to the national Healthlink project. I am confident that additional integration could be explored between the NTPF waiting list data and this referral infrastructure to enable GPs - as Senator Swanick will know also - to make informed referral choices. I welcome the references to accountability in the Fianna Fail amendment. This is an absolute priority for me. The HSE's performance and accountability framework, which has been revised and enhanced for 2017, sets out how the HSE including the national divisions, the hospital groups and individual managers will be held to account for their performance. It makes explicit the responsibilities of health service managers in the four domains of performance which are: access to services; the quality and safety of those services; doing this within the financial resources available; and by effectively harnessing the efforts of the workforce. My Department oversees and monitors the HSE's implementation of its performance accountability framework and monitors implementation of the HSE corporate plan and annual national service plans. I and my Department continue to meet with senior officials from the HSE on a weekly basis to monitor performance including in relation to waiting lists. Let us be very clear that if anyone in this House, or anybody in the State, believes that funding alone - although funding is important - will address the issues in our health service then it is a misplaced and misinformed notion. If it were that simple, then we would have had the best health service in the world during the Celtic tiger era in Ireland. We must get the resourcing piece right - and there was a need to increase health budgets and to do a lot more on the capital side - but we must also ensure that the thousands of managers in the health service are held to account for what they have signed up to deliver. We have many excellent managers. This is not a heads-must-roll mantra from a Minister. There are many excellent managers, but we must identify good practice, demand more of it, and where there is not good practice we must demand that improvement plans are put in place in the interests of patients.

Reference was made to the bed capacity review that is under way. This review will be comprehensive and will have a much wider scope than previous reviews, which focused on bed capacity in acute hospitals only. While acute hospital bed capacity is a critical component of the health service, it cannot be considered in isolation. It is directly affected by capacity availability in other parts of the health service, such as primary care, long-term residential care, home care, respite, rehabilitation and palliative care. Even within the acute setting, we must also take account of emergency and outpatient capacity and utilisation. In examining future capacity requirements, the review will assess current capacity in the health system and benchmark with international comparators. The review will assess trends in better utilisation of existing capacity, examining a variety of efficiency and effectiveness measures, and scope for further gains, all with a view to better planning of capacity. The review will look at drivers of future demand for health care, which is crucial, including demographic and epidemiological trends. The review will also assess how reforms to the model of care will impact on future capacity requirements across the system.

The Fianna Fáil proposal on better utilisation of hospitals without 24-7 emergency departments for the purposes of elective surgery is also in line with the plans currently being implemented. It is appropriate and important. We need to use every bit of capacity within the health service. Through the group structure, hospitals are now starting to work together to support each other, providing a stronger role for smaller hospitals in delivering less complex care and ensuring that patients who require true emergency or complex planned care are managed safely in larger hospitals.During 2017, each hospital group will develop a strategic plan that will show how each group intends to utilise all hospitals, including smaller hospitals, within the group.

Similarly, community hospitals are an essential part of our national infrastructure of public nursing homes and provide a mixture of long-stay and short-stay care. The short-stay beds include step-up step-down care as well as intermediate, rehabilitation and respite care. These are used in a flexible manner to meet local needs at any given time. Community hospitals and their services have been used quite efficiently throughout this winter period and this must continue.

There are some proposals in the Fianna Fáil amendment which cause difficulty although I recognise the thrust and the bona fides behind them. Greater availability and capacity in the public service is something we all want.

The public service agreement provides for planned services to be delivered over an extended day, running from 8 a.m. to 8 p.m. Monday to Friday or a five over seven day basis, while also providing emergency services. The agreement includes flexibility in rostering to facilitate this. To expand services, as outlined in the motion, numerous other issues would need to be factored in and it is important I say as much on the record. These include structural capacity issues, staff shortages across certain grades, contractual issues, possibly, and significant cost implications. However, the thrust of the proposals in terms of expanding capacity is something to which I can agree.

I wish to put on record that we must use 2017 to reduce the length of time people are waiting. I want specifically to discuss scoliosis. It concerns us all and the problem was put into particularly sharp relief by the brave children and young people who told their stories to "RTE Investigates".

Additional funding has been provided in recent years to develop paediatric orthopaedic services, including scoliosis services. I made €2 million available to the HSE in 2016 which saw 50 additional children and teenagers treated for scoliosis procedures under the initiative. While this investment made some progress, it is clear there is far more to be done. Last week, I met the chief executive of the children's hospital group and the chief executive of Our Lady's Children's Hospital, Crumlin. I can now confirm that the new theatre will provide the additional capacity for scoliosis procedures from April, following the recruitment of additional nurses. Furthermore, an orthopaedic surgeon post in the hospital in Crumlin will be filled by June. This means that from July the hospital expects to have additional capacity. The HSE will also submit to me a specific action plan on scoliosis by the end of the month. If this Oireachtas does nothing else, we have to get this issue sorted. Children have been waiting in agonising pain for scoliosis procedures. This is a priority for the year.

I expect to receive the HSE and National Treatment Purchase Fund, NTPF, waiting list action plans by the end of this month. In addition, I expect to receive a specific action plan on scoliosis. I look forward to working with Senators in progressing many of the constructive ideas in the Sinn Féin motion, the Fianna Fáil amendment and the many ideas brought forward to me by Senators on all sides of the House.