Opening Statement by Minister for Health Simon Harris TD to the Joint Committee on Health
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Chairman, Committee Members
I am pleased to have this opportunity to appear before you.
I am joined today by my Ministerial colleagues; Finian McGrath Minister of State with special responsibility for Disabilities, Helen McEntee Minister for Mental Health and Older People and Catherine Byrne, Minster for Communities and the National Drugs Strategy. My colleague Marcella Corcoran Kennedy, Minister for Health Promotion sends her apologies. I am also accompanied by officials from my Department: Jim Breslin, Secretary General; Frances Spillane, Assistant Secretary with responsibility for Disability Services and Older People and Siobhan O’Halloran, Chief Nursing Officer and Assistant Secretary with responsibility for Mental Health and Drugs and Social Inclusion.
I would also like to welcome Tony O’Brien, Director General of the HSE and his officials.
At our last meeting we had a frank and positive exchange. I look forward to an equally interesting discussion today.
One thing that was clear during that meeting was that health is not a party political issue. At any one time we all know someone who is accessing services, a family member, a friend, a colleague. We all share the same goal. Each of us wants to a health service where people feel valued, respected and well cared for.
Since I was appointed I have visited more than 20 hospitals and other health facilities throughout the country. It is important for me to see for myself what professionals, patients and families experience. I can say that there are positives and negatives to report. Do I feel heartened when I witness the levels of professional commitment? Yes. Do I feel encouraged when patients tell me that their lives have greatly improved since they had their surgical procedure? Yes.
But equally I am not blind to the fact that we face significant challenges. We face increased demand from a growing and ageing population and the increasing incidence of chronic conditions.
I know that patients and families and indeed clinicians are frustrated by waiting times.
To address these challenges, I, as Minister for Health, and this Government accept that significant investment is required.
In recent years the Health Vote has typically required an annual supplementary budget to cover deficits. In July of this year, in an effort to properly fund health and break this cycle of Supplementary Estimates, the Government provided an additional €500m funding to Health to bring the total gross funding to €13.695m.
When we last met we were in the last phase of Budget 2017 negotiations. I am pleased to report that Budget 2017 delivered the highest health budget ever at €14.6 billion. Of this amount, just over €14 billion is for current funding and just over €450 million for capital funding.
This unprecedented investment will serve to make a real difference in the services we can deliver.
Budget 2017 includes; €18.5 million to support the development of primary care services, €10m in new development funding for homecare supports like home help and home care packages; €20 million to enable people with a disability to move to more appropriate accommodation in the community. The Budget also provided for automatic medical cards for an additional 10,000 very sick children.
These increased resources will also allow the health services to plan for the challenge of increased demand from a growing and ageing population, and begin some significant new developments which will over time deliver real improvements for patients.
Before going on to talk about the services which will be delivered in 2017, I want to refer to industrial relations matters. You will all know that the INMO Executive Council has decided to ballot on industrial action.
Industrial action is not the way to address the medium or long term needs of the public health system. This Government is committed to a collective approach to industrial relations and pay policy as the most effective means of delivering economic security and stability. Any approach to pay restoration must be within the terms of what is available and affordable.
I am pleased therefore that the INMO have once again confirmed their commitment to the Lansdowne Road Agreement.
The Public Service Pay Commission has started its work and the Government will continue to work with ICTU over the coming weeks to ensure the continuation of a collective pay policy framework that meets the needs of public servants and society.
I will be meeting the INMO next week as part of ongoing engagement with key stakeholders on important issues relating to the health service.
Services to be delivered in 2017
The level of health services to be provided within the available funding will be set out in the HSE’s 2017 National Service Plan which is currently being finalised. I’d like to take the opportunity now to outline key priorities.
Managing Waiting Lists
One of my priorities when I was appointed as Minister for Health was to reactivate the National Treatment Purchase Fund.
This year I secured an investment of €1m specifically to treat approximately 3,000 people who have been waiting for an endoscopy treatment. As a direct result of this initiative, as at the end of October, the number of patients waiting for a GI endoscopy has fallen dramatically from 5,700 to 1,200. The NTPF are confident that by the end of this year there will be no patient waiting longer than 12 months for an endoscopy. Budget 2017 provides an additional €50 million to be allocated to the NTPF to treat patients who have been waiting the longest.
In August, the HSE developed a Waiting List Action Plan focused on reducing the numbers of longest-waiting patients.
Throughout 2017, my Department will continue to work with the HSE on reducing waiting times through driving efficiencies and process improvements, with a particular focus on adherence to chronological scheduling and validating waiting lists.
I am delighted that the €40 million allocated as part of the additional €500m secured in July has been provided on a recurring basis for the Winter Initiative.
Under the Winter Initiative €7 million has been allocated to fund a targeted waiting list programme for orthopaedics, spinal and scoliosis. This initiative had provided resources to treat patients on orthopaedics and scoliosis waiting lists with over 600 patients benefiting. Already 354 patients have either been treated or given an appointment to receive treatment within 6 weeks.
This funding is crucial in enabling winter preparedness measures across our health service and in reducing overcrowding pressures in our hospitals.
Acute Hospitals & Emergency Services
I very much welcome the additional funding of over €90m for acute and emergency services. The increased allocations demonstrate this Government’s commitment to driving key policy and strategic initiatives to improve and expand acute care and emergency services for patients.
Primary Care Services
Patient Safety and the delivery of quality services to patients will remain a key priority. Provision is made for costs associated with new Primary Care Centres, and the extension of the medical card to all children in receipt of the Domiciliary Care Allowance. Work will continue on the delivery of appropriate primary care services through primary care teams.
Of course improving our health services is not just about resources but this does demonstrate the Government’s commitment to investing the gains from a recovering economy in a better health service. With increased resources we can at least plan for the challenge of increased demands.
And of course while we need to consider the challenges facing us, we should also recognise where progress is being made.
Previously, we spoke at length about maternity services. This is one area where in particular we are making a difference. 2016 has been a landmark year for maternity services with the publication of the country’s first National Maternity Strategy – Creating A Better Future Together 2016 – 2026. The publication of the Strategy demonstrates a new and enhanced focus on maternity care at both policy and service delivery level. It provides a roadmap for how we can improve maternity and neonatal care in the years ahead. HIQA will shortly publish new National Standards for Safer Better Maternity Services in the coming weeks. These Standards will provide a framework for maternity service providers to ensure that they are meeting the needs of women, their babies and their partners, and that a consistent service is delivered across the country.
I believe that these developments represent the necessary building blocks to provide a consistently safe and high quality maternity service.
The HSE’s National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death guidelines are also a positive step in the right direction recognising that in the midst of devastation, there are practical ways we can help bereaved parents.
New Children’s Hospital
I am aware that recently the Committee was briefed by the National Paediatric Hospital Development Board and the Connolly for Kids Hospital Group on the development of the new children’s hospital. You have asked me to address the issue and I am more than happy to do so.
Independent reviews since 2006, have reaffirmed the importance of co-location with a major adult academic teaching hospital. 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 hospital that best meets the criteria to be the adult co-location partner.
Enabling works began this summer on the campus of St. James’s Hospital.
The National Paediatric Hospital Development Board is currently reviewing tenders for the main works contractor (and specialist sub-contractors) for the new children’s hospital at St James’s Hospital.
I will now address some of the issues raised at the Oireachtas Committee on 27th October.
Access and Parking: The issue of access to the children’s hospital is of great importance to everyone associated with this project. The design of the hospital has recognised the need of most parents to access the hospital by car, and ample parking has been provided for families based on current and projected future demand. The parking system will also allow families to reserve spaces ahead of arriving to the hospital, and emergency drop-off spaces are also being provided. St. James’s Hospital campus is also better served by public transport than any other hospital in the country.
Neonatal Transport: The question of transporting neonates quickly and safely was raised during the hearing. The National Neonatal Transport Programme serves the whole neonatal population of Ireland across all 19 maternity centres and 3 paediatric hospitals, and retrieves patients from anywhere in Ireland and abroad. In the Programme’s 14 years history, it has transported over 5,000 sick babies and there has not been one single fatality in transport.
Why Connolly is not the answer
It was suggested by Connolly for Kids that a children’s hospital could more easily, cheaply and quickly be built on the site of Connolly Hospital. They have suggested that it is not too late to change the site.
I want to make clear that the cost of transitioning the new children’s hospital to a site at Connolly Hospital has not been assessed in any detail, as no such project exists. However, what we do know is that transition of the new children’s hospital from the current site at St James’s would require the abandonment of all the work undertaken to date, and require a whole new design and planning process. At best, this would lead to a delay in developing this hospital, and would mean that construction inflation would be likely to have a significant impact on project costs. Together with lost expenditure on the project to date, that could offset much if not all of any savings to be obtained from building on a greenfield site. That is the best case scenario. The truth is that such an application would have no guarantee of success.
And let us not forget that An Bord Pleanála’s report ruling on the planning permission for the hospital rightly referred to congestion on the M50, and seriously called into question the view that unfettered access to the Connolly site and to on-site car parking can be accommodated.
I will end my remarks on this matter by saying that we all know that further debate is not going to create a new consensus or identify a new and perfect location with which all can agree. My priority now is to progress the new hospital as soon as possible, so that we can ensure children, young people and their families have the facilities they deserve.
Another topic that I know is of particular interest to this Committee is the opportunities eHealth offers.
Projects under development include
- Implementation of the Individual Health Identifier
- A new national laboratory information system
- Maternal and Newborn Information System
Moving on…. I might also reference some key initiatives being progressed by my Ministerial colleagues at the Department.
I know that you are interested in hearing about disability services. My colleague Finian McGrath has been driving specific measures in this area. He will be happy to discuss this in greater detail but perhaps I might just highlight some positive developments.
The Taskforce on Personalised Budgets for people with disabilities was established in September.
The terms of reference of the Commission of Investigation in relation to a former foster home in the South East are being advanced, informed by the recent Dignam Report.
- The registration of designated centres for HIQA inspections was successfully extended through legislation – all the while the excellent work being carried out by HIQA through their inspections continues.
- Children with disabilities continue to be a priority and in 2016 the health sector worked closely with our colleagues in the Department of Children and Youth Affairs to launch their new Access and Inclusion Model for children with disabilities to avail of the free pre-school year.
- There was renewed commitment to continue to move people with disabilities out of congregated settings, to enable them to live independently and to be included in the community. This is being supported by €100 million in capital funding from the Department of Health from 2016 to 2021.
- This will also be supported through the Service Reform Fund which represents a combined investment of €45m between the Department of Health and Atlantic Philanthropies.
- An additional €31m of the overall health Budget was secured in additional funding for Disability Services in 2016 and included in the Estimates for 2017.
Moving now to the area of mental health. Minister McEntee established a National Taskforce on Youth Mental Health. This is a community-led group with representatives of the public, private, community and voluntary sectors, which is mandated to act as a galvanising force to improve the mental health and wellbeing of our young people. I would like to make particular mention of a very important project which was advanced at Budget time – the National Forensic Mental Health facility at Portrane. Minister McEntee would be happy to update you on this and other developments.
It has long been Government policy to help older people and others to stay in their own homes and communities for as long as possible, with long-term nursing care being seen as a last resort only after home care and other community-based supports have fully utilised. Under this Government that emphasis is being strengthened.
I am pleased to say that overall funding for services for older people has increased to €765 million in 2017, which is an increase of €82 million since the HSE’s 2016 Service Plan. This has focused on additional funding for homecare in particular and is aimed at allowing people to continue to live in their own homes and at facilitating discharge of older people from acute hospitals.
In relation to Minister Byrne’s brief. Since her appointment she launched a national public consultation process and published an expert review to guide that will inform the development of a new National Drugs Strategy in 2017;
Minister Corcoran Kennedy – launched “A Healthy Weight for Ireland – Obesity Policy and Action Plan 2016- 2025” with sixty actions to improve Ireland’s health and to reduce the burden of obesity across society. This policy and action plan aims to reverse obesity trends, to prevent health complications and reduce the overall burden for individuals, families, the health system and the wider society and economy.
These of course are just a sample of the many initiatives being progressed by my colleagues.
The development of primary care is central to the Government’s objective to deliver a high-quality, integrated and cost-effective health care system. The Programme for a Partnership Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities across the country. The Programme emphasises the need to 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 development of a new, modernised contract for the provision of general practitioner services will be key to achieving our objectives of treating more people in the community. Engagements to date have seen the Department of Health, HSE and IMO agree a number of service developments including the introduction of a Diabetes Cycle of Care for adult patients with Type 2 Diabetes, an enhanced support framework for rural GPs, and a revised list of special items of service under the contract to encourage the provision of more services in the primary care setting. The next phase of discussions on other aspects of a new contract is expected to commence before the end of the year. I look forward to the process moving ahead over the next couple of months and am very hopeful that a constructive and fruitful engagement will result.
The enhancement of Speech and Language Therapy Services for children and adults has been the subject of particular focus in recent years. This year, development funding of €4 million was provided to focus specifically on speech and language therapy waiting lists in Primary Care and Social Care for children up to 18 years old. This investment is enabling the HSE to fill 83 new posts in primary care to address waiting lists, prioritising the longest-waiting children. When these positions are filled, the number of Speech and Language Therapy staff will be close to 700 Whole Time Equivalents.
The development of Primary Care Centres to accommodate Primary Care Teams and, where possible, GPs in one location is an important enabler of more integrated primary care service delivery.
Regarding medical Card coverage and developments as at 1st October 2016 there were just over 1,7m medical cards (35.9% of population) and over 460,000 GP visit cards (9.8% of population). Over 45% of the national population currently has free access to GP services under Universal GP Care and the GMS Scheme. This compares to nearly 38.1% at end-2010.
Before I finish I might just mention an upcoming event. I will shortly establish the new National Patient Safety Office based at the Department of Health, which will lead a programme of significant patient safety measures focused on initiatives such as new legislation, establishment of a national patient advocacy service, introduction of a patient safety surveillance system, extending the clinical effectiveness agenda and setting up a National Advisory Council for Patient Safety.
While we have secured a significant increase in funding for the health services, I don’t underestimate the challenges involved in the delivery of a safe efficient health service for the Irish people.
We must maintain our focus on improving the way services are organised and delivered, and on reducing costs, in order to maximise the ability of the health service to respond to growing needs.
I hope that I have given you a good overview of the many initiatives and reforms underway across our health service.
Thank you for your attention. If there are issues that require clarification I am happy to provide further information to the committee after this meeting.
Finally you will have received an invitation from me to raise awareness about blood donation. I hope you are available after this meeting to join me in donating blood. A bus to Irish Blood Transfusion Service (IBTS) will depart from Leinster House at 1 p.m.