Opening Statement by Minister Reilly at the Joint Committee on Health and Children

Check against delivery

Thank you Chairman, and thank you to the members of the Committee for the invitation to meet you today.  I am accompanied by Minister White.  Minister Lynch could not attend because of a personal bereavement, which the committee is aware of.  I’m sure you’ll join with me in sending our condolences to Kathleen on her loss.

I’ll give my opening statement and then we will deal with any questions the committee may have.  I will address the rare diseases centre, as you have requested.  You’ve also asked for an update on the current position regarding Section 38 and 39 funded agencies and Mr O’Brien will address this issue is his Opening Statement.

First though, as the Committee is aware, I launched the White Paper on Universal Health Insurance yesterday.

The White Paper underpins the Government’s resolve to deliver on the Programme for Government commitment to end the current unaffordable and unfair two-tier system and establish a single-tier health service where access to services is based on need and not on ability to pay.

The Government is keen to engage with the public and stakeholders on this major policy reform of the health service.  This gets to the heart of what we want from a reformed health service – accountability and transparency.  Yesterday’s launch of the White Paper is the beginning of a “national conversation” about UHI and the future of our health services.  Government is keen that this committee will be instrumental in enabling that “national conversation” to take place.

At the launch yesterday, we started a formal, public consultation process.  I would encourage everyone to engage in that consultation and the easiest way to do so is through our website.  The process is open for the next eight weeks, to the end of May.

We’ll also – separately – be consulting on the future health basket, including the services to be covered under UHI.  As important as it is to decide what will be in the basket is the values framework that underpins those decisions.  Under UHI, everyone will be insured and will have equal access to a standard package of services, based on need and not on ability to pay.  If that goal is to be achieved, we need to involve the people in the process and this Committee will be invited to conduct hearings on the values which should underpin decisions on the future health basket.

In relation to the basket of services, I will be establishing an Expert Commission in the coming weeks. The Expert Commission will advise on the basket of services, and they will take account of the values framework.  This committee may consider those costed options and the Government will then make a decision on what goes into the basket.  It’s important to note that the Commission will be consulting with the public – it won’t work in isolation.  Again, this goes to the values of transparency and accountability.

The core value of UHI is equity.  No preferential access based on ability to pay, and a system of financial support to pay for or subsidise the cost of standard UHI policy premiums for those who cannot afford them.  People will still be able to pay privately for services not included in the standard UHI package or purchase supplemental health insurance cover for these, but insurers will not be allowed to sell insurance that provides faster access to services covered in the UHI standard package of care.

I won’t go into all the details of the White Paper but I do want to talk about costs.  Obviously, costs are a concern – for this Government, for stakeholders, for families and communities.  As Minister for Health, I want a health service that meets people’s needs but does so efficiently.  Over the last few years, we have delivered significant savings to the Exchequer in our health services and we have managed to maintain – and indeed improve – services.  UHI is part of the overall plan to ensure we can continue to deliver efficiencies but over the medium to long-term.  We have generational challenges to face – like chronic diseases, obesity, tobacco, alcohol misuse – as well as continuing to provide acute and primary care today and tomorrow for our citizens.  That’s why UHI is so important, not just as an end in itself, but as part of a series of interlinked reforms that will deliver a health service fit for the 21st century.

That’s why along with delivering on UHI, we are delivering on Money Follows the Patient, which is a more cost-effective way of paying for vital health services.  It’s why we launched Healthy Ireland, our strategy for improving the health and wellbeing of people in Ireland.  It’s why I am so deeply committed to making Ireland tobacco free by 2025, as set out in Tobacco Free Ireland.

At a very practical level, along with these strategic plans, the White Paper sets out a cost control framework that will ensure affordability and that costs are kept to a minimum. The cost control measures included range from price monitoring of insurers and setting maximum prices for health care providers, to more aggressive measures such as capping insurer overheads and profit margins.

We have a job of work to do in estimating the costs before we implement the reforms inherent in UHI.  This is only right.  It’s only sensible. We need to take into account not just the basket of services but the demand for and utilisation of healthcare, service delivery models, payment systems and regulatory and administrative costs. My Department will progress work in this area during 2014, to be completed in January, 2015.

Then, and only then, will we proceed with drafting of legislation to give effect to the reforms set out in the White Paper, with the approval of Government.  The goal is to introduce UHI by 2019.

If UHI can be seen as our final destination, then structural reform describes the road we must follow to that destination.  We’ve already made good progress with new HSE governance and management structures, establishing hospital groups on an administrative basis and establishing the Child and Family Agency.  The Health Service Executive (Financial Matters) Bill, which I published in December 2013, provides for the HSE to be funded through the Vote of the Office of the Minister for Health from January 2015.  The Bill is currently before the Dáil at second stage and I expect enactment  before the summer recess.

We will also be establishing new and revised structures for Primary, Social and Mental Health Care. This will follow on from the recent Integrated Service Area Review carried out by the HSE.

The next stage is the set up – on an administrative basis – of the entities that will bring in the purchaser/provider split.  We already have the Healthcare Pricing Office attached to the HSE and a new shared services division is up and running as well.  We will be working further on the Healthcare Commissioning Agency, a Patient Safety Agency and a national entity to promote health and well-being as well as the evolution of hospital groups to trusts.  We will also be putting the revised primary and social care delivery system on a statutory footing.

My Department is preparing legislation to set up the new structures on a statutory basis and I have put a high level Steering Group in place, led by the Secretary General, to oversee this process.

The third and final phase of structural reform will see the move to a combination of universal health insurance funding for acute hospital and certain primary care services, with general taxation funding for other services including social care services such as disability and long-term care.  At that point the Healthcare Commissioning Agency will divest some of its purchasing functions to health insurers under UHI.

I’ve mentioned the importance of health and wellbeing and in particular, tobacco control.  We are ten years on from the workplace smoking ban and research has found that the smoking ban resulted in over 3,700 fewer smoking related deaths. This is indisputable evidence that tobacco control measures are saving lives, and improving our overall health as a nation.

The measures that have followed have worked – a decline of 7.5% in the number of Irish adults smoking since the last large scale study in 2007.  Our work will continue – we’re aiming for a smoking prevalence rate of less than 5% by 2025.  We propose to introduce a Tobacco Licensing Bill, in order to introduce a licensing system and other measures in relation to the sale of tobacco products. As you know, I was very pleased that we received approval from Government last November to proceed with a new Public Health (Standardised Packaging of Tobacco) Bill 2013. I want to thank the Committee again for the valuable contribution you have in that area, and for the assistance you will provide to me and my officials in introducing the legislation. We won’t be complacent, we can’t afford to be – in every sense of the word.  We’re saving money but more importantly, we’re saving lives.

You’ve asked that I address the issue of a national office for Rare Diseases.  As this Committee is aware, Rare Diseases place a significant burden on patients and their families. The important work of developing the National Plan for Rare Diseases continues and is close to being finalised.

This policy framework relates to the prevention, detection and treatment of rare diseases based on the principles of high quality care, equity and will be patient centred.  The Plan will deal with the prevention, diagnosis and care of people with rare diseases; enhancing access to orphan drugs and technologies; responding to the needs of patients with rare diseases and their carers; and research into the area of rare diseases.

My Department’s Steering Group is also considering for its report the development of a national office for rare diseases.  Its purpose would be to facilitate and support the HSE in the coordination of Centres of Expertise for rare diseases, both nationally and internationally.  This office could act as a national point of reference on services, diagnostics, on care pathways and on information relating to rare diseases. The report by my Department on recommendations for dealing with rare diseases, including the establishment of a national office, is being finalised and the Department’s officials have met with the Health Service Executive about the implementation of the report.  In the meantime, the HSE is developing a business case about the establishment of such an office.

In addition, the HSE has established a National Clinical Programme for Rare Diseases. A National Clinical Lead has been appointed and a programme manager is in place. The Programme aims to improve and standardise patient care for  individuals affected  with rare diseases in Ireland, by increasing detection and prevention, facilitating early timely diagnosis, intervention and coordination of care, and increasing awareness, information and support.  The Programme has already started its work in mapping out current services and developing care pathways for patients with rare diseases.

That concludes my opening statement – we’re happy to deal with your questions.