Opening Statement – Minister Varadkar at Joint Committee on Health and Children

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Opening Statement – Minister for Health, Leo Varadkar TD

Joint Committee on Health and Children

Quarterly meeting, 13 May 2015

Cathaoirleach, members of the Committee,

Thank you for the invitation to attend. I’m joined by (insert names)

You will recall that at the start of the year, Minister Lynch and I set out our work programme for 2015. It contained 25 actions under five major themes as follows. I want to touch on each of them briefly and record some of the progress being made.

Theme 1
The first theme is Healthy Ireland. We need to improve our health as individuals and as a nation. This is the best way to ensure we live long and healthy lives and the most effective way to prevent illness and to reduce health costs in the long term.

Minister Reilly’s legislation on plain-packaging on tobacco was signed into law by the President on 10th March and my Department is currently drafting regulations on the prescribed aspects of the Act.  It is, as you know, subject to legal challenge.

The General Scheme of the Public Health (Alcohol) Bill was approved by Government on 10th February. I intend to publish it before the summer recess. As it has already been subject of a dedicated committee meeting, I won’t say any more on it today.

Provisions under the Public Health (Sunbeds) Act 2014 requiring health information, warning signs, prohibitions on certain marketing practices, health claims, notification requirements, fee and fixed penalty notices were commenced in February and March. This will discourage younger people in particular from using sunbeds, while imposing stricter regulation on providers.  It will reduce skin cancer prevalence and save lives.

Recent statistics reveal that 61% of Irish adults and 1 in 4 primary school children are now overweight or obese. My Department held a major stakeholder consultation at the end of April on what we need to do collectively to address the challenge of overweight and obesity. The consultation brought together key stakeholders to prioritise the actions which Government and other sectors need to take over the next 10 years to tackle overweight and obesity. A new Obesity Policy and Action Plan will be finalised this year and brought to Government for approval

While some comments and reports on the matter in recent weeks were sensationalised and not evidence-based, which serves no good, it is a real personal and public health issue and needs to be taken as seriously in the future as tobacco in the recent past and alcohol now.

Theme 2
The second theme is patient outcomes and patient safety. As you know, I have taken a personal interest in Emergency Department overcrowding. Overcrowding in our hospitals has eased since January and is trending downwards. Progress is being made but it is still remains higher than at this point last year. Similarly, the number of delayed discharges has fallen from a peak of 850 but remains at about 680.

At the beginning of April the Government approved additional funds of €74 million to reduce delayed discharges by providing €44 million to the Fair Deal scheme resulting in an additional 1,600 places, and €30m to provide an extra 250 convalescent and rehabilitation beds in community and district hospitals. The implementation of these measures has now begun but will take about eight weeks to fully implement. As of 30th April there were 575 people on the Fair Deal waiting list with an average wait time of 4 weeks, down from 11 weeks at the start of the year.  More than half of the additional community and district hospital beds are now open.

The Emergency Department Taskforce Report needs to be fully implemented and I will personally drive this. There will always be surges in demand, and all health services have patients on trolleys from time to time, but trolley waits of 9, 12 and 24 hours represent a real patient safety risk and need to be reduced considerably.

I have mandated the HSE to ensure than nobody is waiting more than 18 months for a surgical procedure or out-patient appointment by July, and no more than 15 months by the end of the year. I know that may not seem very ambitious, and it’s not, but within current resources, it is realistic and achievable in all but a small number of sub-specialties.  While the numbers of waiting lists are likely to continue to rise as demand rises, I want to make sure that those who are waiting, are not waiting as long.

On patient safety, we are continuing to develop and monitor the implementation of the National Clinical Effectiveness Guidelines (6 to date with a further 2 currently in development – National Paediatric Early Warning System, and Clinical Handover (Acute Services)) and develop better implementation of HIQA recommendations. The HSE/SCA Open Disclosure Policy is now being used in 47 Acute Hospitals and five PCCC areas up from 15 hospitals and one PCCC area in 2013.

Theme 3
The third theme is Universal Health. Agreement was reached with the IMO in April on GP care without fees for the under 6s and over 70s, and on the introduction of an Asthma care for kids and a Diabetes Cycle of Care for medical card or GP visit card holders who have Type 2 Diabetes. This represents the first step in the phased introduction of a universal GP service and will benefit over 300,000 senior citizens and children this summer

On Universal Health Insurance, I firmly believe that we need to make health insurance more affordable before we can make it universal. At the end of 2014 I announced a number of actions to achieve this. These include; a reduction in Risk Equalisation stamp duty, a reduction in the HIA levy, no further diminution of tax relief, discounts for young adults and, last month, the introduction of Life-time Community Rating. As a result some premiums have been reduced, others frozen and new affordable products are on offer. The number of people with insurance is rising again and initial indications suggest that a very large number of people signed up in the past few weeks to beat the LCR deadline.

Theme 4
The fourth theme is reform including greater investment in IT, which saw a 30% increase in budget this year to €55 million. Key IT projects include e-referral, electronic patient records and the issuing of the first individual health identifiers later this year. I would encourage the committee to invite Richard Corbridge in to brief you on the plans.

Theme 5
The fifth theme is investment in modern infrastructure and facilities. The most important of these is the new Children’s Hospital, the biggest single health infrastructure project ever in the history of the State. The planning application for the hospital will be lodged this summer and subject to An Bord Pleanala’s decision, we could have planning permission by Christmas or early in the New Year, with construction commencing soon after.  I visited Great Ormond Street in London this week and I can assure the committee that the new Children’s Hospital we have planned will be more modern and have more beds and operating theatres than any in the United Kingdom.

On the overall financial position of the health service, the latest figures from the HSE demonstrate the significant challenge facing us as a result of the changing demographics in Ireland. Over the next few years, the population aged 65 and over will increase by approximately 20,000 per year placing increased pressure on our acute hospital, community, and social care sectors. We will continue to work to develop safe quality services for patients, while at the same time looking for ways to reduce costs.
While it is difficult at this stage to draw conclusions as to the year-end position based on data from January and February, due to a number of factors, including the exceptionally high level of delayed discharges during these two months, the new measures recommended by the ED Taskforce and agreed by Government, along with the ongoing reform of practices and processes in hospitals, are beginning to show results.

Current expenditure projections are preliminary in nature, and my Department and the HSE are working together to understand the deficit to date and the likely full year impact of this variance, and emerging and known funding pressures. The HSE is moving to reduce overspending and is working closely with the Department to mitigate the projected deficit to the greatest degree possible. Tony will speak on this further if you wish.

Maternity Services
I want to turn now to maternity services and, in particular, to the recently published HIQA Report on Portlaoise Hospital.

Many aspects of the HIQA report disturb me. I am ashamed at the manner in which patients were treated without respect, care and compassion when they most needed it by members of my own profession and other professions. Many did not receive the quality of care we should expect from a modern health service in the developed world. Patients and their families were treated dreadfully and at times inhumanely.  As I have said previously, it is not all about resources and we should challenge those who seek to make resources the excuse for all failings. If we allow it to the be an excuse it will always be the default excuse. That in itself is a threat to patient safety. It costs nothing to care. Honesty costs nothing, neither does compassion.  Adherence to professional standards and being properly trained and accredited to do ones job should be a given. Too often, it’s not.

The report highlights the urgent need to embed a patient safety culture right throughout the health service. I intend that this should not just be another report. It should be a watershed report. Patient safety, outcomes and quality must never come second to institutional, corporate, staff or local political interests. Decisions made on resource-allocation and service location must be made on the basis of what is best for patients in terms of safety or outcomes not financial savings or votes.

Having met some former patients and there families last night, I am more convinced than ever that a patient advocacy service should be established and it will be fully independent of the Health Service Executive.  All mistakes are not medical negligence and mistakes and misjudgments will always happen. And all complaints will not be upheld. But we need to move to a new culture when complaints are welcomed and seen as a tool to use to guide us in improving services and patient satisfaction. Too often and for too long the health service is defensive in dealing with complaints, fails to deal with them in a timely manner and therefore adds insult to injury and hurt on hurt. An Independent Patient Advocacy Service will be crucial in supporting patients and changing that culture.

I accept the HIQA report in full and thank the investigation team for their work. The four recommendations made to my Department will be implemented. The HSE has confirmed that it too will implement the four recommendations made to them. I expect the HSE to implement an Action Plan to address the findings of the report without delay, certainly by the end of the year.

Improvements have been, and will continue to be made at Portlaoise hospital. New management and governance structures, both clinical and operational are in place, including a new hospital manager and a Director of Midwifery for the first time, as well as an on-site risk manager.

Appointments have been made to key posts of concern in both the maternity and general services. This includes additional consultants in anaesthetics, surgery, emergency medicine, paediatrics and obstetrics. 16 additional midwives have been appointed and approval has been given for further midwifery posts to include shift-leaders, and posts in diabetics and ultra-sonography. An ambulance by-pass protocol is in place for serious paediatric and trauma cases.

Structural change has begun, with Portlaoise now forming part of the Dublin-Midlands Hospital Group. Governance of the maternity service will transfer to the Coombe in line with an MOU, agreed already.

At the end of April, I appointed a Steering Group chaired by Ms Sylda Langford, former Director General of the Office of the Minister for Children and Youth Affairs, to prepare a new National Maternity Strategy for Ireland. In doing so, I am implementing one of the recommendations of the HIQA Report into the care of Ms Savita Halappanavar.

The new National Maternity Strategy will put the needs of mothers, babies and their families at its centre. The focus will be on maximising patient safety, quality of care, and clinical outcomes as well as the desirability of greater patient choice, the move towards more services in the community, and a renewed focus on prevention and wellbeing. I have asked the Group to report to me by the end of the year.  Ten years ago, cancer care in Ireland was below standard and fragmented, today it is well organised and survival rates are improving all the time. I want to adopt the same programmatic approach to Women’s and Infant Health in the next decade.

There are a number of other initiatives and developments which I would be happy to update you on but I know that time is pressing and committee members want to hear from Tony O’Brien and then ask questions, so I’ll conclude there.