Opening Statement – Private Members Business Minister for Health, Dr James Reilly T.D.

A Chathaorleach/Ceann Comhairle,

This motion could be described as mere political opportunism because that is what it is.

It’s the empty noise of a party that ran out of ideas and idealism a long time ago.

A party that has damaged each and every family in this country because of the economic collapse they presided over.

A party that sold our nation down the river.

It’s a bit ironic to be charged with poor governance by a party

  • That left this government with the biggest budget deficit in our history
  • That through collective incompetency, lost Ireland its economic sovereignty, damaged our credibility and international reputation
  • That gave new meaning to the “brown envelope “and seriously discredited our system of Government

I’m not going to engage in political rhetoric. I’m going to deal rather in facts and measurable outcomes.

I just want to say at this stage, to paraphrase Bill Clinton….

…..what Fianna fail is giving out about is the speed with which Government is clearing up the mess they, Fianna Fail, created.

Yes Deputy Martin, your mistakes, your mess.

The health budget grew in the 14 years of FF/coalition governments by over 320% from € 3.6b to over €15b. During his time as Minister for Health, Deputy Martin spent €13.8m on management consultancy. With all that advice and increased funding one could expect balanced budgets. What we find instead is that Micheal Martin during his tenure still managed to over shoot his Department budget and had to be bailed out with supplementary budgets amounting to €664m. Between 1997 and 2010 €2.2billion was spent on supplementary estimates during Fianna Fail’s period in office.

Michael Martin, as Health Minister during the best economic times, couldn’t control the health spend, yet he has the nerve to criticise those who have controlled it – in the worst economic times.

The challenges besetting our health system are a direct result of Deputy Martin’s fatally flawed budgetary and service planning processes. A recent external and independent review highlighted that the governance and control framework in the HSE lacks clarity, is not properly embedded and does not enable effective control to be exercised over voluntary providers. The financing and operating models are tied to antiquated health board structures and there are significant inconsistencies in approaches to analysis and financial performance management and data collection.

Lets not forget that Deputy Martin was the designer in chief of a new health service where he created an unaffordable, unsustainable and grossly inefficient beauracracy. So instead of getting the normal efficiencies that one gets from merging 11 different companies and reducing overheads we got all the idiosyncratic inefficiencies of 11 different health boards. That still haunts us to this day in terms of financial reporting mechanisms, different ways of counting things, different ways of coding things – information that’s nigh on impossible to analyse.

All the focus was on inputs, instead of looking for outputs and examining outcomes for patients and applying best practice.

I have put in place a financial improvement programme and new performance management arrangements are in train. The new finance improvement programme will transform the way financial management is handled across the health system, working in partnership with all in the sector, supporting capability and capacity building.

Patients, Ceann Comhairle, are the priority – not inputs, not money, Patients, and what happens to them, that is what really matters.

And I’ve often said that no matter how elegant the design or eloquently it is delivered if it doesn’t improve patient outcomes it is for nought.

I found the following when I became Minister for Health:

  • Systems that don’t communicate with each other
  • No analysis of problems merely descriptions of the problems
  • A history where my predecessors where informed of budget overruns. Lámh amach agus airgead isteach….not, “why have we an overrun and what are we going to do about it?”

I am primarily a doctor, a latecomer to politics, but I do know one thing; you don’t just look at the signs and the symptoms. You treat the cause of the problem. You have to analyse the cause and you must have your diagnosis before you start your treatment.

And that is what we have done. The Special Delivery Unit headed up by Martin Connor analysed why it is we have overcrowding in our Emergency Departments particularly every January. Every hospital is different but we are successfully tackling the causes of overcrowding on a site by site basis.

So we didn’t allow that to happen this year. We didn’t get the 569 patients that we saw on trolleys in January 2011, a little more than 18 months ago.

The SDU in conjunction with the clinical programmes and frontline staff knew what the diagnosis was and prescribed the treatment between them and the consequence of that today is despite €1.75billion being taken out of the system and another €750m this year we have 20% less people lying on trolleys, over 13,000 people less so far this year.

To guarantee the integrity of the count, we accept the figures of the INMO, and we go further, we measure it 3 times a day so now we can predict what is going to happen and take action – something that was not possible before and something which you and your Government failed to do in 10 years.

At this point, I would like to express my appreciation to Dr. Barry White for his considerable efforts in his term as the Director of the Clinical Care Programmes. Dr. White is now returning to his clinical consultant post but I am please to announce that he will continue to work closely with me and my Department. The Clinical Care Programmes have three main objectives – to improve the quality of care, to improve access and to improve cost-effectiveness. They will do this by modernizing the way hospital services are provided across a wide range of clinical areas.

So let us look at what we have done since the Government came to power a mere 18 months ago.

  • A 20.6% year on year reduction in the number of patients waiting on trolleys – or over 13000 less people.
  • A reduction from an all time high of 569 patients on trolleys on 5th January 2011 to 139 on 7th September 2012 – a 75% reduction
  • Overall surgical waiting list numbers have decreased in the last year by 7%, while every time band has seen a substantial reduction with those waiting over 12 months down by 85%, those waiting over 9 months by 63%, and those waiting over 3 months by 18%.
  • The Health Service (Governance) Bill 2012 has been published which provides for the abolition of the HSE Board and its replacement with a new Directorate and Governance structures. A Director General Designate has been appointed and is already taking action to change and reform the system.
  • The Health (Pricing and Supply of Medical Goods) Bill 2012 is before the Seanad and will provide for reference pricing and reductions in generic drug prices.
  • Restrictions on GPs wishing to become contractors under the GMS have been abolished.
  • A programme for the development of 20 primary care centres, using public-private partnerships, has been established.
  • The development of chronic disease management programmes are in train, particularly for the management of diabetes which is at an advanced stage
  • I have been particularly concerned about the outcomes for stroke victims and we now have a programme to save lives and improving the quality of life for patients. When fully implemented we are confident it will save 1 life per week and avoid serious disability for 3 people every week.
  • The new 40 bed facility for cystic fibrosis patients at St Vincent’s University Hospital has opened removing the dread of cross infection from this most vulnerable group of patients.
  • We have ongoing progress in introducing new models of care across all service delivery areas to treat patients at the lowest level of complexity and provide quality services at the lowest cost.
  • The restructuring of the hospital sector has commenced and two pilot hospital groups have been established at Limerick and Galway.
  • Specific work has been undertaken to enable the introduction of ‘money follows the patient’ funding methodology. This means a patient centred service……..no patient treated no money paid. This saved €6m in expenditure on orthopaedic services alone.
  • Complex negotiations are progressing with the Irish Pharmaceutical Healthcare Association (IPHA) to further reduce the price of certain medicines;
  • ongoing progress in mental health services in the implementation of ‘A Vision for Change’, with particular improvements in child and adolescent mental health services;
  • Advances in the care of older people with over 22,000 people in receipt of financial support for long-term nursing home care;
  • A catch up HPV vaccination programme for girls in 6th year of secondary school has been introduced – 48,000 vaccinated to date
  • An improved risk equalisation scheme for Private Health Insurance will take effect from 1st January, 2013. This will be central to the effective working of a community rated health insurance market.
  • €125m will be collected from the health insurance system by the year end following intensive discussions.
  • The Clinical Programmes freed up 70,000 bed days last year. That’s a real saving of €63m. This year that figure will be a lot higher, in the region of €90m.
  • We have a new clinical programme being rolled out currently in relation to transitional care for older people so that those who are in this category will be admitted to a ward will have their medical problems dealt with in the first 48 hours and will commence rehabilitation.

Real people have benefited from these achievements and this Government’s reform programme. This could be your daughter, my brother, his sister, her mother. There are still too many people waiting and we want to go further and we will.

We now have for the first time, de facto, 24/7 rostering meaning that consultants will be rostered 5 days out of every 7 (Saturdays and Sundays included). They will be available at night. This will further shorten the stay of patients as we have senior decision makers available 24 hours a day and I believe this will also result in less tests saving more money aswell. It will also reduce the need for Non Consultant Hospital Doctor overtime. It will also save us some 220,000 bed days. All this will save, conservatively, €200m in the running of our health services. But most importantly what it will do is it will improve the quality of care available to our citizens and will mean that more patients can be treated more quickly because the one thing I undertook to do was to change a self serving system back to a patient centred service.

I wish to state that in excess of €310m will be spent on Home Help and Home Care packages this year. I want to assure the House that those in need will continue to receive the required service.

We have travelled along way along that road but have further to go. The new consultant arrangements are an important step on that road and I want to thank all those involved for the leadership they’ve shown in this regard.

I have to thank all the clinicians, managers and support staff for their hard work in ensuring that all this has been possible despite the fact that 4,000 people have left the health service in the last year. Despite the fact that we are operating under much reduced budgets.

Can I just say that as an Irishman I believe that what makes Ireland a great country is not the wonderful landscape, the rivers and the green fields but the people, their resilience, compassion and their capacity for innovation. I similarly believe the health service will be one of the best in the world because of the great people working in it.

It is my honour and privilege to serve as Minister for Health and to be part of this historic change in our health service. Change for the benefit of all our citizens. I intend to continue in this role, to continue the reform and to always put the patient first.