Speech by Minister for Health, Leo Varadkar TD to Seanad Éireann Health Priorities 2015

A Chathaoirligh

I very much welcome the opportunity to address Members of this House on the 2015 Health Budget and my priorities for the health sector next year.  
Budgetary Position
Since my appointment as Minister for Health, I have said, on more than one occasion, that my first priority was to achieve a realistic budget for the health service.  I firmly believe that we achieved that in Budget 2015, with an increase in the exchequer allocation of €305 million when compared to the 2014 allocation.We have also identified once-off increased projected revenues of some €330 million and savings and efficiencies of €130 million.  Taken together, this means that the HSE will have over €750 million more to fund services in 2015 than it did when preparing its Service Plan in 2014.  We are now entering a two year process which stabilises the budget and allows for existing levels of service to continue, along with some targeted enhancements.  Arising out of this, the spending ceiling for health in 2016 has also already been increased upwards by a further €174 million.  This does not mean that all areas of concern across the health sector can be addressed immediately but it does make the funding situation more manageable.  It also means that the cycle of cuts in health has come to an end.
Pressures on the health budget
Despite our additional spending power, next year remains a real challenge.  There are enormous cost pressures.  Drivers of demand and cost include our rising and ageing population and the increase in chronic conditions.  And, advances in medical technology come at a higher price.  Our progress in diagnosis and screening for cancers and chronic diseases means more people requiring treatments.  Health services all around the world are struggling with the issue of rising costs and Ireland is not exempt.  We must recognise the additional resource demands that come as a result of these pressures.In overall terms, therefore, while next year’s health budget remains challenging, its targets are achievable.  This challenge will be reflected in the HSE’s 2015 National Service Plan which will operate strictly within the resources available, deliver existing levels of service and provide for some targeted enhancements.  The Service Plan will also continue the programme of health service reform.
Efficiency & Accountability Framework
In 2015, we will have more control of our resources in the health service.  I already mentioned that specific savings and efficiencies of €130 million have been identified.  These are in the areas of procurement, drug costs, agency costs and clinical audit/special investigation.  However, a significant change for 2015 is that, where further savings or efficiencies are achieved over and above this minimum level, these will be retained and reinvested back into the health service rather than being used to reduce the deficit on our debt.  I hope that this new development can positively contribute to the reform and development of health services.The HSE will also have more autonomy on staffing and human resources in 2015.  The end of the moratorium on recruitment provides greater room for Departments and Agencies to manage their own staffing levels.  This decision was recently announced by the Minister for Public Expenditure and Reform.  It provides a basis for the health sector to take on more temporary and permanent staff in order to achieve savings on agency costs, subject to compliance with their overall pay allocation. This, in turn, provides the HSE with an opportunity to reduce pay costs where less expensive alternatives to agency personnel are available.  I believe this will facilitate a more sustainable workforce and greater continuity of care for patients.  
The HSE has issued a Memorandum to Management on measures to reduce agency usage and costs across the HSE and HSE funded acute hospital services.  It provides for the replacement of NCHD and Consultant agency with fixed term contracts of employment, and limits reliance on doctors employed on an agency basis to two months.  It also provides for the identification of nursing posts currently filled by agency staff which could be directly replaced by two year contracts of employment. These contracts will be offered to nurses currently participating in the Nursing and Midwifery Graduate Programme. With greater autonomy and capacity to reuse such savings for services comes an even greater responsibility for cost containment and cost avoidance.  With this in mind, the HSE, in preparing its 2015 Service Plan, will continue to develop and strengthen its accountability framework.  Management of health spending within available resources next year will require an exceptional management focus with strict adherence by all services and budget holders to their allocations.  The HSE’s accountability framework will set out the responsibilities of managers and will detail the means by which the health service (in particular hospital groups and community healthcare organisations) will be held to account in 2015 for their efficiency and control over service provision, patient safety, finance and HR.  It is also important that budgets are put in place without delay across the HSE and its funded agencies in order that monitoring of monthly expenditure against profile can commence from the very start of 2015.  This will help to ensure that spending remains within budget and that, where emerging trends give cause for concern, appropriate and immediate action can be taken.The return of the Vote to the Department of Health from 2015 is part of this improved accountability framework and will assist the HSE and the Department in its monitoring of health spending throughout next year.  
Health Reform
We are also continuing to progress the health reform programme.  Next year is an important year in demonstrating the benefits of key reforms in the health service.  We must all work collectively to improve safety, quality and the patient experience for those who depend on our services.  It is vital that qualitative aspects, such as the personal care and attention that patients receive, are the subject of focused efforts so that people’s experience of the health service is not only safe but caring and pleasant as well.  Such details can matter a lot to patients and their families.I particularly want the HSE to take an integrated approach across acute, community and residential care settings to ensure that patients are supported at all stages in the care setting that is most appropriate to their needs.  This is most important in the context of the establishment and further development of the Hospital Groups and Community Healthcare Organisations.The reorganisation of public hospitals into Hospital Groups is designed to deliver improved outcomes for patients.  Each group of hospitals will work together to provide acute care for patients in their area integrating with community and primary care.  The objective is to maximise the amount of care delivered locally while ensuring that highly specialised and complex care is safely provided in larger hospitals.  The next phase of implementation of the Hospital Groups will be to develop Strategic Plans in 2015.The Government remains committed to the introduction of the ‘Activity-Based Funding’ funding model whereby hospitals are paid for the actual work they do, in terms of case load and quality outcomes.  The funding model will drive efficiency and increase transparency in the provision of high quality hospital services.  The HSE intends to further implement this new funding model on a phased basis during 2015.Recently, the establishment of Community Healthcare Organisations by the HSE represents an important step in improving how care in the community is delivered.  The new structures will improve services for the public by providing better and easier access to services, closer to where people live, in which people can have confidence.Separately, I have been impressed with the work of the National Clinical Programmes.  They have greatly improved services in many specialised areas, such as stroke and cardiology.  It is planned to organise these National Clinical Programmes into five integrated care programmes.   I hope to see these new integrated clinical programmes embedded into the HSE Service Directorates as it is important that they are very much at the centre of operational delivery and reform.  Structural reform is never an end in itself.  It is, however, a valuable tool that can help us do more and better with the additional resources we now have.  Better structures empower people to deliver better care.  
Services to be Delivered in 2015
In terms of services, my aim is to ensure that existing levels of service are delivered in 2015 and that some targeted enhancements are also introduced.  I have already signalled that Programme Government Commitments on the extension of BreastCheck and investment in mental health will be honoured.  Extra funding of €25 million will also be provided to tackle the issue of delayed discharges, which is having a detrimental knock-on effect on waiting times and Emergency Department overcrowding
GP Services
In 2015, we will deliver on the first phase of Universal Health Care.  Some 240,000 children aged 6 years and under will be able to access a GP service without fees.  This accounts for about 57% of the total population of children in this age group.  43% are already covered by the medical card or GP visit card.Approximately 10,000 seniors aged over 70 years, who currently have neither a medical card nor a GP visit card, will be provided with free GP services without fees. By the end of next year, almost half of the population (49%) will have access to GP services, without charges.  That’s a major step on the way to universal health care.
Mental Health
Budget 2015 provides for an additional €35 million ring-fenced for Mental Health.  This will bring to €125 million the total investment by the Government in mental health services since 2012.  The additional funding will enable the HSE to continue to develop and modernise our mental health services in line with A Vision for Change.  This includes the ongoing development and re-configuration of adult and child and adolescent mental health teams, along with other specialist mental health services.
A Chathaoirligh, Breast cancer survival rates in Ireland have improved significantly in recent years through a combined approach of screening, symptomatic detection and improved treatment.  Additional funding is being provided to commence the extension of the BreastCheck screening programme next year to women aged 65 to 69 years of age.  Screening of the extended cohort will commence towards the end of 2015 and will be expanded on an incremental basis. The additional eligible population is approximately 10,000 and, when fully implemented, 540,000 women will be included.
Delayed Discharges
Senators will be aware that there has been a continuing upward trend in delayed discharges since the beginning of the year, with 768 delayed discharges reported nationally, as of last week.  These are people who are well enough to leave hospital but do not have a nursing home or home care package in place for them to do so.  They are often elderly people and they should not be left in hospital, where they are at a higher risk of a fall or getting an infection.While there will always be delayed discharges, current levels are resulting in more people on trollies and more people having their elective admissions or surgery cancelled.In response to these concerns, the Government has provided additional funding of €25 million in 2015 to address delayed discharges.  This funding will be targeted at hospital and community services which can demonstrate initiatives to address the specific needs of delayed discharge patients most positively and, therefore, improve timelines for admissions from Emergency Departments and waiting lists. These will include measures to place patients in more appropriate settings through the use of home care packages and intermediate and long term care.  
Healthy Ireland Survey
We are all aware of the statistics on the rates of obesity, diabetes and other chronic conditions in Ireland.    That is why improving the health of the Irish population continues to be a priority in 2015.
My Department recently commenced the Healthy Ireland Survey.  This is a major nationwide survey to find out how healthy Irish people actually are.  We haven’t had a comprehensive survey since 2007, and there have been huge changes since then. More people are aware of the importance of diet, lifestyle, health, wellbeing and mental fitness.  But as a nation we now face even bigger challenges on obesity, physical inactivity, diet and many other areas.  This new survey will give us an up-to-date picture of the nation’s health, and will provide us with a baseline set of data telling us how healthy or unhealthy Ireland is.  The survey will provide us with a snapshot of key indicators which influence our health, right across the population. These include nutrition, alcohol consumption, smoking, physical activity, weight management and wellbeing.Participating in the survey is entirely voluntary, so I want to thank in advance everybody who agrees to take part, as their participation is of enormous value.  We can also then use future surveys to assess whether or not our policies are working.
Patient Safety
It is of the utmost importance that patient safety remains an overriding priority across the health service in 2015 and this will be reflected in the HSE’s Service Plan.All health service staff, individually and collectively, will continue to have a responsibility for the quality of services they deliver to the patients and service users in their care.  It is important that they integrate a commitment to quality and safety into their core work and practice.  Priority areas that were identified in last year’s Service Plan will continue to be the focus of attention and include medication safety, healthcare associated infections and the implementation of the national early warning score.  The Health Identifiers Act 2014 provides the legislative framework for a national system of unique identifier for patients and for health service providers for use across the health service, both public and private. Individual health identifiers or IHIs are designed to make sure that the right information is associated with the right patient at the point of care.In addition, identifiers will help make our health service more efficient and will support health reform initiatives including Money Follows the Patient.  Health identifiers are a fundamental building block in support of the eHealth agenda.  The HSE is working to establish the necessary health identifier registers and will manage the operation of the identifiers system.  The provision of identifiers will commence as soon as possible in 2015.
Patients benefit most from safe and cost-effective care.  Therefore we need suitable and appropriate facilities to support health care delivery.  It is important to recognise and acknowledge that we have managed to deliver significant projects large and small since March 2011.  More have commenced.  Investment in high quality health care infrastructure also has an important role in supporting communities.  It sustains local employment because of the health care presence throughout the country.  Progress to date and future planning demonstrate this Government’s commitment to infrastructure developments in health care as set out in its Programme for Government.The priority in 2015 will be to ensure that all projects remain on schedule and are delivered on time.   I would like to update Members on the capital developments which are ongoing and which will continue in 2015.   Since March 2011, 42 primary care centres have been delivered – which is almost one each month.  There are about 30 underway – including the 14 locations to be delivered by the PPP project, and a further 50 locations where projects are at earlier stages of development.  

  • The relocation of the National Maternity Hospital, Holles Street to St Vincent’s is on schedule.  
  • The design team has recently been appointed for the children’s hospital and is working to a demanding schedule.  Planning permission will be lodged by the summer.
  • The Strategic Infrastructure Development (SID) planning application was lodged with An Bord Pleanala in September last for the new mental hospital at Portrane.  It is expected that a planning decision will be made in the first half of 2015, after which the enabling construction works and contractor procurement process shall commence.  
  • There has been considerable investment to date in the community nursing home programme as regards new build and refurbishment. This investment is on-going.  Earlier this year the HSE purchased the Mount Carmel campus.  This refurbished facility will provide much needed capacity for the Dublin area, providing a variety of places in transitional, step-down and long-term care.
  • Our objective will always be to provide high quality, safe and supportive settings across the country.  
Service Plan
I have recently written to the HSE outlining their funding allocation for 2015 and highlighting the key areas to be prioritised in the 2015 Service Plan.  The next step in the process is for the HSE to approve and submit its 2015 Service Plan for my consideration.  The Plan will set out in detail the volume and type of health services to be provided next year within the agreed allocation.  Considerable work has already been undertaken by the HSE on the preparation of next year’s Plan.  Once the service planning process has been concluded, the HSE will publish the Plan and will immediately set to work on ensuring its full implementation.
Senators, I would like to take this opportunity to pay tribute to healthcare staff who have been through some very difficult years.   It’s due to their hard work and dedication that the Irish health service has survived the most challenging period in its history. We still face many difficulties but there’s every reason for optimism and believing that things can become more manageable next year.