Opening Statement – Minister for Health, Leo Varadkar TD – Joint Committee on Health and Children

Opening Statement –  Minister for Health, Leo Varadkar TD,

Joint Committee on Health and Children

Cathaoirleach, members of the Committee,

Thank you for the invitation to attend. I’m joined by Minister Kathleen Lynch, HSE Director General Tony O’Brien, Deputy Director General, Laverne Mc Guinness, and members of the HSE Directorate.

Our last quarterly meeting was in May and I took the opportunity then to update you on progress on our 2015 work programme – 25 actions under five major themes.  I welcome the opportunity to give you a further update on those actions today.

Before I do that, obviously a major focus of attention at the moment is Budget 2016.  Discussions are underway between my Department and the Department of Public Expenditure and Reform. As nothing has been agreed I’m not in a position to go into any detail about what is contained in Budget 2016, for health, or for any other sector, as I’m sure you’ll understand.

What I can say is that the Exchequer funding provided in 2015 provided the first increase in seven years for the health services and was very welcome. However, pressures are arising in a number of areas, particularly in relation to expenditure on hospitals, demand led schemes and legal settlements.  You’ll also be aware that during the year, the Government decided to spend additional funds in a number of areas, including GP care without fees for children under 6 and adults aged 70 or over, and a new programme to manage diabetes in general practice.

The Government also committed additional funding of almost €100 million to address the issue of delayed discharges and ED overcrowding, as well as another €51 million to address long waiting times for public patients.

There will be a Supplementary Estimate to account for the additional investment in the services over the course of 2015. It is not yet possible to quantify exactly the level of the Estimate that will be required given in particular the uncertainty around demand lead schemes and legal settlements. My officials continue to work closely with the HSE to ensure that the greatest degree of budgetary control is exercised.

Getting back to the actions for 2015, the first theme is Healthy Ireland. Tomorrow, I will publish the results of the first Healthy Ireland survey.  It gives us an up to date picture of the health of the nation in areas like nutrition, alcohol consumption, smoking, physical activity, weight, sexual health and wellbeing. The last survey of this type was in 2007 so it is a timely and important update which will help to inform our policy choices in the years ahead.  I know that Committee members have been invited to the launch and I hope to see many of you there tomorrow in the GPO.

I plan to publish the general scheme of the Public Health (Alcohol) Bill very shortly.  Alcohol misuse is a blight on our economy, our society and our health services and the Bill will give us new powers and tools to tackle it.

The Department is developing regulations on tobacco packaging further to the approval by the Oireachtas of the underpinning legislation last spring.  It is, as you know, subject to legal challenge and we are also now addressing some other issues that have arisen relating to the appearance of tobacco packaging.  We will do this through technical amendments to the Act which we will shortly bring to the Government for approval.

On obesity, the Department recently published the results of its public consultation on how we can work together to address the challenge of overweight and obesity.  We’re using these results to finalise, by the end of the year, the new obesity policy and action plan.  This is a major personal and public health issue, in particular, for our children.  It’s vital we address it now, not just for our children, but for their children also.

Through the course of the year, we’ve been phasing in regulations and measures restricting the use of sunbeds to over 18s.  In August, we published guidelines on test purchasing to help Environmental Health Officers to enforce the Public Health (Sunbeds) Act and protect young people from the dangers associated with the use of sunbeds.

The second theme is patient outcomes and patient safety. As you know, I have taken a personal interest in Emergency Department overcrowding and have secured almost €85 million in additional funding this year to alleviate the problem. This has allowed us to reduce the waiting time for the Fair Deal Nursing Home Support Scheme from 15 weeks to four, which in turn has reduced delayed discharges in hospitals from 850 to under 600 now, freeing up 250 acute beds every day. It has also allowed us to open another 150 community beds, including Dublin’s first community hospital at Mount Carmel. More community beds will be opened before the end of the year. It’s also allowed us to increase investment in health services and keep patients out of hospital altogether, or allow them to get home earlier, thanks to community intervention teams, day hospitals, and acute medical admission units. This will continue.

While we have seen an improvement in patient experience times in our emergency departments, and a fall in numbers of people waiting on a trolley for more than nine hours, morning peak overcrowding has not improved and is still worse than the same point last year.

The next steps are to open about 300 additional hospital beds across the country in November and December, and the Director General and his team are visiting the worst affected hospitals to see what can be done to address other blockages such as diagnostics and rapid access to outpatients.

It’s also clear that we need more weekend discharges, and more evening ward rounds to reduce length of stay, and also senior decision makers reviewing patients shortly after or before admission, in order to reduce unnecessary admissions and length of stay.

I understand the distress and hardship that all of this is causing to patients and their families, and of course, staff.

On long waiting times for public patients, a total of €51 million in additional funding has been made available to hospitals to enable them to reach the 15 month maximum waiting time, either in-house, or through out-sourcing if necessary. In tandem with the additional funding the HSE launched a new initiative to ensure that hospitals comply with the new maximums and address any outstanding long waiters for inpatient and outpatient procedures. Hospitals which have breached the 18 month maximum waiting time in August are being fined from September. It’s accepted that for some sub-specialities, the capability simply does not exist in the public or private sectors or even abroad. So and exemption is made for these.

The third theme is Universal Health. Since we last met, we have put in place GP care without fees for the under 6s and over 70s. This represents the first step in the phased introduction of a universal GP service and is benefitting over 300,000 senior citizens and children.

And only last week we launched the Diabetes Cycle of Care for medical card or GP visit card holders who have Type 2 Diabetes. So far 30,000 patients have been enrolled. I hope this can serve as a model for other common chronic diseases, to be managed in general practice, or a primary care centre, rather than a hospital clinic.

The authorisation of the VHI by the Central Bank at the end of July is an important milestone. Lifetime Community Rating is now in place and there are 93,000 more people with health insurance now than at the start of the year. While there have been increases in many premiums, the age of double-digit annual increase is behind us.

I am a strong believer in universal healthcare, by which I mean access to affordable healthcare for everyone in a timely manner. But the foundations have to be put in place first. These include addressing some of the significant capacity constraints that exist in our health service, the full implementation of Activity Based Funding, the establishment of the Healthcare Pricing Office on a statutory basis, a new fairer Drug Reimbursement Scheme, and the further development of the Hospital Groups and Community Healthcare Organisations. I don’t think it’s something to be rushed, but I do think we can do something every year to significantly improve access to healthcare. Universal Healthcare, in steps.

The fourth theme is reform. I am very much behind the Hospital Groups. The CEOs and their senior teams are now in place, and I hope to appoint the remaining boards as soon as possible. Legislation is being prepared to establish the Children’s Hospital Group Trust on a statutory basis, and legislation to establish the other hospital groups can be done within two years.

Nine Community Healthcare Organisations have also been established. Together these reforms will enable the creation of a purchaser/provider split, the establishment of a Commissioning Body, and for the HSE to be dismantled during the term of the next Government.

One of my priorities is to ensure that Activity Based Funding is embedded across the health service. The HSE Healthcare Pricing Office has published an implementation plan which sets out objectives up to 2017. This is a great opportunity to use ABF to improve the quality and efficiency of inpatient and daycase treatment, and expand ABF into other services like outpatients. And after that, beyond the hospital walls to primary care.

The fifth theme is investment in modern infrastructure and facilities including ICT. Earlier this week the Government approved a capital envelope of more than €3 billion over six years for health, and public private partnerships to the value of €150 million.

This will allow works to begin on the four major national hospital projects next year, subject to planning permission. These are:

  • The new National Children’s Hospital on the campus of St James’s and the satellite centres in Blanchardstown and Tallaght;
  • The new National Maternity Hospital to be co-located with St Vincent’s;
  • The new National Rehabilitation Hospital in Dun Laoghaire;
  • And the new National Forensic Mental Health Hospital in Portrane.
  • It will also allow significant progress to be made on five major national programmes:
  • The National Radiation Oncology Programme, in Cork, Galway and Beaumont;
  • A major €300 million programme to refurbish or replace community nursing units and residential facilities for people with disabilities;
  • To continue to provide ten new primary care centres every year;
  • Relocating the three remaining stand-alone maternity hospitals, Rotunda, Coombe, Limerick;
  • A major investment in new ICT, including important projects such as the individual health identifier, online GP referral, the electronic patient record, and a new financial system.

Before concluding I would like to address the challenging area of recruitment in the health service. The challenges are real and well known, less well known is the very real progress being made. In relation to consultant posts, as of the end of July of this year, the HSE had filled more consultant posts than it had during the whole of last year. The number of consultants employed in the year to August 31st has increased by 72 net. That’s an increase from 2,623 at the end of August last year to 2,695 at the end of August this year. At the current rate, we could see as many as 130 additional consultants appointed this year. The vacancy rate is now falling and stands at about 170 (6.3%). In total, there are now almost 300 more consultants than when this government came into office.

While it remains the case that it is hard to fill vacancies in some specialties and hospitals, overall the picture is now improving.

The new pay scales agreed with the Irish Medical Organisation at the Labour Relations Commission mean that post-CSCT experience and relevant higher qualifications are now recognised for incremental credit, making posts more attractive financially.

We now have 5,500 Non Consultant Hospital Doctors (NCHDs), the highest ever, and a thousand more than when the government came to office. Nothwithstanding the difficulties in some rural and urban deprived areas, the number of GPs with a GMS contract is stable. This is, I know,  a somewhat different picture than others would have us believe. But these are the facts.

While overall nursing numbers are down on 2008, the number of midwives, advanced nurse practitioners and clinic nurse specialists is now also at an all-time high, with plans for further recruitment. As of the end of August, there were 44 more nurses working in our health services than at the start of the year and 578 more than this time last year.

In July, the HSE launched a new campaign to attract 500 nurses and midwives back to Ireland from the UK and elsewhere to fill vacancies. As of two weeks ago, over 300 applications had been received and were being shortlisted for suitability. Early indications suggest that the vast majority of the graduating class of nurses in 2015 are staying in Ireland. That’s really encouraging.  The spend on agency staff so far this year is €11 million lower than last.

In conclusion, 2015 is a story of some real progress in some areas amid growing challenges in others. We’ve reduced waiting times for Fair Deal to less than four weeks, reduced delayed discharges to the lowest in many years, stabilised the health insurance market to allow more people get covered, extended free GP care to the youngest and oldest as the first phases of universal health care.

We are turning the tide on recruitment of nurses and consultants.  However, ED overcrowding and long waiting times for public patients persist as serious challenges, as does financial control within the health service

I am going to allow Minister Lynch and the Director General give their updates next, but I will be happy to take questions later.