Dr James Reilly TD, Minister for Health Priorities for the year ahead on the publication of the Third Annual Report on progress on the Programme for Government, 6 March, 2014

6th March, 2014

A cathaoirleach.

It is clear that 2014 will be a very challenging – perhaps the most challenging – year for the health services.

It should be just as clear to members of the House that we have made significant progress since this Government came to office in March 2011.

I want to reflect on the progress made and outline our priorities in the health sector for the year ahead.

We inherited an economy in freefall and a health service in crisis. We have since stabilised the economy as we have stabilised our health service. Just as we seek to implement fundamental reform in our economy to boost job creation and make us the best small country in which to do business, we are implementing fundamental reforms of our health services to provide our people with a health service that they can be proud of. A safe health service. An efficient health service. A health service with the patient’s needs at its core.

Reform is important, critically so. But so is making a difference today for today’s patients. That is why my first priority on taking office was to tackle the trolleys in our emergency departments and to tackle waiting lists in our out and in-patient departments. I am proud to report that there has been a 95% reduction in the number of people waiting over 12 months for an outpatient appointment.We have also achieved a 33% reduction in patients waiting on trolleys between 2011 and 2013 with a 13.4% reduction between 2012 and 2013

We did so in partnership with the hard working staff in hospitals and across the health service. In 2014 and beyond, our priority is to improve these figures. On a sustainable basis. This means, for example, developing better information systems, including the unscheduled care information system for hospitals. Information is key here and I am proud to say that this Government is the first Government to actually quantify the waiting lists numbers. As I said, now that we have this information, we can target resources and implement innovative solutions to address these waiting lists.

It has always been the position of this government that costs in the Irish healthcare system are too high, and we have worked hard over the last three years to reduce those costs.Savings measures of some €3 billion have been implemented, while all the time maintaining – and improving – services. That this has been achieved in the context of staff reductions of some 10% and an 8% growth in population is a considerable achievement.As Minister for Health, I am particularly proud of how our health service staff have responded to this challenge.

We’ve also sought better value for money for patients and the public by reducing the costs of drugs and medicines. Again, we have done so in a sustained and planned way through legislation on reference pricing and generic substitution. By doing so, we’ve cut the costs for the customer while maintaining quality and safety. And we haven’t just cut costs today but for tomorrow as well.

I was deeply distressed at the accounts given by some of the families who had suffered tragedies at Portlaoise Hospital. This House will know that I believe fundamentally that a properly functioning health service must be one that puts the patient at the centre. . That’s why in 2014 we are establishing a Patient Safety Agency. The Agency will first be established on an administrative basis, and will subsequently be placed on a statutory footing. The Patient Safety Agencywill be the ‘patients champion’ - supporting patients in securing an appropriate response to issues they raise about safety. The Agency will also promote and disseminate learning on how we can build and enhance a safety culture in all our healthcare services. We are also preparing the way for a licensing system for both public and private health service providers which will put in place a framework for enhanced accountability and monitoring of standards of care.

So, since 2011 we’ve cut the costs of healthcare for patients and the public, reduced expenditure on health services, while reducing wait times and numbers and maintaining patient safety and quality.

But this isn’t enough.

Our population faces significant public health threats not just for this generation, but coming generations. Obesity. Misuse of alcohol. Tobacco. These aren’t just individual threats. They represent public health risks which will consume us if we don’t address them at a strategic level in a planned way.

That’s why we published Healthy Ireland. It is our strategy for improving the health of Irish people and enhancing our health and wellbeing. It is an ambitious strategy which aims to embed health and wellbeing across public policy and services. A healthy population is a productive one. And it is clearly cost-efficient to combat public health threats through preventative strategieslike Healthy Ireland rather than simply treat the consequences of lifestyle related conditions through the healthcare system. That would be unsustainable. And it wouldn’t be fair.

Under Healthy Ireland, we’ve published Tobacco Free Ireland, our strategy for making Ireland tobacco free by 2025. In 2014, we’re progressing legislation on plain packaging for tobacco products, on smoking in cars with children present and on licensing the sale of tobacco products. These are long-term initiatives that will have long-term benefits, for our people and for our health services.

I sought and received Government approval for a package of measures to tackle the misuse of alcohol, through a Public Health bill. We want to bring our average annual alcohol consumption figures down and we want to combat the ill-effects of the misuse of alcohol, not just for our health service, but for our economy and most importantly, our society.

Healthy Ireland is a framework through which we want to tackle obesity, in particular childhood obesity. I am sure that everyone in the House would agree that our future generations are precious and we need a sustainable strategy to protect them for the wide-ranging negative health effects of childhood obesity. We’ll be focussing on this in 2014.

If Healthy Ireland seeks to address future health issues in our population, then Future Health – our strategy for reforming the health services – is about putting in place the building blocks for a 21st century health service. A single-tier health service, where care is available on the basis of need, not income, through Universal Health Insurance.

Since its publication in November 2012, we have made significant progress. We have established hospital groups. We have appointed chairpersons for each group and we are currently recruiting Chief Executive Officers for those groups. Through 2014, work will continue to fully establish the groups,as this is a critical step in improving hospital performance and ultimately, patient outcomes. As hospital groups evolve into hospital trusts, they will harvest the benefits of increased independence and move away from the traditional command and control style of the HSE – and patients will benefit from better services.

In July 2013, we established the Directorate of the health services under the Health Service Executive Governance Act which also abolished the HSE Board. In coming months, I will bring forward legislation to begin the process of dismantling the HSE. We are bringing the HSE Vote back to the Department through the Health Service Executive (Financial matters) Bill. A Finance Reform Board is in place and a Chief Financial Officer in the HSE has been appointed. A new financial and cost management system has been identified and is being costed. Through 2014, we will progress the legislation and continue to work on the management system. This will enhance accountability as well as establishing a sustainable system for controlling costs, essential in the current and future fiscal environments.

I remain concerned about the high cost of private health insurance in this country, and to that end I asked Mr. Pat McLoughlin to chair a forum of health insurers so that we can work together to bring down the high cost of health insurance. In December 2013, we published the report on the first phase Mr. McLoughlin’s work. The second phase of work is well underway, and the Chair will report back to me very soon. Effectively tackling the high cost of health insurance is critically important in the context of universal health insurance, and in the coming months, I will bring forward legislation in that regard.

Another key element of Future Health is the concept of “Money Follows the Patient”. The introduction of the new funding system on a phased basis lays the foundation for universal health insurance. Following a pilot study in 2013, it is being introduced across the health services on a phased basis through 2014. Money Follows the Patient will provide the funding framework for improved and enhanced outcomes for patients as well as the professionals who serve them. To support this new funding system, a Healthcare Pricing Office has been established this year, which will play an important role in bringing greater transparency to health care pricing, and be an important tool in driving costs down.

Despite the challenging financial circumstances, as part of Budget 2014, we will introduce free GP care for children aged 5 and under. Work is well advanced on the drafting of the required legislation and the development of an associated GP Contract to ensure this service commences by mid 2014.

This government is committed to ensuring that everyone will have access to GP care free at the point of use as a core part of their universal health insurance. This is because we must move away from the current over reliance on hospital care and make proper use of primary care where up to 90% of our health needs can be met. The true significance of providing GP care without fees to children under six is the commitment it represents to enhancing primary care services in general. We will develop more dynamic, more efficient health services with better outcomes through Universal Health Insurance.

In December 2013, we published the Health Identifier Bill and launched our eHealth Strategy. Technology can enhance healthcare, improve outcomes and drive efficiency. to progress these goals, we will soon commence an open competition for the position of Chief Information Officer for the health service. Priority areas for initial technological development in the health sector include ePrescribing, online referrals and scheduling, Telehealth and the development of summary patient records. Again, on a day-to-day basis the judicious use of technology brings greater efficiencies but in the long term, the use of technology gives us more information and enables us to make better healthcare decisions. This saves lives and saves money.

A 21st century health service requires high quality, dedicated facilities. Again, despite the significant financial challenges we face, since 2011, the Government has progressed 34 Primary Care Centres and a further 12 are approved for building. As resources permit, this network will be expanded. In relation to the National Children’s Hospital, we aim to secure planning permission by Spring 2015 to progress this landmark commitment to the future health of all our children. In relation to the relocation of the National Maternity Hospital, Holles Street to the St. Vincent’s University Campus at Elm Park, a project team has been appointed and we expect a design team to be appointed shortly.

As well as looking to the future, we have sought to address legacy issues. In particular, the State Claims Agency is implementing a Redress Scheme for women who had been excluded from the 2007 Lourdes Scheme on age grounds alone. I commissioned a Research Report on Symphysiotomy and appointed Judge Murphy has to bring her expert assessment to the situation. When she reports, I will consider that report and bring proposals to Government for approval. We can’t move forward on the issues of tomorrow without having resolved the issues of the past.

In relation to Universal Health Insurance, the House will be aware of the significance attached to the plan by this Government. Universal Health Insurance is fundamental to the reform of our health services – it goes to the core of Future Health. It has garnered significant media attention in past weeks.

While UHI is undoubtedly the final destination for health care reform, the White Paper represents the beginning of the journey. The publication of the White Paper in coming weeks will signal the beginning of a ‘national conversation’ on the future of the Irish health service. A comprehensive programme of consultation will ensure that we all – the providers of health services, health insurers, the staff who work in our health service, and most importantly, the Irish people – have the opportunity to participate actively in this critically important debate.

If UHI is about one thing, it is about fairness. A fair system is one where everyone pays according to their means – and where no one is denied care because they can’t afford it. A fair system is one where the everyone has access to a comprehensive basket of health services, designed to meet the needs of a 21st century population . A fair system is one where good performance is nurtured and encouraged and bad performance is addressed and improved, so that everyone can has timely access to high quality and safe healthcare services. This is the health service we envisage, under Universal Health Insurance. All of the various reforms I have outlined – Money Follows the Patient, Hospital Groups, eHealth – are designed as building blocks for UHI and for a health service that is pragmatic, practical and rational. A health service that is open and transparent and one that can deal with future challenges. A health service that is efficient and productive, so that it guarantees safe quality and timely health services.

That is where we are going and I look forward to working in partnership with stakeholders and the health services in achieving this goal.