Gay Mitchell
Question:28 Mr. G. Mitchell asked the Minister for Health and Children the action he intends to take to address the criticisms of his Department and the health board system contained in a report (details supplied). [31009/01]
Priority Questions. - Health Service Reform.
In the first place the report referred to by the Deputy is a very substantial document and the most comprehensive report on value for money in the health services ever published by the Department of Health and Children. In keeping with its programme of reform of the health services, the Government decided, as part of the action programme for the millennium, that consultants should carry out a VFM audit of the health service. The consultants, working with the Departments of Finance and Health and Children, began work last year. This involved intensive consultation with health boards, voluntary hospitals, staff organisations, etc.
The work of the consultants informed the consideration given to the new health strategy, Quality and Fairness – a Health System for You. It was seen as one of the key documents supporting the work on the strategy together with the primary care model and the review of bed capacity. The Government, when deciding on the publication of the new health strategy, also decided that these other reports should be published in order that a full picture of the key strategic issues would be available to all.
The consultants acknowledged that there had been progress in many aspects of the health services during the 1990s. In summary, these were: in defining health needs and formulating the relevant strategies and actions necessary to meet those needs; the numbers treated in acute hospitals have significantly increased; significant additional investment has been made in recent years in services for older people, in child care and for the intellectually disabled, among others; policy development has been strong, with well developed strategies in areas such as cancer, cardiac services and children; the introduction of service planning in the health sector is also a positive development.
The following summarises the areas commented on by the report and the action to be taken in the context of the implementation of the new health strategy: an independent health information and quality authority will be established in 2002. It is expected that a report on the national health information strategy will be completed in January. Under the new strategy a review of the role and structures of the Department of Health and Children and an independent audit of functions and structures in the health system will be carried out.
Additional InformationIn response to the points made in the VFM study regarding requirements concerning hospital policy the strategy contains a commitment to establish a national hospitals' agency to do the following: prepare a strategic plan for hospital capacity expansion; advise on the organisation and development of all acute hospital services; advise on the designation of national specialist services and development of designated services; develop a strategic relationship with the private hospital sector; co-ordinate actions to reduce waiting lists; and liaise with regulatory and professional bodies. Following a detailed assessment, the health strategy has commented that “the present centrally funded tax-based system of funding, complemented as at present by private health insurance will be retained.” In addition, there will also be a review of the allocation process for health boards.
The need for a full policy framework has been comprehensively addressed by the health strategy which has been acknowledged as a wide ranging document which has set down policy for all the major programmes in the health area. The role of the office of health management will be expanded to meet the objectives of the strategy for organisation development and, with the health board executive, HeBE, will address the needs for improved co-ordination of actions as identified in the VFM report.
Priority will be given to health promotion and preventive measures. The health strategy and the primary care report, A New Direction, set out a comprehensive programme of action in regard to health promotion and preventive measures based firmly on the concept that primary care should be at the centre of future developments with particular emphasis on the prevention of illness and the promotion of a healthy lifestyle.
There are many other recommendations in the VFM report which have been taken on board by the health strategy and other reports such as the primary care report and the continuing work on the national health information strategy. The VFM report has, with the other publications described above, created a positive framework for change which will be acted upon to ensure a quality and cost effective service for the next decade. When I launched the new health strategy last week I made it clear that I would be publishing the value for money report. Given the above facts, it should be clear to any fair minded observer that the entire process has been marked by openness. Any suggestion that the VFM report was carried out in anything other than a very open and transparent manner is entirely mischievous. The Government's intention to commission the report was widely known, the process of the work was wide-ranging both at national and local level and its importance as a crucial part of the overall consideration of the health strategy was underlined by the Government's decision to publish it with the other strategy documents.
Does the Minister agree that the Deloitte & Touche report on value for money was commissioned by the Government and not by the Minister for Health and Children because the Government, in particular the Minister for Finance, could not tolerate any longer the indecisiveness of the Minister for Health and Children who was pouring more and more money into a black hole and not getting value for taxpayer's money? It is a fact that the House has given the Minister unprecedented amounts of taxpayer's money to provide a proper health service which he has not had the competence to deliver. Is that right? That is the real finding of the value for money audit carried out by Deloitte & Touche. I repeat that the Minister did not commission that report, that it was commissioned by the Ministers around him who are fed up with his performance in his determination to leave the Department to his successor in the same state as he left the Department of Education and Science – a management shambles where he would not let the civil servants do the job they wanted because of his constant interference for popularity and PR purposes.
The Deputy is inaccurate and incorrect. The commitment to a value for money audit was given as part of the action programme for the millennium in November 1999 before I became Minister for Health and Children. We can take it from that fact that everything the Deputy has said is erroneous and without foundation. That also applies to his comments on my term in the Department of Education and Science which I leave it to others, particularly those in the educational community, to judge.
The value for money audit was necessary and the Department of Health and Children, with the Department of Finance, engaged in it honestly and transparently. Many recommendations emerged, but the critical analysis which was part of the process will inform better practice and enhance service delivery. The audit also praises and compliments many worthy initiatives, strategies and significant improvements in service in recent years, particularly for older people and those with disabilities. The audit is a three volume document which deserves considered analysis, not knee-jerk reaction. In time, it will be seen not only as the document that informed the process leading to the publication of the health strategy but also wider considerations of the structures of the health service and the methods of delivering services.
Is the Minister aware that the Deloitte & Touche report to which he refers states that, at £50 a head on average, the medical card is value for money? Why, then, did he pay five times that amount to doctors to take on those aged 70 and over?
The report stated that medical cards were good value for money. The Government took the decision to extend it to people over 70 as it was a logical extension of the earlier decision to double the eligibility thresholds for older people who have recourse to a doctor more often than younger people.
At five times the rate.
I will explain. They have recourse to a doctor more often and have greater medical needs and this was a departure from the rigid income approach. We wanted to introduce it together with social welfare initiatives for older people. This Government will be remembered more than any other for discriminating in favour of older people.
It will be remembered all right.
We had to negotiate that move because it was a departure from established agreements.