Vol. 751 No. 1
1Deputy Billy Kelleher asked the Minister for Health the measures he intends to take to deal with the drop off in the number of persons that have private health insurance; the measures he will take to ensure the increase in the community rating levy will not be passed on to private health insurance customers; and if he will make a statement on the matter. [1629/12]
Ba mhaith liom fáilte a chur roimh gach éinne ar ais anseo inniu. I welcome everybody back after the Christmas break.
I am concerned that private health insurance is becoming harder to afford, especially for older people, as insurers increasingly tailor their insurance plans towards younger, healthier customers. I am strongly committed to protecting community rating, whereby older and sicker customers should pay the same amount for the same cover as younger and healthier people. To protect community rating, we need a system of risk equalisation which ensures that community rating can survive. We have an interim scheme in place since 2009. It is designed to compensate insurers which have older, less healthy customers and therefore higher claims costs, compared to insurers which have younger, less costly customers. The interim scheme is funded by a community rating levy in respect of every health insurance policy written. I extended the interim scheme for a further year in 2012 and will introduce a more detailed risk equalisation scheme under new legislation from next January.
To keep down the cost of health insurance for older people, I increased significantly the age-related income tax credit for insured persons aged 60 years and over, from 1 January 2012. The measures I took are designed to result in no overall increase of premiums in the market and to spread the risk more evenly between the healthy and the less healthy, the old and the young. I welcome the announcements by Aviva and the VHI that they do not envisage passing an increase on to customers' premiums on foot of revised rates of age-related tax credit and community rating levy for 2012.
In December 2011 I agreed with the three commercial health insurers to establish a health insurance consultative forum, to tackle issues of mutual concern. We agreed to work co-operatively in driving down costs related to health insurance and to identify savings that could be achieved by public and private hospitals. I indicated to the insurers that I would be happy to hear proposals from them which would result in lower costs for the health insurance sector. A new review of the VHI's claims costs will be carried out to establish what further savings can be made. The review is to be completed early this year and will contribute significantly to more effective cost control within the private health insurance market. I am determined that these and other measures will have a significant impact in containing the level of any future increases in health insurance premiums.
I also wish everybody a happy new year and in respect of the Department of Health, a peaceful new year among the Ministers.
While I welcome the Minister's reply, it does not address the key issue, that the cost of health insurance is inflating rapidly and many families are no longer able to afford to have private cover. During a Dáil debate this time last year the Minister stated he fundamentally opposed an increase in the community rating levy and he was vehement in his criticism of an 11% increase. A few weeks ago we found out he had sanctioned a 40% increase. What is the difference between what he stated in January 2011 and the decision he made recently? What has changed with regard to the issues in the health insurance industry generally that it is now okay to increase the community rating levy by 40% when previously he fundamentally opposed an increase, stating it was an attack on the elderly and every person who was trying to take out private health insurance?
With regard to the comments made on people leaving the health insurance market, there is no doubt families trying to afford to take out insurance are feeling pressure. However, it must be stated the results of surveys which have shown that up to 700,000 people will leave the health insurance markets reflect the results of surveys undertaken in the past which showed similar figures but which never materialised. Sometimes the wording of surveys needs to be examined.
I was critical of the levy on insurance premiums because I did not see it as leading towards what was required - a proper risk equalisation scheme. For a period of years we have had the levy, with promises of things to come, but there has been no delivery. In the short nine months in which we have been in power we have put before the market a risk equalisation scheme. It has been passed by the Cabinet and legislation will enact it into law. People can see what risk equalisation will mean for the market which needs a year's advance notice to address any changes required in premiums and insurance packages offered and we have provided for this. The key point is that this is the final year of the levy. The levy is about fairness to those individuals who when they were young and well supported those who were older. They now have the right to expect the same and we owe them that courtesy. That is what the levy is about.
Nobody disputes the fact that there should be intergenerational solidarity and that we should support those more in need of private health insurance as they grow older and become more dependent on the health service. The key point, however, is that more people are giving up private health insurance. The Minister has a proposal with regard to implementation of a universal health insurance policy, but while he is pursuing this agenda, people are leaving the health insurance market. More than 60,000 left the market in 2011. I do not blame all the decisions made by the Minister for this. Many have done so because of the financial difficulties being faced by families. However, the decisions made by the Minister have encouraged some to give up private health insurance. The difficulty is that there is grave uncertainty. Nobody is sure how much private health insurance will cost this year or next year and there is the promise of a universal health insurance system at some stage down the road in nirvana time. Many, however, will be forced to give it up in the meantime and this will place huge pressure on public services which are already overwhelmed.
One of the prime reasons people have to give up private health insurance is that they have lost their jobs and I do not need to remind the Deputy as to the reasons for this. Thankfully, there are now fewer than 450,000 people unemployed; last month there was a drop in the number on the live register for the first time in a number of years. That is the main reason people cannot afford to take out health insurance. I reassure the House that the levy does not increase the cost of insurance in the marketplace, rather it is a transfer of funds from those who are younger and well to those who are older and unwell. The market has become segmented, by which I mean the insurers have sought to create products more attractive to younger people and less attractive to older people and to price them accordingly, the net effect being that it has become more expensive to insure older persons.
The purpose of the levy is to redress that issue.
If the market was truly stable and there was a fair distribution of people across the three companies, there would be no inter-company transfer. The moneys would transfer within the companies.
The clinical programmes in the public hospitals are showing real change and improvement in efficiency and they can do the same in the private hospitals. The VHI is engaged with the clinical programmes to achieve that objective. Equally, the forum which we set up is to ensure we address the costs of medical care, particularly in the private sector, to drive them down. There has been a belief that 9% medical inflation year on year is acceptable. I send a strong message from the House that it is not acceptable to the Government or to my Department.
2Deputy Caoimhghín Ó Caoláin asked the Minister for Health the status of the Health Service Executive draft service plan for 2012; if he has approved all or part of it; the process for assessment of its proposals and approval or rejection thereof; if the plan will be put before Dáil Éireann for debate; and if he will make a statement on the matter. [1360/12]
The HSE submitted its draft National Service Plan 2012 to me on 23 December last and it is currently under consideration in my Department. In line with the Health Act 2004, the plan sets out the type and volume of services to be delivered by the executive for the moneys allocated under its Vote.
The budget provision for 2012 represents a major challenge to the HSE and comes at a time of significant reform of the public health system. The HSE will be required to deliver, at a minimum, the levels of service set out in the plan as well as operating within the limits of its voted allocation of €13.317 billion. The bulk of the reductions the HSE is required to deliver in 2012 will impact on front-line services more directly than in previous years. This is partly because of the anticipated reduction in the numbers of staff at the end of the so-called grace period on 29 February. I intend to review the plan once the impact of the grace period exits is known. This is not an exit scheme; this is a period of grace under which people can leave the service under the current terms and conditions applying to their pensions and lump sum.
The plan will be implemented in the context of ongoing radical reform of the health service and the significant restructuring of the HSE which I recently announced. A rigorous examination of budget allocations is being undertaken across the care programme areas with the explicit aim of reducing the impact on services and identifying where efficiencies will be driven. This process has involved re-prioritising funding to protect areas of greatest need and meet programme for Government commitments.
While it will be impossible to avoid an impact on service delivery in 2012, the plan will commit the HSE to minimising this impact by fast-tracking new, innovative and more efficient ways of using the reducing resources. It will reflect the need to move to models of care across all care groups which treat patients at the lowest level of complexity and provide services at the least possible unit cost. It will also include a commitment to addressing staffing levels, skill mix and staff attendance patterns within the context of the public service agreement.
Once approved, the service plan will be laid before both Houses of the Oireachtas, after which it will be published. During 2012, the HSE will provide me with monthly performance reports on all aspects of the plan.
The Minister did not indicate when he intends to sign off on the plan. He indicated it would be laid before both Houses but he did not confirm, as my question sought, that it would come before the House for debate, and there is a stark difference. Does the Minister not accept that no matter what service plan he signs off on, the fact of the matter is that we will face significantly reduced services in the course of 2012, consequent on the cuts that the Government imposed in budget 2012? The situation that has to be faced by patients throughout the State is a very serious one. We have already seen the consequences of cuts imposed by the former Government over a series of years under its administration and we know the impact that has had on the lives of ordinary people. What we will face with cuts of some €850 million, signalled for the 12 month period under budget 2012, is an ever-deepening crisis.
The Minister's reconsideration of the service plan is interesting in itself given that the Secretary General of the Department of Health is also the chairperson of the interim board of the HSE, so it is hardly a case of the dog wagging the tail, or which way is it at present? Who is in control? Could it be that the Minister and his officials had little or no input into something that presented on the eve of Christmas Eve, just gone by?
Thank you, Deputy.
This is a jointly worked out plan that is presented annually after substantial consultation between the Department of Health and the Health Service Executive, HSE, at the appropriate level.
I am sorry, but I must call on the Minister to reply.
I will conclude with these two points. In the review of the service plan as presented to the Minister in Christmas week, will he ensure that a process of restoration of now-closed hospital beds across the acute hospital network will be a part of the plan in 2012? Will the Minister take appropriate steps to remove the recruitment embargo to ensure that we will not face an ever deepening crisis in the health service with the signalled departure of some 2,000 further HSE employees under the February pension arrangements?
In answer to the first question on when we sign off on this - it is next Friday - Friday the 13th.
That is auspicious.
There you go. Not being of a superstitious nature I do not see any problem with that date. That is what the law requires me to do and that is what will be done. The Deputy opposite has correctly highlighted the difficulties that will arise in maintaining services. That will be especially so if it is to be business as usual, but it will not be business as usual. In reply to a previous question I mentioned some of the initiatives taking place between clinical programmes and their implementation with the help of the special delivery unit, SDU. We have seen initiatives such as the orthopaedic initiative which has resulted in savings of €6 million across orthopaedic services by insisting that patients would be admitted on the day of the procedure not the night before. If patients are admitted on the day of the procedure we pay the hospital directly. In the acute medical assessment unit in Cork we have avoided the admission of patients and saved 11,000 bed days in a six month period. That could lead to a saving in that hospital alone of more than €10 million - I am told between €15 million and €17 million - in a full year. We will have precise figures on that. Not transposing excellence across the system has been the big failure of the HSE in the past. We intend to ensure the system is transposed through the efforts of the SDU and those working within the system who are buying in to these new ways of doing business in a major way because they see that it improves patient care, the number of patients that can be treated and it makes it easier for them to do their job.
Thank you, Minister.
Nobody is more frustrated than a surgeon or physician trying to do a procedure who is not able to do the work planned for the day because of a lack of beds, personnel, nursing staff or an anaesthetist. That comes down to organisation and planning, which will be addressed.
The productive theatre initiative which applied in five theatres - that is only 2.5% of theatres - saved €2.5 million. If the initiative were transposed across the system it could save another €100 million. I agree with Deputy Ó Caoláin that if it is business as usual there will be a serious impact on services but if we change the way we operate and work the impact of the plan will be minimised.
I am frustrated by the time limits. I must point that out to every Member of the House. Deputy Ó Caoláin should be brief with his supplementary question.
We accept the difficulties and that there will be real challenges in terms of delivering the level of service people need, but in terms of the service plan and given the 2,000 hospital beds that are already closed in the public hospital system and the signalled closure of 62 beds in Tallaght Hospital last week, 31 of which are in a single ward, does the Minister intend to include in the service plan a plan to restore those beds, not to go ahead with the closures in Tallaght but to restore some of the other public hospital beds in order to meet the crying need that is evident? What will the Minister do in response to the departure of a further 3,000 health care workers by the February deadline? What does he intend to do in terms of those who are entrusted with the delivery of key services on which each and every one of us depend for our health at some point in the course of our lives?
I share your frustration, a Leas-Cheann Comhairle at the lack of time. These are important issues and I am prepared to spend as much time as can be given to them.
For the information of the House, because of meetings which took place regarding the service plan between me and my fellow Ministers and the Minister, Deputy Howlin and his Department, through a re-understanding of how to deal with superannuation - and this is contingent on how many people leave the service - we have been able to reduce that €868 million down to €750 million meaning that the impact should be less. Nonetheless, it is a serious challenge. While beds are an important part of the infrastructure of the provision of care, what is really important is the level of service and the number of patients treated and this is where the focus will be. We will protect beds where this is possible but it is far better to use these beds more efficiently than to seek to open more beds.
I refer to what Deputy Ó Caoláin said earlier. I am the Minister for Health and my fellow Ministers and I are not in a position to redraft the plan. The HSE service plan comes from the HSE which is a legal entity, headed by its chief executive who has control of the Vote. He and he alone presents the plan to me. I have to interact with him through the chairman of the board and by whatever other means possible to get what I regard as a politically acceptable form of the plan to put before this House. It is baloney or nonsense - I am not saying those were the words used by the Deputy but others have used them - to say that I am writing letters to myself, but it is not baloney to say that I have to send the plan back to the Minister because that is what I must do under the law. That is how it operates.
3Deputy Joan Collins asked the Minister for Health if he will confirm that cuts in the health budget in 2012 will severely impact on frontline services and will result in longer waiting times for surgical procedures, the shortage of non consultant hospital doctors will mean longer waiting times on trolleys and longer queues in emergency departments and that the planned closure of community nursing units will impact heavily on older persons and their families and makes no economic sense whatever in view of the fact that the cost of caring for a person in such units is approximately €1,300 a week as opposed to €1,000 a day in an acute hospital [1599/12]
The gross current budget for the Health Vote group for 2012 is €13,644 million. An additional €79 million is to be raised through a number of measures to increase the level of income from private patients treated in public hospitals and to improve the collection rate of these charges. This reflects the Government's savings target of €183 million for the health sector in 2012. In addition, the comprehensive review of expenditure identified a range of unavoidable cost pressures and priority programmes for Government commitments. When account is taken of these and the Government's savings target, the overall target for the health sector is estimated in the review at approximately €540 million. Other unavoidable costs were not identified in the review which will also have to be addressed in the context of determining budgets for hospitals and local health offices. These include addressing an underlying deficit which it is carrying into 2012, as well as increments, the EU directive on agency workers and the VAT increase.
It is clear that 2012 will be a very challenging year for the health services. The combination of the savings measures, the absence of extra funding for unavoidable extra costs and service needs plus the further reductions in numbers employed will inevitably impact on services across all care programmes. The extent and nature of the impact on specific services will be set out in the HSE's national service plan for 2012 which was adopted by the board of the HSE and submitted to me on 23 December. I am currently considering the plan with a view to making a decision on it by the end of this week.
My Department has worked in collaboration with the HSE to develop the plan in the context of the comprehensive review of expenditure, the programme for Government reform agenda and commitments for mental health and primary care. The plan as submitted indicates at a high level the impact the savings measures will have on the various care areas. It would not be appropriate for me to discuss the details of the plan in advance of my final decision. However, I can indicate that there will be a greater emphasis on maximising the level of services through innovation and more efficient use of the resources available. I have already alluded to some of these when replying to the previous question. The HSE acknowledges the need to accelerate the process of health care reform and through the use of initiatives, such as the national clinical care programmes, to move to models of care across all programmes delivering services to patients and clients at the lowest level of complexity and the least possible unit cost. I hope to minimise the impact on services but the reality is that we are in very challenging times and there will be a consequence for every programme. We will work in tandem with the HSE, the unions and our staff to find ways of changing how we do our business while minimising the impact on service provision.
People outside this House who will hear this reply will not be confident that there will be a better or more efficient health service in the future. A total of €868 million has been taken out of the health service in what is already a crisis. People generally and in my constituency believe services are collapsing around their ears. What has happened is that services have been cut to the bone and the cuts are now eating into the marrow. There are still up to 365 patients on trolleys, huge waiting lists and hospitals are trying to get patients back into community care services. However, there is a lack of care services in the community. When stroke victims who receive very good care in acute hospitals move back into the community they cannot access services as the system is not working. People do not believe it is working. We need further direction from the Minister who says he is guiding the health service into a better position, but that is not happening.
With respect, the system is working. Let us look at the facts, rather than the rhetoric and hyperbole. Perhaps the Deputy missed the point made, but the figure will be €750 million, not €868 million, as I explained to Deputy Ó Caoláin. I disagree that the service has collapsed and I stand over this assertion. The trolley count, week after week and month after month up to August last year, was 30% higher than in the preceding year. The special delivery unit, SDU, headed by Dr. Martin Connor, was formed in June and became operational in September and week on week the numbers have fallen since. Up until the last third of December, the trolley count was approximately 40% lower than in the previous year. That is a 70% turnaround in a matter of four months which I see as cause for cautious optimism, although l know we could run into serious problems and the trolley count could rise significantly again. Nonetheless, the initiatives taken by the SDU and hard-working doctors and nurses working in a different way in hospitals with support from management are yielding results. The great thing about the hospitals I have been to around the country is that the staff are buying into this. They now realise that instead of there being command and control from the centre, they are receiving support from the centre.
Is the Minister saying that with a further €1.5 billion in cuts we will deliver a much-needed service, despite more people needing access to hospitals and some 3,000 health care workers being taken out of the system? He has mentioned the reduction in the trolley count, but we have heard from those on the ground that patients are being taken from accident and emergency departments to wards to pretend that there is not the same volume in traffic. This has been reported as true by workers on the front line. We can play with the figures which can always be played with, but those on the front line tell us about patients waiting in emergency departments, for access to hospitals, community care services and occupational therapists to help them to return to their homes. The only way they can receive that care is by going to private occupational therapists, in the process putting more pressure on ordinary working people. The Minister can play with the figures, but the reality is not as he states it.
I said the Government's health policy would be based on evidence based information. I challenge the Deputy to go to the Irish Nurses and Midwives Organisation trolley count site and measure the results. The figures indicated have been agreed by the organisation and us. There is a dispute in one or two areas because, as happened today in particular, there was an alarming difference between our count and that of the organisation. It is being investigated. However, the figures this time last year were far greater. On the first Wednesday of the new year last year there were 569 patients lying on trolleys; this year there were approximately 325, which is still too many.
The Deputy asked whether a further reduction of €750 million in the health budget would help; of course, it would not. However, I can tell her - time has proved this - throwing money at the problem, in the way the previous Government did, would not fix it either without basic reforms. These reforms are now being introduced.
Last June and July we asked that no one be left waiting for longer than 12 months for an inpatient procedure. At the end of December 2010 there were 14,000 such patients. Our target was met everywhere, with just one exception, Galway, which is receiving special attention. The target this year will be a wait of nine months and I expect it to be met. I will offer my support in this regard.
In agreement with the Irish Nurses and Midwives Organisation, we examine an arbitrary figure at 8 a.m. and again at 2 p.m. and 4 p.m. in order that we can predict what will occur the next day and take action to avoid problems experienced in the past. By the middle of this year, we will have moved to a six hour target. For 95% of patients, the time which should elapse between their arrival at an emergency department and discharge or admission is six hours. We want 100% of them to be discharged or admitted within nine hours. That would be real progress, but we have not succeeded absolutely; the 350 waiting on trolleys are 350 too many.
4Deputy Billy Kelleher asked the Minister for Health if he has carried out an impact analysis of changes in Budget 2012 to generate extra revenue from private health insurers and their customers; and if he will make a statement on the matter. [1630/12]
As part of budget 2012, the Government agreed a number of changes to charges for patients who chose to be treated on a private basis in public hospitals. These changes will have no impact on public patients who comprise the vast majority of those treated in public hospitals.
When individuals elect to be treated privately, they agree to meet the consultants' fees and the hospitals' maintenance costs. These issues were examined in the value for money and policy review of the economic cost and charges associated with private and semi-private treatment services in public hospitals, which was published by the Department of Health and Children in December 2010. It is estimated that the average maintenance cost per bed day in a category 1 hospital is €1,046. In keeping with the long-standing policy of moving towards recovering the full economic cost of providing treatment for private patients in public hospitals, the maintenance charges for private patients in public hospitals have been increased by between 3% and 5%, depending on the category of hospital, with effect from 1 January. It is anticipated that this will yield additional revenue in the region of €18 million in 2012.
While the HSE and voluntary hospitals recoup considerable sums from private health insurance companies in respect of private and semi-private treatment services provided for their members, lengthy delays often occur between the discharge of patients and the receipt of payment from the companies. This has led to an unacceptably high level of debtor days, with a significant amount in fees outstanding. Some hospitals are much more efficient at collecting this income than others. It is intended that more hospitals will achieve the income collection standard of the better performing hospitals and, as a result, a target of €50 million in accelerated income has been set for 2012.
A significant proportion of private patients who are treated in public hospitals are not charged for the services because of the current rules on bed designation. In contrast, the public hospitals' consultants receive private fees, even where the hospitals cannot collect their maintenance charges. This represents a loss of income to the public hospital system and a significant subsidy to private insurance companies. It is intended to introduce new arrangements during 2012 to allow public hospitals to raise charges in respect of all private patients in public hospitals. This new system will be entirely in keeping with the changes required as we move along the road towards universal health insurance. It is estimated that the new system will yield an additional €75 million in 2012.
My meeting the three commercial private health insurers resulted in clear agreement that all would work competitively and co-operatively in driving down private health insurance costs. There was also agreement that savings could be achieved in the services provided by public and private hospitals, a matter to which I have alluded. Significant savings can be made in the costs of the health insurance companies. In addition, I indicated that I would be happy to hear of any proposal from the insurance companies that would result in lower costs. The Department is also happy to enter into new arrangements with the companies. For example, instead of charging per day, a fee per procedure could be agreed, whereby those hospitals which were efficient, carry out procedures and reduce their patients' average length of stay would benefit, while those which were inefficient would suffer.
In last weekend's edition of the Sunday Business Post I read an article on some of the Minister’s comments last January when he described the increases in insurance premium as an horrendous and appalling attack on ordinary families. The key decisions in the budget from the Department and the Government in the context of redesignating beds and charging the full amount will have a major impact on the cost of insurance for families. The Minister can stand here talking about cost analyses, reassessments and economies of scale but no insurance company can absorb the full cost and they will have to pass it on to the policy holders, ordinary hard-pressed families who are already struggling with the cost of health cover. Almost 60,000 people left in 2011 and the forecast is that another 100,000 could leave in 2012. That will lead to huge pressures for the insurance companies being able to fund procedures and for the public health system, which is already under huge strain and incapable of dealing with the numbers coming through the door as it is. This will have a fundamental impact on people’s ability to retain health cover and the ability of the public health system to provide services.
I remind the Deputy that his party's policy was to charge the full economic cost.
Fine Gael is in government and when the Minister was in Opposition his view was completely different. I am only quoting his view.
The Deputy is not.
The paper of record must be mistaken then.
I am saying that increases in charges will hurt families; there is no question about that. Why was no effort made over the 50 years of monopoly, most of them under Fianna Fáil Governments, particularly over the past 12 years, to address the costs of medical care here? Why is it possible for an individual to make €1 million out of a single company? Too much has clearly been paid for the services and no real cost analysis has been done of the real costs of providing hips, knees or endoscopy. That is what must be addressed. I have asked the companies to look at this not just in terms of an overall cut in costs, but to be more targeted. If a procedure is carried out by a consultant in a hospital that could be done by a consultant or primary care physician in primary care where no side room fee applies, the consultant's fee should be heavily discounted.
That is only one example; there are many areas here where we can reduce costs. The consultative forum is about reducing costs.
Going back over the history lesson briefly, the insurance market has been opened up. Does the Minister not agree? There are now other health insurers providing cover. This has led to difficulties in the context of risk equalisation and cherry picking but, fundamentally, the bottom line is that premiums are going through the roof continually and the decisions the Government made in the budget for 2012 will increase premiums for hard-pressed families, whether the Minister likes it or not. It will happen or insurers will not be able to afford to provide cover.
We do not have to go too far back in history to find that rises in premiums in recent years were the most astonishing rises of all. I want a situation where the costs to the insurers are examined and reduced in a meaningful way and, therefore, the cost of premiums should be reduced as well. I do not suggest that some of the changes we have made will not cause upward pressure, I say that upward pressure can be mitigated by reducing the cost of care.
I hope the Deputy did not suggest in his earlier comments that we subsidise private insurance companies. Surely the public system is entitled to recoup the cost in the same way as the consultant? If someone chooses to see the consultant privately, they will be a private patient in the hospital as well; that is the rule. If he chooses to see the consultant as a public patient, the hospital will treat him as a public patient.
5Deputy Caoimhghín Ó Caoláin asked the Minister for Health if the number of senior managers in the Health Service Executive receiving salaries of more than €100,000 per annum will be reduced as part of the changes in management and administration of the HSE he announced recently after Cabinet approval; and if he will make a statement on the matter. [1361/12]
As a step toward achieving this goal, I will bring legislation forward involving significant changes in the governance of the HSE. The legislation will abolish the board of the HSE and will replace the board structure with a directorate structure. The purpose of the new directorate structure is to drive greater transparency, accountability and efficiency, and to reshape the system to better support the Government's health reform programme.
The following seven areas will be the subject of a directorship: - hospital care, primary care, mental health, children and family services, social care, public health and corporate/shared services. One of the directors will be appointed as the Director General. The directorate team will run the health services as they exist and prepare for the transformation required in the move to UHI.
The new structure is intended to provide clarity as to the responsibility for the delivery of the services under each director, as well as greater financial transparency and accountability in those services.
Given the very challenging situation the health service faces in 2012 and future years, strong management capacity is needed to improve performance, to deliver on service targets in an effective and efficient way within available resources and to lead change in a complex environment. The changes I have announced are intended to improve the management of the service. In view of the nature and scale of the changes proposed, it is not possible at this stage to say whether there will be a reduction in the number of senior managers being paid salaries of more than €100,000.
It is envisaged that the directorate posts will be filled on an accelerated basis in accordance with the Public Service Management (Recruitment and Appointments) Act 2004. The remuneration for these positions will be in accordance with Government policy and will be subject to the approval of the Minister for Public Expenditure and Reform. The following seven areas will be the subject of a directorship: hospital care; primary care; mental health; children and family services; social care; public health; and corporate-shared services. One of the directors will be appointed as the director general. The directorate team will run the health services as they exist and prepare for the transformation required in the move to universal health insurance.
The new structure is intended to provide clarity as to the responsibility for the delivery of the services under each director, as well as greater financial transparency and accountability in those services. Given the very challenging situation that the health service faces in 2012 and future years, strong management capacity is needed to improve performance, to deliver on service targets in an effective and efficient way within available resources, and to lead change in a complex environment. The changes I have announced are intended to improve the management of the service. In view of the nature and scale of the changes proposed, it is not possible at this stage to say whether there will be a reduction in the number of senior managers being paid salaries of more than €100,000.
It is envisaged that the directorate posts will be filled on an accelerated basis in accordance with the Public Service Management (Recruitment and Appointments) Act 2004. The remuneration for these positions will be in accordance with Government policy and will be subject to the approval of the Minister for Public Expenditure and Reform.
I am sure the 110 senior managers will heave a sigh of relief that at least the Minister is not signalling that their salaries will be cut any time soon. Why did the Minister wait until the Dáil went into recess to announce this so-called package of reforms? Why was it not done it in the previous weeks when we had the opportunity to discuss it here in the Dáil Chamber? He has not given us a timeline for legislation. He heralded wholesale change in the HSE appointing an interim board and now seven directors are signalled to take over responsibility. However, accountability must rest with him. When will we see the legislation and what exactly is involved? What reduction in bureaucracy does the Minister expect from changes and how does he expect that to impact? If the salaries of those 110 managers earning in excess of €100,000 are not to be touched, what reductions will take place in the administration and bureaucracy of the HSE as against the cuts in front-line services we have seen all too regularly in recent years, which are continuing apace in the current year?
I call the Minister.
When does the Minister expect to introduce legislation? When will we see the reality of the changes he intends?
I assure the Deputy that he will have plenty of opportunity to discuss this in coming weeks. I intend to introduce the legislation at the earliest possible time - probably towards the end of next month. As I said in my original response, we are doing this because I want much clearer sight of money. We know what happened during the fair deal issue when moneys were put aside to accommodate people in long-term institutions. Once it went below the level of the regional director of operations it became very difficult to follow it. Moneys were going under different headings, which was unacceptable. I want to be able to know where the money went from the very top down to the very bottom. Hard pressed taxpayers have the right to expect that we, as Ministers acting on their behalf, have full sight of where money goes and how it is spent, and who makes decisions and why.
In addition we will move care, particularly of chronic illnesses, from the hospital sector back to primary care. I am working very hard with the Minister of State, Deputy Shortall, in this regard. We want a clear line of vision of the funding for those pillars, whether it is mental health under the Minister of State, Deputy Kathleen Lynch, primary care under the Minister of State, Deputy Shortall, or hospital care. When we can see those lines we can move money from one to the other in a very clear transparent fashion. When we have that done, we can look back towards universal health insurance through an integrated care agency.
Nothing in what the Minister said indicates we will see changes that will impact on the important front-line service delivery systems within the health services. Nothing he has signalled in terms of so-called reform will in any way reduce the impact of the cuts announced in budget 2012 in terms of the delivery of front-line services this year.
I welcome that the Minister is putting a timeframe on the introduction of legislation, which means we will at least have an opportunity to scrutinise what is intended. The Minister, in response to a question from me on the White Paper on the financing of universal health insurance which he proposes to introduce, indicated in this House that it will be three or even four years before that White Paper presents. Is that still the case? As such, these so-called reforms are very much long-fingered proposals and what the Minister is doing is tweaking at the higher echelons of oversight and management. Nothing the Minister is doing will impact on the front line in terms of the needs of people and patients.
I can assure the Deputy that the needs of patients and patient experience are to the fore of everything we are doing. That is the key issue for us. The Deputy is correct that many people who work within the service believe we are only moving the old pieces at the top again and that this will make no difference to them. It may not be easy to see when one is down on the floor working hard dealing with emergencies day in, day out but things are going to change, including how budgets are organised, where money is going and who is making the decisions on where it is spent.
On the White Paper, it will be finished by the end of this year. The directorates around the universal health implementation group have been formed but the names have not yet been signed off on.
Is the Minister bringing forward the White Paper in 12 months' time?
Yes.
When did the Minister make that decision, given just over a month ago he told me it would not be ready for three to four years?
Deputy Ó Caoláin should allow the Minister to continue without interruption.
It is in the service plan. I would prefer to under-promise and over-deliver than to do it the other way round.
We will see. I regret the Minister has not yet ticked that box.
Lessons have been learned.
I would like to make the following final point, much to the mirth of our friend from Cork. The reality is that we must reform the service at the top so that structures can be put in place to allow people on the front line to deliver the service they are well capable of delivering. We must support those at ground level at the same time. This is being done through the service delivery unit, SDU, which has made a real impact. The clinical programmes commenced their genesis under the previous Administration. Without the support of the SDU in terms of implementation, the impact made to date would not have been made, which is acknowledged by the people concerned. What we have is a powerful combination of clinical programmes and a service delivery unit to ensure they are implemented, not alone where they start, namely, Cork, but across the system.
