Priority Questions

Mental Health Services Funding

James Browne


15. Deputy James Browne asked the Minister for Health the way in which the additional €35 million for mental health services will be spent in 2017; if, with regard to the commitment in the confidence and supply arrangement and in order to provide clarity, he will commit to a multi-annual plan for the period 2017 to 2021, setting out the way the services and measures required for the full and complete implementation of A Vision for Change will be put in place; and if he will make a statement on the matter. [30969/16]

I ask the Minister of State the way in which the additional €35 million for mental health services announced in this year's budget will be spent in 2017. Having regard to the commitment in the confidence and supply agreement and in order to provide clarity, will she commit to a multi-annual plan for 2017 to 2021, setting out the way the services and measures required for the full and complete implementation of A Vision for Change will be put in place, and will she make a statement on the matter?

I thank the Deputy for his question. I am pleased to confirm that the allocation for new developments within mental health services will be even greater than the significant resources made available in recent years. This arises as a result of a combination of increased revenue funding and a major capital allocation which has been secured for mental health services.

In line with my commitment to achieve a full-year allocation of €35 million in additional funding for mental health, I am initiating €35 million in new services for 2017. Key mental health priorities to be addressed in the Health Service Executive, HSE, 2017 service plan include youth mental health, including the improvement of child and adolescent mental health services; improvement in adult services and those relating to older people, improvement in services for those with eating disorders, and the enhancement of out of hours response for those in urgent need of services. As has been widely acknowledged, and as I acknowledged last week, recognising the time lag in new staff taking up posts and the completion of other preparations for the introduction of these services it is estimated that the revenue spend in the calendar year 2017 associated with this increased allocation will be some €15 million. However, €35 million in service developments will be initiated in the course of the coming year. I look forward to briefing the Deputy on these developments once the details have been finalised and the national service plan approved. In addition, there will be further increases in mental health current spending associated with increased pay rates, and this will be subject to separate funding of approximately €9.7 million.

A priority for me for 2017 was to secure additional capital spending for mental health. This was urgently required to allow the construction contract for the National Forensic Mental Health Campus at Portrane to be awarded. This project has been subject to a significant increase in costs arising from price inflation in the construction sector, some additions to the project, and the need to spend additional money in meeting planning conditions. Completion of the tender process meant funding of these increasing costs needed to be secured before the contract for the project could be awarded, and I am delighted that I obtained the support of my Government colleagues to proceed with this landmark project. It is estimated that approximately €50 million in capital funding will be spent on the project next year, with further spending in completing the project from 2018 onwards.

Additional information not given on the floor of the House

The Central Mental Hospital was established in 1850. The project to develop a new service to replace the hospital was first initiated in 2000. In 2009, the Portrane site was selected. The award of the construction contract, which my Department has approved, means there will be no further delay in the long overdue replacement of the Central Mental Hospital with a modern, purpose-built facility at Portrane.

With regard to the continuing implementation of A Vision for Change, the Department of Health is currently leading the review of this policy with a view to the development of a successor document which will complete the process of modernising mental health services and effectively promoting mental health. I envisage this successor policy including detailed implementation arrangements, underpinned by a multi-annual investment plan, will inform the allocation of resources in future years.

I thank the Minister of State. I need clarity on this issue. Appendix 1 of the confidence-and-supply arrangement commits to fully implementing A Vision for Change. The confidence-and-supply arrangement votes are dependent on the full implementation of the policies attached to that document. We agreed to facilitate budgets consistent with the agreed policy principles attached to the document, which runs over the full term of Government or five years. In response to a parliamentary question I tabled during the summer, the Minister stated that the required amount needed to fully implement A Vision for Change is €35.4 million per annum. Will the Minister of State confirm that the full €35 million will be spent in 2017 and that there will not be a repeat of what occurred earlier this year when money was withheld?

I will agree with the Deputy on that. In order to implement A Vision for Change, we need to continue to increase our funding. That is a commitment this Government has given and, for me, it is a commitment it has honoured. However, we know that is not possible over one budget but that it will be implemented over the course of the next three to five years. The Deputy will agree that it includes not just spending on revenue but also capital spending. If we are to bring ourselves in line with A Vision for Change, we need to improve our services and facilities, and where we provide those services.

The central mental hospital was built in 1850 as a lunatic asylum but we still house people there. In order to bring ourselves into line with A Vision for Change, we need to begin the construction of the new forensic hospital and the €50 million will allow that to happen next year. We will increase spending next year with €35 million of new developments to be initiated. The focus will be on capital and ensuring that the new forensic hospital is started.

The €50 million in capital expenditure is very welcome but the Government needs to understand that the commitment to increase investment by €35 million annually is just that - a commitment to increase investment by €35 million annually, to meet the requirements under A Vision for Change. In 2016 the Government announced €35 million and then withheld €12 million in a U-turn into which it was forced in June. Fine Gael pledged increased funding of €175 million for mental health on page 135 of its programme so I hope that, having announced €35 million in the budget this year, it is not going to perform another embarrassing climbdown. I emphasise that €35 million means €35 million.

As announced last week, we will be initiating €35 million of new developments. As the Deputy points out we have not spent all of our funding, nor have we been able to spend it. In anticipating that we would not be able to spend it all in one year, we have decided that we will initiate €15 million of the €35 million to begin the development. All €35 million will be in the base next year but the focus this year is on the €50 million to further develop services at Portrane. It will take five years to commit fully to the pledge we gave but there is no sugar-coating here. We are initiating €35 million of developments and, overall, we will be spending €74.7 million more on mental health next year than we are spending this year.

Ambulance Service Provision

Louise O'Reilly


16. Deputy Louise O'Reilly asked the Minister for Health if he is satisfied that expenditure of over €19 million in the years 2012-15, inclusive, on private ambulance services represents value for money; if an investigation has happened on the reason some hospitals are outliers in terms of their use and spend on private ambulance services; the action he will take to divert public moneys spent on private ambulance services into resourcing and equipping the national ambulance service; and if he will make a statement on the matter. [30724/16]

Does the Minister think we are getting good value for money by spending €19 million on private ambulance services, €6.3 million of which was spent in 2015? Does he have any insight into why there is such disparity across the country, with certain hospitals relying very heavily on privatised services while others hardly use them at all?

The main role of the national ambulance service is to respond to emergency 999 or 112 calls. It also provides an interhospital transfer service through the intermediate care service.

There is a significant requirement for transfers of non-urgent patients for various clinical reasons, including transfers between hospitals, between residential and acute settings and transfers for diagnostic tests at other hospitals. In the context of the continued increase in demand for emergency ambulance services in recent years, there is a need to avail of private ambulance services to secure additional capacity for such patient transfers where required.

To this end, the HSE has put in place arrangements under a framework agreement, which provide for the utilisation of private ambulance providers. Public patient interhospital transports are carried out under this agreement.

Hospitals are permitted to seek patient transport services from other providers recognised by the pre-hospital emergency care council, where those included in the agreement are not in a position to provide the service required.

I am aware that acute hospitals have provided resources to the national ambulance service to facilitate the development of intermediate care services, and I welcome this. However, the reality is that there is an ongoing need for hospitals to have the flexibility to access private ambulance services where necessary and appropriate. The Deputy may wish to note that the HSE is reviewing public and private ambulance service provision. The review is expected to be completed by December 2016 and will answer the Deputy's question on value for money, as well as the question of consistency in deployment and policy around the country.

Since my appointment as Minister for Health I have met with the national ambulance service, NAS, and engaged with it on a broad range of issues including the various reviews of ambulance services which have been undertaken in recent years. I am therefore fully conscious of the need for a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. In that regard, the Deputy can be assured that increased funding will be available to the national ambulance service for 2017. The detail of the improvements to be funded will be provided in the HSE's 2017 national service plan. Over the coming weeks my Department will work closely with its counterparts in the HSE and the national ambulance service to agree priorities in relation to the 2017 allocation.

I asked the Minister specifically whether he thought this represented good value for money and maybe I will get the answer in the next minute. Investing money in private companies will never improve our public health system. The Minister will be aware that national ambulance service personnel balloted for industrial action and that this was only averted on the promise of additional staff being recruited, specifically 461 paramedics. What is the plan for this and what is the budget allocation to ensure it is achieved? The Minister met with members of the Dublin fire brigade, whose members also provide a paramedic and ambulance service. Why do they not use a privatised service? There is no commitment on the Minister's part to the ring-fenced funding they have sought.

The HSE is carrying out a policy review and it will be able to advise me on whether these services represent value for money. It is about more than value for money. At the moment the service is essential. We need our public ambulances, our national ambulance service and Dublin fire brigade ambulances to pick up emergency cases and answer the 999 or 112 calls. In 2015, there were 308,000 calls to 999 and 112 numbers so there is a hugely increased demand. The ability of the national ambulance service to meet non-urgent patient care demands varies geographically. We try to make sure ambulances are used in urgent cases so that for non-urgent cases, such as transferring a patient from an acute setting to a residential setting, we will look at the use of private operators.

The Deputy is right that we need significant investment. An additional sum of €3.5 million will be allocated to the national ambulance service in 2017, the details of which will be set out in the service plan. I have had some very useful meetings with SIPTU on the Dublin fire brigade and the national ambulance service.

I have questioned the Minister a few times and my views on privatisation are well known. For those who do not want to listen, I repeat that we cannot improve the public health service by investing in private companies. It is very disappointing that the Minister says that we can. He also said the intention was to use more of these services, with €6.3 million in 2015 going to private providers outside our public health system to provide services national ambulance service personnel and Dublin fire brigade want to provide. These providers can give value for the money that is spent. The €6.3 million in 2015 shows that the amount going to private companies is going up, when it should be going down.

It might upset the Deputy to know that I agree with her on this.

It does not upset me. I just want to see the Minister do something about it.

I want to see investment in the public ambulance service and a reduction in reliance on private ambulance services. The Lightfoot report on capacity states that, even if we put in place all the extra ambulances and all the extra paramedics, we will still not have adequate provision in this country because of the geographic dispersal of our population. We need to invest in the national ambulance service and to provide it with more funding. This is why we are investing an extra €3 million in 2017, the details of which will be set out in the HSE service plan, but there are issues involved in supporting this service. Using private ambulances for non-urgent cases has a role to play and I want to keep our national ambulance service on the road to answer the urgent 999 and 112 calls.

The Dublin fire brigade brought up an important matter regarding how it is funded and I am due to receive a report on it, probably at the end of this year. I will have conversations with the Department of Housing, Planning, Community and Local Government in this regard as Dublin City Council currently funds it.

Health Services Staff

John Brassil


17. Deputy John Brassil asked the Minister for Health if he will be implementing in full the decision taken by his immediate predecessor to protect the two titles of physiotherapist and physical therapist in one register; and if he will make a statement on the matter. [30970/16]

I wish to ask the Minister if he will implement, in full, the decision taken by his predecessor, Deputy Varadkar, to protect the two titles of physiotherapist and physical therapist in one register and if he will honour the commitments made by the then Minister in this regard.

I appreciate Deputy Brassil asking this question because it provides me with an opportunity to provide once-and-for-all clarity on the misinformation that is being spread by some on this. Not only will I be implementing in full the decisions taken earlier by my predecessor, the Minister for Social Protection, Deputy Varadkar, I will be implementing them to the last letter, the last full stop and the last cross on the t. There has been no policy change in this. I intend to go ahead with implementing in full the decision taken by my predecessor that the titles of physiotherapist and physical therapist would be protected under the Health and Social Care Professionals Act 2005 and that there would be only one register for the profession.

Last month, the Physiotherapists Registration Board established its register under the Act with effect from 30 September 2016. This ensures the specified title of physiotherapist will be protected for the exclusive use of registrants when the register's two-year transitional period ends in September 2018.

Earlier this year, my predecessor, having consulted relevant parties, concluded that protecting the title of physical therapist under the Act as a variant of the title of physiotherapist would be the best way to eliminate the ongoing risk of title confusion and the consequent risks to public safety. He also decided to allow particular existing users of the title of physical therapist, who are not physiotherapists but who hold qualifications of a certain standard, to continue to use this title. New grandparenting provisions will allow such practitioners to apply, on a once-off basis and for a limited period, to register in the physiotherapists register, confining their practice to musculoskeletal therapies.

Preparation of the necessary legislation to give effect to these decisions is now at an advanced stage. The legislation will involve the making of regulations under the Health and Social Care Professionals Act 2005 in tandem with the enactment of necessary amendments to that Act to allow existing qualified title users to continue to use the title. I intend to seek Government approval shortly to include these amendments to the Act in a health (miscellaneous provisions) Bill that is being drafted by the Parliamentary Counsel to the Government.

I want to be clear, there has been no policy change in this regard.

I welcome the clarification. To be thoroughly clear on the issue, the decision of the previous Minister, Deputy Varadkar, stated that qualifications would be equivalent to an existing user of the title physical therapist in the State holding specific qualifications from the Institute of Physical Therapy and Science, IPTS. This is the position that the Irish Society of Chartered Physiotherapists supported.

This confusion seems to have come from a letter the Minister, Deputy Harris, sent on 29 September where he stated that it is envisaged there may also be a requirement to set an assessment of professional competence to be set by the board for applicants who can demonstrate existing use of the title but who do not have IPTS qualification. That is where the confusion has arisen. If the Minister can clarify that such is not the case, I will be satisfied with his response. We have a reputable and highly qualified group of people from the best universities in this country and they should receive the clarification and respect they deserve.

I could not agree more. As Deputy Brassil will be aware, in the rest of the English speaking world the title of physical therapist and physiotherapist are interchangeable and their users are qualified physiotherapists. We have excellent physiotherapists in this country and I want to protect their title.

In Ireland, however, the title is also used by a number of practitioners who are not physiotherapists but who have been providing musculoskeletal therapies in the private sector for many years. Physiotherapists are trained to provide musculoskeletal, cardiorespiratory and neurological therapies, working in both the public and the private sector.

In January of this year, my predecessor, Deputy Varadkar, announced what I outlined in my previous answer. The Department is preparing the necessary legislation to give effect to these decisions.

The Irish Society of Chartered Physiotherapists issued a press release on 25 January 2016 which stated that it "today welcomed the decision made by the Minister for Health Leo Varadkar to also protect the title Physical Therapist under section 95(3) of the Health and Social Care Professionals Act 2005 which will eliminate the ongoing risk of title confusion between Physiotherapist and Physical Therapist and the consequent risks to public safety". Presuming that it welcomed it then and given that I am assuring it today on the floor of the Dáil that such policy has not changed, I am sure it will still welcome my policy.

I am quite sure it will. It is good to have the opportunity to clarify any misconceptions there are. There are myriad courses of varying duration and it would be important to ensure there is a separation and a clear definition of physiotherapist and physical therapist and that they can get on. There is a public safety issue. The public needs to know exactly who is administering treatment and what they are capable of treating.

I very much welcome the Minister's clarification. I am sure its members are watching but I will let the Irish Society of Chartered Physiotherapists know of his reassurance. I thank the Minister for his response.

I sincerely thank Deputy Brassil. This is an important issue for many professionals working throughout the country. It is an issue of public safety, and patient safety as well. We as a country have done a lot of work in recent years in terms of patient safety, the establishment of CORU and ensuring patients know exactly what they are accessing in terms of qualifications when they use a health care professional.

I am due to meet the Irish Society of Chartered Physiotherapists on 27 October and I look forward to providing the society at that meeting with face-to-face clarification, as I have done today in the Dáil. I have also repeated to it in my recent correspondence that my officials continue to remain available to clarify the details of the ongoing implementation of the decisions.

I note that there is a period now of almost two years of transition until September 2018 for practitioners to join the register. I note the concerns of physiotherapists. I would ask them to join the register. They should join the register. To be clear, the legislation will be in place long before that September 2018 date expires.

There has been no policy change. I want to move on and protect this title and I look forward to meeting the society.

Emergency Departments

Alan Kelly


18. Deputy Alan Kelly asked the Minister for Health if his attention has been drawn to the fact that private investor-owned, profit-oriented hospitals, details supplied, are advertising for patients on the radio while poorer, less well-off patients are spending days on trolleys in overcrowded emergency departments; his views on whether the capacity of these private hospital emergency departments should be used by the State temporarily; and if he will make a statement on the matter. [30922/16]

If we have a bad flu epidemic this winter, we will face hell in our emergency departments. Listening to the radio most mornings, it galls me to hear private hospitals advertising - almost rolling out the red carpet - that they are available for anyone who has an emergency while down the road patients are waiting for hours or days on trolleys. Will the Minister consider renting, or in some way finding access for public patients to, these hospitals because in this day and age it is completely unacceptable to have this disparity?

The short answer is "Yes". The Deputy raises an important issue in terms of trying to ensure we have parity of access to our health services for all patients. We have seen in other waiting list areas where we have, through State expenditure, supported our patients accessing health services. My commitment is to beef up the public health service, but we must also acknowledge where there is capacity in other parts.

As the Deputy will be aware, I have no role at present in regulating the activities of private hospitals, although there are a number of issues in the suggestion that I would like to tease out with him. Emergency departments in public hospitals provide comprehensive 24-7 emergency care to all patients regardless of health insurance status. Currently, no emergency department in a private hospital offers a 24-hour service and only a minority provide services at weekends.

My Department is engaging with private hospitals on their potential to contribute to meeting the demand for acute services right across a range of services. There is already significant experience in using the services of such hospitals to assist in addressing lengthy waiting times for scheduled care. An example of such collaboration is that this year €20 million is being allocated to the National Treatment Purchase Fund, NTPF, rising to €55 million in 2018. I envisage the NTPF utilising both the public and the private hospitals to reduce waiting lists. I recently met the Private Hospitals Association to review both this experience and the further scope for private hospitals to contribute to urgent health priorities. Our patients waiting for care do not want a big ideological debate. They want to know that we are expending taxpayers' money to get the access to our health service.

To date this year, the HSE has reported an increase of approximately 5% in emergency department attendances. Despite increased demand, there has been a decrease of almost 5% in numbers of patients waiting on trolleys. That is no comfort to someone waiting on a trolley but we have seen increased demand yet fewer patients on trolleys. In addition, patient experience times have been improving, with 82% of all patients completing their emergency department episode of care within nine hours.

My Department, working with the HSE, has been driving a range of measures to alleviate overcrowding and reduce patient experience times in emergency departments. In September, the HSE published the Winter Initiative Plan 2016–2017, which provides €40 million of additional funding to manage increased demand for health care during the winter. Indeed, I will be visiting Deputy Kelly's county with him shortly on this matter.

I thank the Minister. He started off the answer fairly well but he went downhill after that. There was no meat in the detail except to agree with my hypothesis that it is wrong that a 90 year old woman who goes into an emergency department such as the Mater hospital could be on a trolley for two to three days while 100 yards down the road an executive can go into another emergency department and be treated immediately. In the Beacon Hospital, as Mr. Brian Fitzgerald has said, 95% of the time patients will be seen almost immediately by a consultant. The Blackrock Clinic states its highly valuable facility is there for those who "prefer to receive this treatment without delay".

This is not acceptable. We will have an epidemic this winter if a crisis develops because of influenza. We need quick answers, quick decisions and quick engagement with private hospitals to use their capacity immediately. I am aware they do not provide all the services, as the Minister rightly outlined, but they do provide services and they have capacity because they continue to tell us that through advertisements on the radio.

That is the closest I will ever get to a compliment from Deputy Kelly. It started off well but I wanted to start off well because I did not want to dismiss the Deputy's idea. There is merit in scoping out this issue. Discussions would be needed on the type of procedures, how it would work, how we would make sure we do not divert resources from public hospitals, and how we make sure that we get on with solving the pressures in our accident and emergency departments. It is not that we are sitting on our hands doing nothing for this winter, as the Deputy knows. While my Department will have further meetings with the Private Hospitals Association and while we have already begun a dialogue as to how it can contribute more services, taxpayers provide funding and we are already putting in place €40 million for the winter initiative. That involves some of the things the Deputy is talking about regarding an influenza epidemic. It involves more people getting the influenza vaccine, and we should all take this opportunity to remind people to get it. It involves 13 community intervention teams, which can reduce our hospital bed requirements by approximately 73. It involves opening our primary care centres and expanding out-of-hour GP services. It involves, as we have done in Cork, opening acute medical assessment units, AMAUs, at the weekends. The unit in Cork is the first one in the country that is open seven days a week. It involves more home care packages, so it is multifaceted. The private hospitals have a role to play and I am happy to examine that aspect.

The Minister should make them play their role. He said it is not an ideological debate but I beg to differ. It is an ideological debate. When we had to provide emergency measures to socialise the debts of banks a number of years ago, we did so. I disagreed with it and voted against it, unlike others in this Chamber.

It is a good job the Deputy lost that one.

We have an issue here because we have to socialise the dearth of infrastructure when it comes to emergency departments and we need to do it immediately because people are going to die on trolleys if this is not done. Despite all the Minister's measures, we will not have the immediate capacity that we need in emergency departments if he does not take this proposed measure. There is an issue over what is more appropriate and what is a priority - the common good versus private property interests. The Minister should make a name for himself and gain access to the private hospitals immediately in order to alleviate the terrible situation we could be facing into this winter.

Of course the Deputy knows it is more complicated than just making that decision. We have to look at what we would like to do in the private hospitals rather than what would be done.

We could do it in 48 hours a few years ago.

I do not think he is suggesting that we would replicate the way decisions were made about banking debt in regard to health policy.

I agree with the Minister on that.

We can all learn collective lessons in that regard. When we are talking about this winter and any winter, we should not only talk about the hospital solution. I will examine the Deputy's idea. There is merit in what he said. We also need to examine why people are turning up in our hospitals given that such patients would not turn up in hospitals in other countries. That is down to a considerable lack of an out-of-hours general practitioner, GP, service. It is also down to AMAUs and having more home care packages.

It will not be solved this winter.

We have put €40 million behind it. It is my job to make sure that taxpayers and patients see benefits from that. We cannot just say to the HSE, "here is €40 million", and not expect to see an improvement. I want to drive that improvement but I will engage with the Deputy further on this because he raised an important point.

HSE National Service Plan

Billy Kelleher


19. Deputy Billy Kelleher asked the Minister for Health when the 2017 HSE service plan will be published; when the programme for Government commitment on a five-year service plan will be published; and if he will make a statement on the matter. [30971/16]

When will the HSE service plan for 2017 be published? There is a commitment in the confidence and supply arrangement to publish a five-year plan. When will that commitment be honoured? It is important there is a strategic timeframe in place for HSE service plans to be planned not only on an annualised basis, but over a five-year period, which would allow it to assess the demands in terms of demographics, the care to be provided, manpower hours, training and all that goes with that. Can the Minister give a commitment on when that will be published?

I thank the Deputy for his question. As provided for under the Health Act 2004, as amended, my Department must write to the Health Service Executive to notify it of its allocation for 2017 not later than 21 days after the publication by the Government of the Estimates for Public Services. The legislation further provides that, on receipt of the letter of determination, the HSE has 21 days to prepare and submit its service plan for 2017 for my approval. The Health Act allows me to extend the period provided to the HSE to prepare, adopt and submit its service plan, if required. I understand that preparatory work is already under way within the HSE on the 2017 national service plan. I expect that the letter of determination will issue from my Department within the next week and that the HSE will submit its draft plan for my consideration and approval within the timeframe that I have outlined as set down in the legislation.

Following the submission of the draft national service plan, the legislation provides 21 days for me to examine the proposed plan and where necessary to seek amendment to, or approve, the plan. The national service plan must be laid before the Houses of the Oireachtas within 21 days of its approval. Once the service plan is laid before the Houses of the Oireachtas, the HSE will ensure it is published at the earliest possible time.

The programme for a partnership Government sets out our intention to work with the Oireachtas to sustain annual increases in the health budget. Expenditure will be based on multi-year budgeting supported by a five-year health service plan based on realistic and verifiable projections. The funding increase of €959 million provided to the HSE since this Government came into office, and the enhanced performance and accountability framework introduced by the HSE, provide an important basis for planning multi-annual health expenditure and the operation of the health services within the limits determined by the Oireachtas, which will be key to the sustainability of this approach.

As the Deputy will be aware, the recently established all-party Oireachtas Committee on the Future of Healthcare, in which the Deputy is involved, is undertaking significant work aimed at developing a cross-party consensus on a ten-year vision for the health service with an emphasis on quality of patient care, supported by strong managerial and organisational accountability. It is my view that the HSE should take account of the work of the committee when developing its five-year plan. It is vital that any recommendations are considered in the context of multi-year budgeting and extended service plan timeframes. The Deputy will also be aware that the committee is required to present a final report to the Dáil by 23 January 2017. Five year budgeting is the way we need to go, and a five year service plan is certainly the way we need to go, but I wanted it to be informed by that committee's work.

The Minister has acknowledged the Dáil committee is engaged in its deliberations and will publish a detailed analysis of what type of health system we hope we can deliver in the years ahead. In the meantime, he has statistics and figures available to him in terms of demographics, the requirements and needs that will exist in the years ahead not only in the ageing profile, but in the chronic illness profile, and in the care areas of obesity, diabetes, arthritis, asthma and other areas, that require long-term planning to ensure we have the necessary professional competence. This is an issue that consistently causes the health service huge problems. For example, we are now trying to recruit nurses and attract those abroad to return home. We never seem to be able to plan so far ahead that we will know the number of graduates, and the numbers in the types of specialties and sub-specialties, that will be coming out of our colleges. Not knowing the budget on an multi-annual basis is a clear impediment to the hospital services, and the broader HSE services, in trying to deliver care.

I agree largely with what the Deputy has said, but I must acknowledge a few points. The confidence and supply agreement is not a document that is meant to be introduced in one budget, and I know the Deputy's party recognises that point. It is something for a period of three budgets and is then to be reviewed, so obviously it cannot all be delivered in budget one. There also needs to be an acknowledgement of the timeframe within which the Government came to office and the gap between that and the Estimates period. The challenge was to get one budget in place for the health service, which happens to be the largest health budget ever on a like-by-like basis. That was the priority for this year. I would be rightly criticised if we asked an all-party Oireachtas committee to come up with a consensus for ten years and then I drove on and said here is the plan for the next five years anyway. I genuinely agree with the Deputy, and we see this in other countries, regarding having at least a service plan, if not a line-by-line budget, in terms of where we want to go. It allows our health services to plan and it also gives certainly to patients. It is something towards which I want to work with this House, but I see it very much happening in the context of the publication of the report in January.

We know of the overcrowding in our emergency departments, to which Deputy Kelly referred. We know there are capacity issues in the public health system. We also know that to do deal with them, we need to invest in community care, primary care, home care packages, home helps and supporting people in the broader community. We do not need an Oireachtas committee strategy to tell us that is the way to go because there is consensus across the House and among service providers, public and private, that this is a requirement. We need to plan on a multi-annual basis in the key areas of the health services to ensure that we are not, on a continual basis in August or September, trying to winter proof our hospitals without having sufficient capacity in terms of home help hours, home care packages and high dependency packages, and equally the professionals to underpin those services. That is something that should be done very quickly by the HSE. It could complement the work of the Oireachtas committee because it could feed into our deliberations if we had access to some of the information and some of the HSE's thinking in terms of manpower requirements and strategic planning in the time ahead.

The Deputy would acknowledge that both the HSE and my Department have provided and will provide any and all information needed to the committee. We are very eager to do that, but I would not want him to think that we are in any way bored or waiting for this report.

We are driving on with trying to make a number of improvements in the health service. The Deputy will see funding to take on another 1,000 nurses in the budget allocation, which was already announced in the House. He will not only see that but also the rectification of a pay inequality issue relating to the increment for a graduate nurse between 2011 and 2015, which graduate nurses tell me will help with recruitment and retention.

At my first Question Time in this House, Deputy Kelleher said to me that people have been talking about primary care since Rory O'Hanlon was Minister for Health. What will we do? Work is already under way in my Department and the HSE for a new GP contract. Those talks commence this year. The Deputy will see the first ever plan for the national obesity strategy, which is a ticking time bomb for our health service. There is also the work of the Minister of State, Deputy McEntee, in terms of implementing A Vision For Change and the youth mental health task force. A new national drugs strategy will be published in January. There is a new accountability framework to hold HSE managers to account and we will bring the HSE budget in on budget for the first time in several years. We are certainly not sitting around waiting but we should align a five-year health service plan with the work of the Committee on the Future of Healthcare.