I thank the Chairman for his welcoming words. It always is a privilege to be elected and to serve in this House. It is a particular privilege to be selected to be a member of the Government and it is one that I enjoy and take seriously. Obviously, it brings with it great responsibilities and I am pleased to be returned as Minister for Health and Children. I look forward to the day when the health ministry will be sought after by a large number of Deputies because it is perceived to be a popular place in which to be a Minister and not a place that is constantly embroiled in controversy, difficulties and challenges.
As members are aware, the Ministers of State will not be appointed until next week, with the exception of the Chief Whip, the Minister of State at the Department of Health and Children with responsibility for children and youth services, Deputy Barry Andrews, the Minister of State at the Department of Foreign Affairs with responsibility for European affairs, Deputy Dick Roche, and the Minister of State at the Department of Agriculture, Fisheries and Food with responsibility for horticulture and food, Deputy Trevor Sargent. A health-related Adjournment debate is scheduled in the Seanad and I cannot rely on Ministers of State that I do not have to take it. Consequently I thank members for facilitating me in this regard and for agreeing to postpone the discussion on the Vote on the Office of the Minister for Children until a later date.
All members are aware of the massive resources being invested in the health system and I do not propose to read out the statement I have circulated to members, who are able to read it for themselves. However, I will comment on a couple of issues. In 2008, Votes 39 and 40 involve a gross expenditure of €15.461 billion, €614 million of which is capital funding. By any standards, this constitutes a massive investment into public health services by the Exchequer. At present, 78% of the money spent on health services comes from the public purse and approximately 22% from private sources. The level of spending by the Exchequer has increased substantially, from 71.5% of total expenditure in the mid-1990s to 78% of expenditure at present. This is higher than the OECD average, where 73% of health spending generally is from public sources.
Ireland spends 8.8%, or almost 9%, of its national income on the health services, which is close to the OECD average of 9%, even though its population is relatively young, as 40% of its population is under the age of 25. When adjusted for purchasing power parity, Ireland spends US $2,759 per head. This is a relevant comparison and is higher than the OECD average by approximately $200 per year. I make these points because sometimes the view is expressed that the Government is not making a sufficient investment in public health services. However, together with Norway, Ireland has the highest investment in capital infrastructure and health from national income of any country in the OECD.
It is not all about spending money and the recruitment of employees. The OECD report shows that Ireland has 3.9 employees per acute hospital bed, which is twice the OECD average. Rather, this pertains to outcomes and outputs and my Department has published its output statement, of which members have copies. Instead of concentrating on inputs, such as staffing and financial inputs, we must concentrate on outputs and move to a position whereby we can do so. One cannot deal with outcomes on a year on year basis. In respect of cancer, for example, one refers to five-year survival rates and so on. The transformation programme is taking us in this direction. In particular, it is about trying to deliver better services by changing the way we do the business. Both within hospitals and between hospitals, community and primary care, we seek to change the way in which services are provided so that they focus on the needs of patients
The cancer programme is of particular interest to members and to the country in general. Since 1997, €1 billion has been invested in cancer services nationally and in 2005, 94,000 patients were discharged from hospital following a diagnosis of cancer. This constitutes an increase of 70% over an eight-year period. Moreover, 58,000 people were treated as day cases in 2005, which was an increase of 130%. Increasingly, patients now have the capability of being treated on a day case basis and I will deal with this matter in a moment.
Moves are afoot to provide eight specialist cancer centres and I will repeat comments I made in the House last night. Great improvements in the outcome for cancer patients in Ireland only will take place when initial diagnosis and surgery are provided in a specialist centre. As I noted in the House, the National Cancer Registry has been established and has produced two reports, for example, on survival rates from breast cancer. We know the outcome for those treated in specialist centres in Dublin shows an improvement of 25% when compared to those treated in either the midlands or the west. Moreover, as the data in question have not been compiled since BreastCheck was rolled out, it is not the reason this is the case. I make this point because if one concentrates on outcome, compelling evidence exists in respect of specialist centres. All members recognise that one cannot locate specialist centres everywhere. Specialists are difficult to procure as their expertise is in high demand globally. We must use the expertise available in our health care system to the best effect for patients. This means organising services around eight centres.
I referred previously to our great success regarding cancer treatment for children, which is centralised in Our Lady's children's hospital, Crumlin, although a course of chemotherapy planned in Crumlin can be delivered in 16 other hospitals nationwide. This is what we seek to do with cancer treatment in general. Obviously, Professor Keane started the job last November and is making a major impact. In particular, I salute the massive clinical buy-in from surgeons. Last week he met urologists to discuss issues pertaining to prostate cancer and is gaining huge clinical buy-in from the available expertise. People strongly support putting in place the best possible cancer services for its citizens that this country can provide.
The National Treatment Purchase Fund was mentioned in the supplied statement and recently, the fund acknowledged its treatment of more than 100,000 patients. I had the opportunity to meet some of those patients on that occasion and they certainly were highly satisfied with the treatment they received. A total of 90% of the treatment is provided for in Ireland, of which 90% is provided for by private hospitals. Approximately 10% of the treatment is provided outside this jurisdiction.
On disability services, I recently created a new office headed by a Minister of State with is own director. The office is modelled closely on the Office of the Minister for Children, which has been acknowledged to be a great success. The Minister of State in question has responsibility across several Departments to co-ordinate services for people with disabilities and to make the Government's system suit the needs of the services users, rather than expecting such users to be obliged to find their way around the Government system.
As for services for older people, the amount of money spent on such services has been increased by €500 million in the past three years, which is a considerable investment. Moreover, more than 10,000 older people now are clinically managed at home. This provision did not exist a decade ago and is highly successful. In addition, 53,000 families receive home care support. Clearly, the vast majority of older people wish to remain in their own homes and communities. Not only do I want this wish to be fulfilled, it also is better from a health perspective.
Much debate centres on the fair deal at present and I wish to inform the committee that we are at the final stages in the drafting of that legislation, of which 12 drafts have been completed. Legal issues arose that involved discussions. While I emphasise they were not constitutional issues, complex legal issues exist.
We must put in place a system to support older people in care that is affordable for the older person and his or her family, that removes the worry from the older person and that is equitable in respect of those in privately-funded nursing homes and publicly-funded institutions. As we know, there is a huge discrepancy. In publicly-funded nursing homes 90% of the cost is funded, while in privately funded nursing home, about 60% of the cost is met by the State. This is not equitable or fair. There are 18,000 residential places in the private nursing home sector, and about 10,000 in the public nursing home sector. Rather than concentrate on who funds the infrastructure, what we are doing is providing a system of support that is fair and equitable between both.
We will have standards that will apply to both public and private facilities and an inspectorate that will inspect both. Heretofore, the inspection regime only applied to the private nursing home sector. Recently, HIQA sent me draft standards for nursing home care. These standards are being considered. We must undertake a regulatory impact assessment, which we are required to make for all new Government proposals to ensure the standards we are introducing are considered in the context of the impact they will have. At the same time, we are drafting the regulations to give effect to the standards and expect them to be in place later this year.
In respect of primary care, as I said, one of the major planks of the Government's reform programme as far as health services are concerned is transferring more activities from the hospital environment to the primary continuing community care environment. We know that 95% of health care needs can be met in that context. The HSE is putting in place the resources required to give effect to that commitment. Recently, it invited expressions of interest for the provision of key infrastructure in order to provide a modern environment for primary care. Everybody can read the script to see the amount of money being spent on this area.
As I said, 200,000 more people have medical cards and free access to their doctor as opposed to three years ago. We have the highest number with free access to their doctor than at any time since the 1980s when unemployment was three times what it is today. The number of persons with a GP visit card increased from 51,000 on 1 January 2007 to 75,000 on 1 January 2008, an increase of 23,000. As a result of these changes, 31.56% or 1,369,000 people now have access to their general practitioner.
Prescribing by nurses was something I was very keen to see introduced in the health care system. We provided for this in the Irish Medicines Board Bill. By the end of this year 150 nurses will have completed the prescribed programme to facilitate such prescribing. I had the opportunity to visit a number of health care settings, including the National Maternity Hospital in Holles Street, where nurses were prescribing, and meet some patients. Allowing nurses to prescribe in certain settings is very responsive to patient requirements.
On capital funding, with Norway, we are making the largest investment in capital infrastructure in the OECD. I have documented on page 9 where much of that investment is taking place. Clearly, we are moving forward rapidly in the provision of a new paediatric hospital to provide tertiary health care for very sick children and secondary health care for children in the Dublin area. Alongside this, there will be a facility as part of the paediatric service at Tallaght Hospital. The board is working aggressively and thoroughly to ensure we live within the timeframe set down for the provision of the hospital. I have said and given a commitment to the board that this is a priority for funding.
The consultant's contract has been seen by many, including me, as a key part of the health reform agenda. We have in place a contract of employment that does not meet the needs of the public health system. I am happy to say we reached agreement with the Irish Hospital Consultants Association and the new contract of employment has been sent to its members. The result of the ballot will be announced after 4 p.m. on Friday, 16 May. I very much look forward to the vast majority of the members of the Irish Hospital Consultants Association, which represents between 75% and 80% of practising consultants, agreeing to it. The contract is not so much about money and hours but about a new way of working in the system.
In putting in place a system that will facilitate doctors in being clinical leaders and very much involved in management at hospital level and in the health care system generally, we know we need to greatly expand the number of consultants. There are 6,000 doctors working in our hospitals, of whom 2,000 are consultants and 4,000, non-consultant doctors. We need to change the ratio in the other direction. We have advertised about 120 posts and there will be further advertisements in the next number of weeks.
The new doctors will come in under a new contract of employment that places much greater emphasis on the needs of patients, rather than on whether they are public or private. For example, in accident and emergency departments or in respect of outpatient activity, there will be a one for all system under which patients will access services on the basis of medical need, not on any other basis. This is fundamental to increasing access for many in society. It is not satisfactory that up to 40% to 50% of elective activity in some of our publicly funded hospitals is accounted for by private patients.
Mental health services are a major priority. We produced the strategy, A Vision for Change, which is very much about moving away from the service delivered in the past in large stand-alone mental health institutions to one in which the majority of services will be provided in a community setting, with acute psychiatric facilities at key locations around the country. I always find it heartening when I visit a town like Castlebar which even in the mid-1970s had over 2,000 patients in its psychiatric hospital and see that it is now a place of learning and no longer a facility that houses 2,000 patients who did not need to be there. There is now a small acute facility in the general hospital. That is the story we want to see repeated around the country.
This year new units are being progressed in Letterkenny, where 30 beds will be provided by 2011 and at University College Hospital, Galway. A total of 80 to 100 beds are required for specialist child and adult residential units in 20 residential units. Currently, 20 bed units are being progressed in Cork and St. Anne's in Galway. A six bed unit is being developed at St. Vincent's Hospital, Fairview, while a site is to be chosen shortly for a unit in Dublin-mid-Leinster, most likely in the greater Dublin area.
As always, I am very happy to come to the committee to engage with members, every one of whom wants to see improved health services, even if we have different perspectives on how we might get there. There is considerable emphasis on budgets and activity levels this year. From January to March, in terms of inpatient activity in hospitals, there was virtually no change from last year. The big change is the increase in the number of day cases dealt with. That is the model of care to which we are moving, like the rest of the world. In the first three months of this year we have seen a 7.5% increase in the number of day cases in our acute hospitals, which I find encouraging.
Contrary to popular perception, we are not scaling down activity, but we are doing things differently. We are providing care in the most effective way we can and are learning from what is happening here and in other countries in terms of best practice. I am the first to acknowledge that there are deficiencies in the health care system but, as I said yesterday, huge progress has been made in a host of areas in terms of improved outcomes in treating patients with cancer and heart disease. The number who die from heart disease has been more than halved. Life expectancy has increased by three years in the past six years and by five years in the past 30 years. We are making significant advances as a result of the expanded availability of medical interventions. We want to continue the health reforms to ensure that we respond in a speedy fashion to the health requirements of the population.
