Dáil Éireann Debate, Tuesday - 18 October 2016
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]
View answerWhen 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.
