I am pleased to come before the committee to discuss health policy and my priorities as Minister. I am accompanied by Mr. Paul Barron and Mr. Dermot Smyth, assistant secretaries in the Department of Health and Children, and Mr. Fergal Goodman, who is a principal officer in the Department.
I do not propose to speak for half an hour or to circulate a script. I do not have a prepared script but intend to speak for a few minutes and then engage with the committee, which might be more fruitful than giving a long speech. There are many debates in the House on health issues. Every couple of weeks there is a Private Members' debate on health and there are also debates on legislation and issues of concern to Members. It is more appropriate when one engages with a committee that has a particular interest in health matters to do so on policy priorities and ideas.
Everybody agrees, regardless of their political perspective, that the focus of the debate on health services must be on patients. Sometimes, in many of the debates that affect different people who work in the health services, one would be forgiven for thinking that we were talking about patients. Whether it is hospital services, services for people with disabilities, community services or health reform, we must focus on what is in the interest of patients and particularly what is in the interests of sick patients. I am impressed by the interest members of the public have in health reform. If we approach the issue of reform from a patient's perspective, particularly from the perspective of how we can deliver the world class health service I have spoken about on a number of occasions, and if we could agree on certain priorities, it would be a major advance not only for politics in this country but also for patients.
Sick patients cannot have services too quickly. Sick patients are more concerned about clinical outcomes than anything else. However, they are also concerned about care settings, facilities, resources and after care. When one talks about health services, therefore, one must have an all-inclusive approach. One cannot separate the different pieces.
There is much debate at present about accident and emergency services. These services are for accidents and emergencies but because of deficiencies in the health service, many people end up in accident and emergency departments who need not be there. That is the reason the approach this year to the issues surrounding accident and emergency services includes out of hours general practitioner services, providing more step down facilities for those who do not need to be in hospital beds and providing a more appropriate setting for those with high dependency requirements who do not need to be in the acute hospital service. In addition, we wish to provide acute medical assessment units in order that those who require to be treated in a facility such as that can have the resources available to them.
The speed of delivery of health reform will also be important. We have many strategies. We have generally been good across the political divide and across Departments at devising strategies. One can never have effective reform without having a strategy or road map indicating where one wants to go and how one wants to get there. The most effective strategy is the one that delivers improved services for those who require them.
When we discuss improved services there is much emphasis on bed capacity. This morning, I will also focus on bed usage. I was impressed recently by a number of comments from leading experts in health care. Conor Burke, one of our leading lung specialists, who is not just an Irish leader in that field but a global leader, conducted an analysis of 4,000 patients. He concluded that more appropriate and effective use of beds would have eliminated the pressure points that arise at accident and emergency departments. When we discuss more beds, we must also discuss the more effective use of the current stock of beds in the hospital system.
The issue of discharge policies, particularly daily discharge, must be on our agenda. Miriam Wiley of the ESRI has also spoken at length about some of these issues. When a doctor certifies that somebody is fit to leave the acute setting it is often many days later, sometimes many weeks later, before that person is moved to a more appropriate setting, whether that is their home or a different setting. The issue of bed capacity, therefore, is not entirely about new beds, and new beds are needed, but also about the effective use of existing beds.
In today's newspapers there are many references to the Hanly report and to letters I am supposed to be writing to Mr. Hanly. I do not know if somebody is being innovative and imaginative but I have no proposal to write to Mr. Hanly. I will meet him next Monday. I have met him on one occasion since my appointment as Minister for Health and Children. Health reform is not off the agenda. We should not personalise the issue of health reform either with regard to David Hanly who has done an outstanding job on health reform, or anybody else.
We must create regional self sufficiency in so far as we can. It is not good enough that patients from the west, south east or south west must come to the Dublin area for essential health care. Of course, in the complex tertiary area we might only be able to provide at one centre in the country or perhaps two centres in the capital certain services or facilities. However, the vast majority of people who require hospital admission and the services of the acute hospital system do not need to come to the capital. Those services can be provided in the regions, particularly if we increase the stock of hospital consultants. We have greatly increased the number of consultants in recent years. The current figure is approximately 1,940 but that number must be increased substantially to more than 3,600 in the coming years. In some regions we do not have a specialist in some areas and, in many other cases, we may have only one or two specialists. No matter how good they are, they certainly cannot provide the kind of service required in the region. The EU working time directive will be implemented. It is a priority for me and for the Government.
In regard to cancer care, only yesterday I had an opportunity to meet representatives of the Irish Cancer Society to discuss the society's priorities and hear its perspectives. Of course, when we talk about cancer care, we must talk about cancer prevention and, in particular, population screening programmes. BreastCheck has been really successful. We must roll it out to the two remaining regions which do not have it — Cork and Galway — and that is a priority for me. Likewise, cervical screening is important and it is still only in place in the mid-west. Yesterday, I had the opportunity to discuss with the Irish Cancer Society — I have discussed it with other experts in the area and with my officials — the most effective way to provide these screening programmes nationally. Whether it is cancer screening, cancer prevention or other areas, we must be prepared to look at the most innovative way to provide services to the population.
Earlier this week I had the opportunity to do some work on the extension of the medical card. When the Government decided to extend the medical card on a doctor only basis to 200,000 people, we felt we could do that under the existing 1970 Health Act by ministerial order. However, in the light of advice from the Attorney General and the more cautious approach we are taking subsequent to the issue of charges for long-term care, we need primary legislation and a minor amendment to the 1970 Act. I have cleared that Bill and hopefully it will go to Cabinet on Tuesday of the week after next. The intention is that those cards will be issued from April.
There has been some public debate on the issue of extending the medical card on a doctor-only basis. The Irish Medical Organisation has made comments but I am satisfied that the card, and the issuing thereof, is not in breach of any agreements we have with the organisation. In fact, it welcomed the extension of the card on that basis. I have had discussions with the president of the IMO and the current contract with the organisation facilitates up to 40% of the population having a medical card as far as the doctor is concerned. Even with the extension of this card, it will only bring us to 34% of the population. The IMO has always maintained that if the card is given on a means test basis only and not on a class basis, like the over 70s, it is not an issue for it. An issue arises in regard to the form on which the prescription will be written. Clearly, since the card only covers the doctor, the prescription will be written on a private prescription basis rather than on the traditional medical card basis. Other than that, I am not aware of any other issue and nobody has brought any other issue to my attention.
Like other reform, we must focus on the patients and what they want. Certainly, the people are anxious to have this card. The reason we have extended the card on that basis is that it allows us to give cover to a greater number of people so they may at least have the advice of their doctor. The idea was first brought to my attention by members of the IMO and by Deputies, namely, that we should consider extending the medical card on that basis.
On health care generally, I said on many occasions since the end of September that we want to provide a world-class health service. When we talk about world class, we must talk in terms of how we manage and deliver health services and standards of safety and excellence. Above all else in the health reform debate, we must focus on safety. That must be the priority for all of us. Sometimes in this debate, safety is left aside. No chief executive officer of an airline would ignore the advice of the safety experts on how to operate an airline. No serious Minister for Health and Children should ignore safety advice when it comes to where, how and the basis on which services are provided. Therefore, experts in this area must be listened to. Experts sometimes differ but we know that in certain key areas, volume is important. If it is not safe to carry out only 20 particular surgical procedures at a particular facility and 100 are required, that must be the guiding principle in relation to health reform and we must have the courage to see that through. That does not mean closing facilities. What it means is that every facility should be used for its most appropriate purpose, whatever that might be.
As I said, I am a strong fan of regional autonomy in every respect, particularly in health care. I do not want to see people having to travel unnecessary distances and being away from home when they could be closer to home when they have serious illnesses. Having said that, we must be guided, above all else, by what safety dictates in this particular area.
The private, independent sector, has played an important role in Irish health care delivery for many years. We have a mixed system where approximately 50% of our population have private health insurance as opposed to 11% in the United Kingdom. I want to exploit how the independent sector can provide more services for patients in Ireland. Again, if services are to be provided privately and if private investment is to supply health care, then at national level, the Health Service Executive, the new Health Information Equality Authority or the Department of Health and Children and the Minister should decide the basis on which those services are provided. Services must be made available to everybody regardless of whether they have insurance. If services are available in a region, the State must be capable of buying those services if they are provided to high standards.
There is great interest among the private sector in the provision of health care facilities. We must move forward on a coherent and sensible basis. Recently, I asked Prospectus, following a tender process before Christmas, to work with me and my officials on drawing up a framework on how we can involve the private sector in the provision of health care facilities on hospital sites. I am very anxious to ensure that any new bed capacity and any new services are provided in conjunction with the existing hospital infrastructure. There is a host of reasons for that. The synergy and efficiencies which come from that are obvious. Also, we want to keep the medical expertise on site and ensure that the public hospital system gets the benefits of any investment that can be made in this area. Prospectus has been asked to come forward by the end of this month with some parameters on how we can have a framework in this area. After that, we hope to be able to move very quickly to support initiatives for health care development from the private sector.
Three new public hospitals are being built in Portugal by private sector investment and they will be run and operated by the private sector. The same has happened in Sweden. When we look at many other countries, we see how innovative they have been in bringing forward increased bed capacity and new services. Unfortunately, we have been too traditional. We have always felt that unless the Government does it, it cannot happen. We do not live in that model anymore and it is certainly not the model being followed in many other countries. The role of Government is obviously to provide services but, in particular, to ensure that the services provided are provided to the highest possible standards. The Government's role is to ensure the standards and the services are appropriate. It should not matter thereafter whether they are provided by the taxpayers directly or by other operators provided they are supplied to the highest possible standard.
I will conclude my opening remarks or else I will fall foul of what I said at the outset which was that I did not want to take a half an hour because there can be more engagement if we have a question and answer session. My Department supplied a long brief to members of the committee on the various issues of concern. I said during the debate on the HSE that I intend to supply members with the heads of Bills before they are finalised because we can have better debates and more effective legislation if we do that. Clearly when it comes to some emergency issues, that might not always be possible. There is a huge amount of legislation on the way from the Department of Health and Children, including the Medical Practitioners Bill, the Nurses Bill and the pharmaceutical Bill. As regards the latter, somebody recently commented that it is old legislation because we have been discussing it for over 12 years. Those Bills will come forward this year. The priority for me is the health, information and quality authority Bill. As stated earlier, standards and information are very important, particularly in the context of reform. We must be guided by what is in the best interests of patients, from a standards perspective, and the HIQA Bill is a priority for the earlier part of this year.
I look forward to engagement with all of the members of the committee because I know that everyone here is genuinely interested in health care. It is not about party politics; it is about patients. This, however, is notwithstanding the fact that people have different ideas about and perspectives on health reform and on how we can supply and provide services for the population. I confirm what I said privately to the Chairman, namely, that it would be my intention, if members so wish, to come before the committee during each Dáil session to discuss issues of priority outside the normal legislative framework. This would be beneficial for the committee and for me.