Before I start, I wish to join you, Chairman, in extending my congratulations to Professor William Campbell, a graduate of Trinity College Dublin and of Irish birth, on winning a Nobel Prize. It makes all of us very proud.
I thank the committee for the invitation to attend the meeting today. I am joined by the Minister of State, Deputy Kathleen Lynch, HSE director general, Mr. Tony O’Brien, deputy director general, Ms Laverne Mc Guinness, and members of the HSE directorate. Our last quarterly meeting was in May and I took that opportunity to update the committee on progress on our 2015 work programme - 25 actions under five major themes. I welcome the opportunity to give a further update on those actions today.
Before I do that, a major focus of attention at present is budget 2016. Discussions are under way between my Department and the Department of Public Expenditure and Reform. As nothing has been agreed at this stage, I am not in a position to go into any detail about what is contained in budget 2016 for health, or for any other sector. I am sure the committee will understand why that is the case.
What I can say is that the Exchequer funding in 2015 provided the first increase in seven years for the health services and was very welcome. However, pressures are arising in a number of areas, particularly in expenditure on hospitals, demand-led schemes and legal settlements. The committee will also be aware that during the year, the Government decided to spend additional funds in a number of areas, including general practitioner, GP, care without fees for children under six years of age and adults aged 70 or over, and a new programme to manage diabetes in general practice. The Government also committed additional funding of almost €100 million to address the issue of delayed discharges and emergency department overcrowding, as well as another €51 million to address long waiting times for public patients.
There will be a Supplementary Estimate to account for the additional investment in the services over the course of 2015. It is not yet possible to quantify exactly the level of the Estimates that will be required given, in particular, the uncertainty around demand- led schemes and legal settlements. My officials continue to work closely with the HSE to ensure that the greatest degree of budgetary control is exercised.
Getting back to the actions for 2015, the first theme is Healthy Ireland. Tomorrow, I will publish the results of the first Healthy Ireland survey. It gives us an up-to-date picture of the health of the nation in areas such as nutrition, alcohol consumption, smoking, physical activity, weight, sexual health and well-being. The last survey of this type was carried out in 2007, so it is a timely and important update which will help to inform our policy choices in the years ahead. Committee members have been invited to the launch and I hope to see many of them there tomorrow in the GPO.
I plan to publish the general scheme of the Public Health (Alcohol) Bill very shortly. Alcohol misuse is a blight on our economy, society and health services and the Bill will give us new powers and tools to tackle it. The Department is also developing regulations on tobacco packaging further to the approval by the Oireachtas of the underpinning legislation last spring. As the committee knows, it is subject to legal challenge and we are now addressing some other issues that have arisen relating to the appearance of tobacco packaging. We will do this through technical amendments to the Act which we will shortly bring to the Government for approval.
On obesity, the Department recently published the results of its public consultation on how we can work together to address the challenge of excess weight and obesity. We are using the results to finalise, by the end of the year, a new obesity policy and action plan. This is a major personal and public health issue, in particular for our children. It is vital we address it now, not just for our children but also for their children.
Through the course of the year, we have been phasing in regulations and measures restricting the use of sunbeds to people over 18 years of age. In August, we published guidelines on test purchasing to help environmental health officers to enforce the Public Health (Sunbeds) Act and protect young people from the dangers associated with the use of sunbeds.
The second theme is patient outcomes and patient safety. I have taken a personal interest in emergency department overcrowding and have secured almost €85 million in additional funding this year to alleviate the problem. This has allowed us to reduce the waiting time for the fair deal nursing home support scheme from 15 weeks to four, which in turn has reduced delayed discharges in hospitals from 850 at its peak to under 600 now, freeing up 250 acute beds every day. It has also allowed us to open another 150 community beds, including Dublin’s first community hospital at Mount Carmel. More community beds will be opened before the end of the year. It has also allowed us to increase investment in health services and keep patients out of hospital altogether or allow them to get home earlier, thanks to community intervention teams, day hospitals and acute medical admission units. This will continue.
While we have seen an improvement in patient experience times in our emergency departments, that is the length of time a patient spends in the emergency department before being admitted or sent home, and a fall in the numbers of people waiting on a trolley for more than nine hours, morning peak overcrowding has not improved and is still worse than it was at the same point last year. The next steps are to open approximately 300 additional hospital beds across the country in November and December. The director general and his team are visiting the worst affected hospitals to see what can be done to address other blockages, such as diagnostics and rapid access to outpatients.
It is also clear that we need more weekend discharges and more evening ward rounds to reduce length of stay, and senior decision makers reviewing patients shortly after or before admission to reduce unnecessary admissions and length of stay. I understand the distress and hardship that all of this causes to patients, their families and, of course, staff.
On the long waiting times for public patients, a total of €51 million in additional funding has been made available to hospitals to enable them to reach the 15 month maximum waiting time, either in-house or through outsourcing if necessary. To date, 5,770 people have benefitted from this initiative and have had a procedure or operation done that would not have been done otherwise. A total of 970 of those were done in the private sector.
Some 48,702 people have had an outpatient appointment under this initiative, 14,000 of them in the private sector. So most of it has been done in-house.
In tandem with the additional funding, the HSE launched a new initiative to ensure that hospitals comply with the new maximums and address any outstanding long waits for inpatient and outpatient procedures. Hospitals that breached the 18-month maximum waiting time in August began being fined from September. It is accepted, however, that for some subspecialties the capacity simply does not exist in the public or private sectors or even abroad. Therefore, an exemption is made for these.
The third theme is universal health. Since we last met, we have put in place GP care without fees for those aged under six and over 70. This represents the first step in the phased introduction of a universal GP service and is benefiting more than 300,000 senior citizens and children. Last week we launched the diabetes cycle of care for medical card or GP-visit card holders who have type-2 diabetes. To date, 30,000 patients have been enrolled. I hope this can serve as a model for other common chronic diseases to be managed in general practice or a primary care centre rather than a hospital clinic.
The authorisation of the VHI by the Central Bank at the end of July is an important milestone. Lifetime community rating is in place and there are now 93,000 more people with health insurance than there were at the start of the year. While there have been increases in many premiums, the age of double-digit annual increases is behind us.
I am a strong believer in universal health care, by which I mean access to affordable health care for everyone in a timely manner. However, the foundations have to be put in place first. These include addressing some of the significant capacity constraints that exist in our health service, the full implementation of activity-based funding, the establishment of the health-care pricing office on a statutory basis, a new, fairer drug reimbursement scheme and the further development of the hospital groups and community health care organisations. It should not be rushed but we can do something every year to significantly improve access to health care, which might be considered universal health care in steps.
The fourth theme is reform. I am very much behind the hospital groups. The CEOs and their senior teams are now in place and I hope to appoint the remaining boards as soon as possible. Legislation is being prepared to establish the children’s hospital group trust on a statutory basis and legislation to establish the other hospital groups can be done within two years. Nine community health care organisations have also been established. Together, these reforms will enable the creation of a purchaser-provider split and the establishment of a commissioning body. They will also provide for the HSE to be dismantled during the term of the next Government.
One of my priorities is to ensure that activity-based funding, ABF, is embedded across the health service. The HSE health care pricing office has published an implementation plan which sets out objectives up to 2017. This is a great opportunity to use ABF to improve the quality and efficiency of inpatient and day-case treatment, expand ABF into other services such as those relating to outpatients and, after that, beyond the hospital walls and into primary care.
The fifth theme is investment in modern infrastructure and facilities including ICT. Earlier this week the Government approved a capital envelope of more than €3 billion over six years for health and public private partnerships to the value of €150 million. This will allow works to begin on the four major national hospital projects next year, subject to planning permission. These are: the new National Children’s Hospital on the campus of St James’s and the satellite centres in Blanchardstown and Tallaght; the new National Maternity Hospital to be co-located with St Vincent’s; the new National Rehabilitation Hospital in Dún Laoghaire; and a new national forensic mental health hospital in Portrane. It will also allow significant progress to be made on five major national programmes: the national radiation oncology programme in Cork, Galway and Beaumont; a major €300 million programme to refurbish or replace community nursing units and residential facilities for people with disabilities; to continue to provide ten new primary care centres every year; relocating the three remaining stand-alone maternity hospitals, Rotunda, Coombe and Limerick; and a major investment in new ICT, including important projects such as the individual health identifier, online GP referral, the electronic patient record and a new financial system.
I wish to address the challenging area of recruitment in the health service. The challenges are real and well known. Less well known perhaps is the very real progress being made. By the end of July of this year, the HSE had filled more consultant posts than it had during the whole of last year. The number of consultants employed in the year from 31 August 2014 to 31 August 2015 increased by 72 net - from 2,623 at the end of August last year to 2,695 at the end of August this year. At the current rate, we could see as many as 130 additional consultants appointed this year. The vacancy rate is now falling and stands at 170, which is 6.3%. There are now almost 300 more consultants than when the Government came to office.
While it continues to be difficult to fill vacancies in some specialties and hospitals, overall the picture is improving. The new pay scales agreed with the IMO at the Labour Relations Commission mean that post-CCST experience and relevant higher qualifications are now recognised for incremental credit, making posts more attractive financially.
There are now 5,500 non-consultant hospital doctors, the highest number ever, and 1,000 more than when the Government came to office. Notwithstanding the difficulties in some rural and deprived urban areas, the number of GPs with GMS contracts is stable. This is a somewhat different picture than others would have us believe, but these are the facts.
While overall nursing numbers are down on those which obtained in 2008, the number of midwives, advanced nurse practitioners and clinic nurse specialists is now at an all-time high, with plans for further recruitment. As of the end of August, there were 44 more nurses working in our health services than at the start of the year and 578 more than this time last year. In July, the HSE launched a new campaign to attract 500 nurses and midwives back to Ireland from the UK and elsewhere to fill vacancies. As of two weeks ago, over 300 applications had been received and were being shortlisted for suitability. Early indications suggest that the vast majority of the graduating class of nurses in 2015 are staying in Ireland, which is very encouraging. The spend on agency staff so far this year is €11 million less than last year.
In conclusion, 2015 is a story of real progress in some areas but of growing challenges in others. We have reduced waiting times for the fair deal to less than four weeks, reduced delayed discharges to the lowest in many years, stabilised the health insurance market to allow more people get covered, and extended free GP care to the youngest and oldest as the first phases of universal health care. We are turning the tide on recruitment of nurses and consultants. However, emergency department overcrowding and long waiting times for public patients persist as serious challenges, as does financial control across the health service.
I will now allow the Minister of State, Deputy Kathleen Lynch, and the director general to provide their updates and I will be happy to take questions later.
