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 Header Item Ceisteanna - Questions
 Header Item Priority Questions
 Header Item Health Services Provision

Thursday, 13 February 2014

Dáil Éireann Debate
Vol. 830 No. 3

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Ceisteanna - Questions

Priority Questions

Health Services Provision

 1. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the way he will address the deep concerns of both hospital consultants and general practitioners regarding the provision of health services; and if he will make a statement on the matter. [7186/14]

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher I am asking how the Minister for Health will address the deep concerns of both hospital consultants and general practitioners about the provision of health care. I tabled this question because it is an issue of major concern. Hospital consultants have expressed very strong views about patient safety, the lack of consultants and supports in hospitals, the overcrowding in emergency departments and all that flows from that. A report commissioned last year outlines the difficulty the Department and HSE are having in recruiting consultants. If we allow this to continue, we will have a diminution of services because we will not have consultants to provide those services. A crisis is evolving in general practice. That is the responsibility of the Minister of State, Deputy White, so we will blame him for this particular part of it, but it is of major concern. There is no point pretending that this issue is not beginning to gather pace in terms of young doctors leaving this country because they do not want to practice here or that practices are under major pressure and strain trying to provide the primary care the Minister talks about rolling out.

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly There has been significant focus over recent weeks on the very demanding and challenging financial and resource constraints within which the HSE has been required to prepare and adopt its 2014 service plan. It is important to recognise that this focus is not particular to the preparation and adoption of this year's HSE service plan as similar constraints have applied in each of the last number of years as a direct consequence of the emergency financial situation the State has had to address. At such an early hour of the morning I do not want to upset the Deputy opposite, but we all know why we are in these financial troubles.

  As in previous years, the delivery of the health and social care services provided for in this year's service plan will focus on the dual challenge of protecting patient outcomes while, at the same time, reducing costs. This requires increasing emphasis on models of care that treat patients at the lowest level of complexity, providing safe, quality services at the least possible cost. I commend the manner in which the HSE and its workforce have successfully focused on how best to minimise the impact of unavoidable constraints on front-line services by utilising innovative and more efficient and effective ways of using scarce resources.

  This year, the HSE needs to achieve saving measures of €619 million in order to remain within the approved 2014 health expenditure ceiling. It is important to recognise that the bulk of these required savings measures, including €268 million in pay and related savings and €172 million in reductions in pharmaceutical prices and expenditures and general practitioner fees, will not impact on the general public. These savings, allied to additional cost containment measures of €129 million in areas such as public procurement, shared services, value for money and energy efficiency savings, will allow the HSE to maintain and, in many cases, improve and build on the range of services provided to the public, as they reduce the cost of delivering such services to those in need.

  Additional information not given on the floor of the House

  I refer to the ongoing work of the special delivery unit, SDU, which was established in the Department of Health in 2011 in order to drive down waiting times for both scheduled and unscheduled care in hospitals and to introduce a major upgrade in the performance capabilities of the health system. In the case of unscheduled care, there has been an overall reduction of 14% in the number of patients waiting on trolleys during 2013. This is on top of the 23.6% reduction achieved in 2012 compared to 2011. In terms of scheduled care, at the end of December, 99.99% of adult inpatients and day cases were waiting less than eight months, 95% of child patients on the waiting list were waiting less than 20 weeks and 99% of routine gastrointestinal endoscopy patients were waiting less than 13 weeks. The number of patients waiting over 12 months for an outpatient appointment has reduced by 95% in 2013, from a high point of 103,433 in March of that year to 4,626 at end of December 2013. The SDU and health service staff across the health system are to be commended on these positive developments.

  The significant increase in the number of consultants over the past five years is also of note. In the five years since December 2008, the number of consultants has increased by 295, from 2,260 to 2,555. The number of doctors on GMS contracts has also significantly risen. On 31 December 2013, there were 2,413 GPs contracted to provide services under the General Medical Services scheme. This compares with 2,098 on 31 December 2008, an increase of 315 GP contract holders over this period.

  In the light of these developments, I have every confidence that, despite the unavoidable resource reductions already referred to, the HSE will maintain core services in 2014 while also supporting the growing demand for services arising from population growth, increased levels of chronic disease, increased demand for prescription drugs, higher numbers of medical card holders and new costly medical technologies and treatments.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher We do not have time to discuss the whole budget and the provisions of health care, but the feeling out there is that there is a crisis in GP services and that they are being forced to take on more complex cases. This is because of the outsourcing from the acute hospital system, the transfer of long-term illnesses and other complex conditions that are now expected to be treated in the primary setting. No additional resources have been put into GP services. GP services are under financial pressure. They are laying off staff. Then there is the added dimension of younger GPs not finding it an attractive option as a career path. That is sustainable only for so long. The budget for primary care has been consistently reduced, yet we expect GPs to take on additional responsibilities from a clinical point of view and that is unsustainable. It is time the Minister acknowledges that there is a problem and addresses it. Until he decides that, we will have major difficulty in the years ahead in terms of provision of primary care.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly Let us deal with the facts rather than the hype. There are more than 200 additional GPs in the GMS than there were when we came into government. We all know we are about to enter into - I must be very careful with the language here - consultation with general practice.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher Discussions.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly The Minister of State, Deputy White, has already met the various organisations. We expect to hear a lot of noise from that section until the new contract is in place, but let us deal with the facts. There are more than 200 additional GPs in the service than when Deputy Kelleher was in government. He alluded to overcrowding in our hospitals. Coming towards the end of his term in government, there were 569 people on trolleys in a single day. We have reduced that number by 34% over 2012 and 2013. This year so far, we are already over 3% lower than last year. That is still too many and I want to see it improved.

It is important to have the facts out here. There are more consultants and GPs in the service than there were three years ago and we recruited over 700 nurses last year. The people who work in our health service face serious challenge and pressure but they are doing that magnificently and I congratulate them on the great improvements they have made.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher We can have this debate again and again but the Minister is in his fourth year in government. He can only shelve his responsibility for so long.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly We are not in government three years yet.

Deputy Kathleen Lynch: Information on Kathleen Lynch Zoom on Kathleen Lynch Former Deputy Batt O'Keeffe must have taught Deputy Kelleher mathematics.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher He is going into his fourth year and it is time he would believe he can stand over his policies and decisions. There are serious difficulties in the acute hospital setting. It is difficult to get people out of hospitals. Step-down facilities are not available. We are having difficulty trying to transfer people from the acute hospital setting to step-down and then home. That is happening day in day out in hospitals across the country and this adds to the difficulties at the front end in emergency departments.

Deputy Alex White: Information on Alex White Zoom on Alex White Does Deputy Kelleher have any proposals about anything on health?

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher I am making those points because if the Minister wants to deny the facts and the realities and what the clinicians at the coal-face are telling us, then he should deny them.

Deputy Alex White: Information on Alex White Zoom on Alex White It is ten years since Deputy Kelleher had a policy on health. He has no policies.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher The Government does not have any either.


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