Contribution to the Debate on the Health Service Executive (Financial Matters) Bill 2013: Second Stage (Resumed) (Continued)

February 19th, 2014 - Pat Breen

I thank my colleagues for allowing me to speak now, as unfortunately I have official business and must get back to it. I welcome the opportunity to speak on the debate this afternoon. While the Bill is somewhat technical in nature, it provides for the disestablishment of the Vote of the Health Service Executive and the funding of the executive through the Vote of the office of the Minister for Health.
The Minister for Health has embarked on one of the most radical overhauls of our health service in the history of the State and is driven by his determination to ensure equality of access for all patients based on needs rather than the size of their wallets. I commend the Minister on his work in the area.

Previous attempts to reform the health system failed because the way health care was delivered was fragmented. During the period of greatest economic growth in this country, the disparity between those with private insurance and public patients grew, and as public representatives we have dealt with all cases and seen the unfairness of the two-tier health system. Real health care reforms require restructuring of health services and how they are organised. The restructuring is well under way and the various hospital groups have been established. The Health Service Executive (Governance) Bill 2012 provided for the new directorate structure and today’s Bill provides for the financial structures. I also understand the White Paper on universal health insurance is due to be published shortly and I look forward to that and the following debate.

The changes have already had an impact. For example, a new governance structure has been introduced in the University of Limerick hospitals group, which comprises University Hospital Limerick, Mid-Western Regional Hospital Ennis, St. John’s Hospital in Limerick, Nenagh Hospital and Croom orthopaedic hospital, and they are bedding down well. Under the new structure, 7,472 more inpatients and 11,094 more outpatients were seen in the system with a smaller budget. There are challenges, particularly in the accident and emergency department in Limerick, and, as I stated in this House, I am anxious to see that fast-tracked as soon as possible. Nevertheless, the new hospital structure is ensuring a better future for hospitals such as that in Ennis and will allow the University Hospital Limerick to focus on the areas in which it can deliver and transfer services to Ennis.

It was always envisaged that Ennis hospital would become the left arm of the regional hospital in Limerick, but until the Minister for Health assumed office, development was very much restricted. The opening of the new wing and the provision of a full range of services, as well as accreditation as a centre of colorectal screening, is allowing the hospital to expand the level of services. More can be done within the framework, such as maximising the use of the acute medical assessment unit by opening it seven days a week and expanding the range of day surgical procedures that can also be carried out. We cannot just patch up health services; we must transform the way they deliver.

Recently at a meeting in Limerick with HSE personnel, the absence of a model three hospital in the region was noted. There is one in Tralee and Clonmel but there is none in the mid-west regional hospital group. Limerick is a model four hospital and Ennis, Nenagh and St. John’s hospitals are model two. The absence of a model three hospital in the region is putting pressure on University Hospital Limerick and I call on the HSE to consider Ennis hospital as a model three hospital. Much investment has gone into the hospital recently and the rooms have been upgraded and are state-of-the-art. Some further investment may be required but it would be a very small amount, and the only element that is really needed is a roster of consultants.

I suggest that it would be well worth considering Ennis hospital as a model three hospital to alleviate the pressure in the system, particularly in that area. I will focus on that in future with the HSE.
We have an aging population so we must move away from treating people in hospitals to treating them in the community. I very much welcome the Minister’s support for day care centres and the voluntary community initiatives which facilitate people in living longer in their homes. Priority is also being given to primary care and provision of preventative care. This health system offers the best way forward for the most important player in our health system, which is the patient. I support the Minister’s efforts to drive reform.

It is essential that functional structures are in place to support the new health care model, and today’s legislation is another important step in this regard.

I commend the Bill to the House.