Health Ministers Publish Future Health: A Strategic Framework for Reform of the Health Service 2012 – 2015
The Minister for Health Dr. James Reilly TD and Ministers of State Kathleen Lynch TD & Alex White TD have today (15 November 2012) published Future Health: A Strategic Framework for Reform of the Health Service 2012-2015. It sets out the main healthcare reforms that will be introduced in the coming years, as key building blocks for the introduction of Universal Health Insurance in 2016. Future Health is about prioritising the needs of the patient even as difficult decisions on health financing are made.
Future Health contains a set of specific actions, with timelines, that will prepare the way for Universal Health Insurance. Speaking at the launch of the document today, Minister Reilly said:
“The core of the Government’s health reform programme is a single-tier health system, supported by Universal Health Insurance in 2016. Future Health sets out the steps to bring us improved health and wellbeing; faster, fairer access to hospital care; free access to GP care by 2015; better management of chronic illness; more people cared for in their own homes and improved quality and safety. The goal is to put the needs of the patient at the centre of the health system. The essential public nature of the health system will not be changed.”
Future Health will deliver a major reshaping of the health system by restructuring our service delivery, and improving our organisational, financial, governance and accountability systems across the board – in the primary, community and hospital sectors.
Minister Reilly said:
“I am determined to press ahead with the key reforms of our health system that we promised in the Programme for Government. Future Health sets out the main building blocks to achieve these reforms. The changes are right for the system, right for staff and, most importantly, right for patients and all users of our health service. The financial pressures on the health system make it even more important that we introduce comprehensive health reform. Only in this way can we deliver the services our people need, even as the available financial resources diminish.
I look forward to working with all of the stakeholders to give us the health service we all want.”
Speaking at the launch today Minister of State Kathleen Lynch said:
“This Government is committed to reforming social care as a key element of the health reform programme. The objective is to deliver social care at the lowest level of complexity through a service focussed on the care needs of older people, those in need of palliative care, people with a disability and those with mental health issues. I believe that with the on-going commitment of all involved, we can design and implement an equitable and responsive social care system that will bring tangible benefits to some of the most vulnerable in our society.”
Minister of State Alex White said:
“The development of primary care is an essential element of this government’s healthcare strategy. Working with colleagues, my task is to bring forward the reforms that are necessary to make this a reality.
This will include the further development of Primary Care Teams and Centres throughout the country, together with pioneering new legislation paving the way for GP-care without fees. The first stage will be to extend GP care to persons with chronic diseases. The legislation required to achieve this will be published shortly.
Primary Care Teams will give people access to integrated, multi-disciplinary care by GPs, nurses, physiotherapists, occupational therapists and others – working in collaboration, and from the same facility.
These are critical elements of the Government’s plan Future Health being launched today. I look forward to working with all involved in the delivery of primary care, and in helping to construct a truly equitable healthcare system, dedicated to the health and wellbeing of all our citizens.”
View the document
Note for Editors on ‘Future Health: A Strategic Framework for Reform of the Health Service 2012-2015′
1. The Approach to Reform – Four Pillars
1.1 Health and Wellbeing
There will be a new focus on the need to move away from simply treating ill people to a new concentration on keeping people healthy. Future Health recognises the need for a whole-of-government approach to addressing health issues and commits to the development of a comprehensive Health and Wellbeing Policy Framework and the establishment of a Health and Wellbeing Agency.
1.2 Service Reform
Future Health commits to service reform that will move us away from the current hospital centric model of care towards a new model of integrated care which treats people at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. This will help to reduce costs, improve access, and move away from the existing emphasis on episodic reactive care towards preventative, planned and well-co-ordinated care.
1.3 Structural Reform
The Minister recognises that structural reform of the health service will be key to addressing the problems within our current health system and will also be critical in the journey to UHI. Getting the structure right will be a complex task and as such, each phase of the transition will be evaluated carefully as we progress towards UHI. The Minister’s key concerns in terms of structural reform are to promote good governance, avoid duplication and ensure a strong regional focus in managing performance and delivering value for money.
The first phase of reform will deliver a greater degree of accountability for the HSE. It includes abolition of the HSE Board, establishment of a Directorate and a new management structure in the HSE. Hospital groups will be established on an administrative basis, with Group CEOs having budgetary responsibility for both the HSE and voluntary hospitals in their group. There will be a review of Integrated Service Areas which will ensure maximum alignment between all service providers at the local level, review executive management and governance arrangements and inform new structures for the delivery of primary care. This phase will also see the establishment of the new Child and Family Support Agency. The legal status of the HSE will not change during phase one. The second and third phases, which are key to the implementation of UHI will involve: firstly, the development of a formal purchaser/provider split and effectively, the dissolution of the HSE and; secondly, a move from a tax-funded system to a combination of UHI and tax funding. The essential public nature of the health system will not be changed.
1.4 Financial Reform
The financial challenges facing the health system are immense. Future Health measures aimed at addressing the financial control issues include the return of the Vote to the Department of Health from the HSE; the introduction of programme based budgeting; implementation of the recommendations of the 2012 Review of Financial Management Systems in the Irish Health Service; and the development and roll-out of a comprehensive financial management system as a matter of priority.
A new ‘Money Follows the Patient’ (MFTP) funding model will be introduced in order to create incentives that encourage treatment at the lowest level of complexity. The introduction of ‘MFTP’ will be used both to reduce costs and to achieve key quality and safety objectives. The ‘MFTP’ system will be designed so that money can follow the patient out of the hospital setting to primary care and related services. This, along with other initiatives such as the introduction of integrated payment systems, will help to support integration between primary, community and hospital care.
Important reforms of the private health insurance market are also planned, including a new permanent scheme of risk equalisation from 1 January next, an emphasis on cost control and a continuing examination of the options in relation to the future status of the VHI.
2. Reform of the Delivery System
2.1 Primary Care
The vision for primary care is one where: no one must pay fees for GP care; GPs work in teams with other primary care professionals; the focus is on the prevention of illness and structured care for people with chronic conditions; primary care teams work from dedicated facilities; and staffing and resourcing of primary care is allocated in a planned manner to meet regularly assessed needs. Future Health commits us to retaining the community ethos of primary care, in which the patient’s needs are the first concern.
Future Health identifies three main areas of reform for the hospital system: (i) delivering more responsive and equitable access to scheduled and unscheduled care for all patients through continued implementation of the Special Delivery Unit’s initiatives in this area; (ii) reorganising public hospitals into more efficient and accountable hospital groups that harness the benefits of increased independence and a greater control at local level; and (iii) publishing a Framework for the Development of Smaller Hospitals, in which they will play a vital role in service delivery.
2.3 Social and Continuing Care
Future Health commits to the development of a social and continuing care system that maximises independence and achieves value for the resources invested. The measures include a reform of the Fair Deal scheme to allow many more people to continue living at home as they would wish. Disability services will be reformed in line with the findings of the recent Value for Money and Policy Review of Disability Services. Future Health also reaffirms our support for the move from the traditional institutional based model of mental health care, towards a patient-centred, flexible community based service. Other important measures identified include the introduction of: a standardised framework to commission services from both public and non-public providers; individualised budgeting to bring about a closer alignment between funding and the outcomes of individuals; and a robust regulatory regime to ensure quality and safety. Social and Community Care will continue to be tax funded separately from UHI.
3. Approach to Implementation
While the reforms envisaged are comprehensive and transformative, the Minister is determined to maintain access and quality during the reform process. For this reason, Future Health proposes that change will be implemented in a step by step manner, on the basis of good evidence. Further detailed actions will be built on the foundations of Future Health as the reform programme proceeds. A White Paper on Universal Health Insurance, to be published in 2013, will provide the basis for many of these actions and a preliminary document will be produced by the end of this year. A preliminary paper will be published this year.
Robust governance and management arrangements will be crucial to drive, manage and monitor implementation of the reform programme. To this end, the Minister will establish a Programme Management Office in the Department of Health to act as a central, overarching, co-ordinating function for health reform.