Address by Micheál Martin Minister for Health and Children National Consultative Forum
Good morning chairman, colleagues, ladies and gentlemen. It gives me great pleasure to welcome you to the second National Consultative Forum since the launch of the Strategy in 2001.
The process of consultation has become a way of working within the Department of Health and Children, built, I believe, on the success of the approach in drafting the Health Strategy itself. It is my firm belief that it is crucial to retain your valuable input in the ongoing implementation of the National Health Strategy of which the Health Service Reform Programme forms a vital element.
The Health Strategy
In November 2001, the Government launched the National Health Strategy Quality and Fairness A Health System for You. The Strategy is centred on four goals based on these core values, better health for everyone, fair access, responsive and appropriate care delivery and high performance.
Full implementation of the Strategy has always been seen as a longer-term project. It quite deliberately set out to get away from short term thinking and piece-meal policy making to create a longer term overarching framework, with clear goals, objectives and action points which will guide day to day and year on year decision making over the period of implementation. I am restating today the Government´s commitment to full implementation of the Strategy.
In spite of the more difficult economic climate within which we operate the progress in implementing the Health Strategy continues to be impressive. There has been very significant investment in a number of priority areas, and there are a number of very positive developments that have occurred, including:
- 568 additional acute hospital beds have been commissioned;
- Decreasing death rates, and longer survival times are being achieved under the cardiovascular strategy;
- Planning for the National roll-out of the very important breast check programme, following its successful pilot;
- The National Treatment Purchase Fund is having a positive impact on waiting lists, and the majority of adults waiting longer than twelve months and children waiting longer than six months have now been offered treatment;
- There are General Practitioner co-ops in every Health Board region in the country, providing a structured out of hours service.
- The National Health Information Strategy will shortly be published, and will provide an important platform for Health information and communications technologies going forward;
- Finally, in spite of the more difficult economic environment Health still managed to secure additional funding through the 2004 estimates campaign, once again re-enforcing the Government´s commitment to Health and the implementation of the Health Strategy.
The Secretary General will talk through some of these achievements in more detail in his presentation.
The Health Service Reform Programme
What I want to focus on today is the vital role of the Health Reform Programme as the integrated platform describing the key enablers and drivers to deliver the Health Strategy.
The Reform Programme brings together the work of the Audit of Structures and Functions in the Health System and Commission on Financial Management and Control Systems in the Health Service. The recent publication of the Report of the National Task Force on Medical Staffing was the final element of the Health Service Reform Programme.
The Health Strategy recognised the need for significant change in the way services are provided, planned and delivered. It forms the framework within which all of the supporting analysis and sectoral strategies, which have emerged over the past eighteen months, have been developed.
It is extremely important that we place the ongoing reform programme within that context, as it is this which brings our focus back to what the Reform Programme and the Health Strategy is really about – it is about making health a number one priority for the Government, in such a way as to have the maximum positive impact on the health of the entire nation and about improving the scope, quality and accessibility of health services for all of those patients and clients who need them.
But the Reform Programme is not just about changing structures -a dramatic gesture, which might in itself imply change – it is about far more than that. It deals with a whole range of changes in governance, accountability, planning, financial management and control systems which will really be the key to achieving the real change that the public, the patient and the client expect of a health system in today´s world. To date there has, in my view, too much emphasis on the establishment or abolition of structures. The kind of change we are seeking has as much to do with systems, protocols, culture and behaviour. Without these changes the changing of structures will not be enough. The analysis goes much deeper than that and so too must the implementation of the change programme.
I realise, as I´m sure most of you do, that this reform agenda is an unprecedented programme of change which will affect every single corner of the system – every service delivery unit -every specialist agency – the statutory and the voluntary system -the Department itself – and most importantly, I hope, the experience of every patient and client who has to use our services.
We are not operating a bank or a department store chain, we are operating one of, if not the most complex systems in the public or private sector in the world. I challenge anyone to name a service or system, which is comparable in scale, scope and complexity to the health services – you won´t be able to.
As I already said, this is not something that can be achieved overnight, and it certainly cannot be achieved without detailed planning. Nor can it can it be achieved without the effort and goodwill of everyone currently working in the system. The challenge of achieving change, which involves 100,000 people, cannot be underestimated – and it´s not going to happen without them. I certainly recognise that.
Even more importantly, we are relying on those in the system to embrace change while, at the same time, they work to ensure that the experience of patients and clients is not negatively effected by the transition process. From what I can see, not only is this being achieved, but despite the upheaval, there continues to be constant development within the system, with new initiatives and innovative ways of working being developed at pace.
Nevertheless, we need at this stage to begin to show real results in terms of what’s happening in terms of implementation. I am delighted to be in a position to announce today the chair of the interim Health Service Executive. The Government has agreed to the appointment of Mr Kevin Kelly as chair of the HSE. I will be announcing the rest of the Board later today. It has taken some time to co-ordinate the bringing together of the right mix of competencies to undertake this onerous task. I am very pleased with the calibre of people who we have managed to attract and I see this as marking another major step in advancing the process.
Of course there has been a range of activity underway throughout the sector in recent months and indeed, many of you have been directly or indirectly involved in some of that activity.
You will be aware of the process of consultation, which was undertaken during the summer, to engage with stakeholders in relation to the reform agenda. The report by the Office for Health Management has been completed. My Department has responded to many of the issues raised in the report and I am pleased to say that copies of both documents will be made available to you later today.
This phase of implementation involves taking the Government decision and developing the recommendations into concrete action. The projects are:
- The Health Service Executive
- Primary Community and Continuing Care
- National Hospitals Office
- National Shared Services
- Information and Communication Technology
- Financial Management & Control
- Health Information and Quality Authority
- Restructuring of the Department
- Human Resources/Industrial Relations
Each project group has met on a number of occasions and at this stage are well into the work of this phase which will be completed in a matter of weeks. The groups are grappling with difficult issues and attempting to design an integrated system based on the Government’s decisions. The output of these groups will flesh out the Government´s decisions in relation to;
- Structural issues;
- Working through the key next steps; and
- Elaborating in practical terms the next phase of implementation.
While many of the recommendations contained in the three key reports are unequivocal and have been accepted by Government. Mapping the pathway from the current situation to the new structures and business processes requires planning. In addition, integrating the recommendations of both reports and bring the concepts into practical reality requires detailed analysis and testing. For example,
The Health Service Executive Group is dealing with a whole range of issues, including what the new regional boundaries within the Health Service Executive. As you can imagine this is an issue that has provoked a great deal of interest, but it is important to bear in mind that what we are designing here are administrative regions, and not recreating health board structures. That point has been misunderstood at times. In planning the implementation of a split into four regions for primary, community and continuing care, it has been important to take cognisance of a whole plethora of different issues, including Government policy in areas such as the National Spatial Strategy, whilst also balancing that against existing service delivery systems.
Another area under consideration is to how to separate out the functions of my Department from those of the Health Service Executive -– a strong recommendation in both reports. The Government decision, and indeed as far back at the National Health Strategy, had identified that my Department needs to be restructured. An action project group is specifically examining how that can be best achieved. Describing the respective roles of the new Health Service Executive and the Department is key to this debate. This is a perfect illustration of how the decisions of one Action Project have a real impact on the thinking and decision making of other groups.
Another important question relates to achieving integration from a patient perspective in the new structures. The Action Projects considering the role and function of the National Hospitals Office and the Primary Community and Continuing Care Directorate are both examining the question from their respective viewpoints.
A further challenge is identifying the role and position of the voluntary sector in the context of new structures; and the changing business processes required to meet new standards of accountability throughout the system.. We all realize the vital role that the voluntary sector play in health services – particularly in areas such as intellectual disability. It is important that they are seen to have a place in the new structure. Indeed, where in the past, they have mapped their activity to specific health board regions it will be important to ensure vital links are not disrupted by the move to a new administrative structure at regional level.
A final issue relates to the voice of patients, clients, communities and their representatives in having their say and being listened to in the new structures. Again, this is about mapping some existing good practice on to the new structures but it is also about some fundamental changes. What we are trying to bring is greater consistency across the system, in a health service where decisions are based on best evidence, in a culture of continuous improvement. Combined with the opportunity to discuss and influence the planning of services at national, regional and local levels with the health system, comes an accountable way in which resources in the system are used. In a country the size of Ireland it has become more and more apparent that we need to take a ´bigger picture´ view of health policy and planning. This ability to take the bigger view and to be accountable for decisions made has also to be translated to every level within the system.
These are just some of the issues, which are challenging us as we implement the Government´s decision. Later today, you will have an opportunity to discuss 8 key themes, you will get a flavour of the issues and thinking which is emerging from the work to date. These themes have been structured in such a way to draw that thinking back to the core principles and goals of the Health Strategy in delivering a better health service. We can all indulge in thinking at a conceptual level but the time now is for action and the development of practical plans to move the system forward so that it can develop into a strong person-focused, integrated, quality health service.
Since the launch of the Hanly report it has received a lot of media attention, and I think it´s timely to bring people up to speed with current developments. As you are aware at present, most frontline medical care and round the clock emergency services in smaller hospitals are delivered by junior doctors, most of whom work excessively long hours. Patients have limited access to consultant care. This situation is no longer sustainable. The European Working Time Directive requires that from 1st August 2004, junior doctors must work an average of 58 hours per week. The Hanly Report addresses a key question: how to provide safe, high quality acute hospital services, 24 hours a day, 7 days a week and to do so as the working hours of our junior doctors are reduced in line with EU law?
In response, the Hanly Report recommended that we put in place a consultant-provided service, harness the contribution of all our hospitals, and provide a wider range of appropriate services and procedures in Local Hospitals. This will mean a better service for patients. It will result in a consultant-provided service that captures the contribution of all our hospitals, enabling a wider range of appropriate services and procedures to be provided in local hospitals.
The Hanly report makes specific recommendations for reorganising hospitals in the East Coast and Mid West – and sets out the principles for the national organisation of hospital services. It proposes measures to reduce doctors’ hours and improve medical education and training. It also recommends further investment in local hospitals to provide more services, including elective medical and surgical procedures, outpatient services, pre and post-natal maternity services and diagnostic facilities.
The report states that a full range of acute hospital services should be available within each region, so that patients should not have to travel beyond it other than for specialised supra-regional or national-level services. Furthermore in local hospitals minor injury and illness services would continue to be catered for 70% or more of patients attending A&E departments. Emergencies will be catered for by well-trained ambulance staff who can provide immediate treatment and bring the patient to the hospital best equipped to provide high quality care.
In essence the Hanly report is about ensuring the provision of the Right care, in the Right setting and at the Right time. This is an essential element of the overall reform programme, and consequently is a key element of the implementation of the National Health Strategy. The implementation of the Hanly Report is being advanced. The membership of an expert group to prepare a plan for the national reorganisation of acute hospital services (Phase 2) will be announced shortly. Membership of the implementation Project Groups in the East Coast and Mid-Western Health Board areas will be agreed shortly, which will allow work to begin in those areas.
With regard to the important topic of Non-Consultant Hospital Doctors working hours meetings have been scheduled to progress this issue.
As you will appreciate there is a significant body of legislation that is required to underpin this most ambitious of reform programmes. As well as defining the legislative requirements for the reform programme, which is being addressed by one of the action project groups, there is also a significant other body legislation being developed.
Work is well advanced on the creation of a new medical practitioners bill and the Heads of Bill for this significant and wide ranging amendment to the 1978 Act are now being completed and it is hoped to present this to Cabinet in December of this year. There is also important legislation for the regulation of health and social care professionals, which was a Health Strategy recommendation. In essence, the proposals are for a system of statutory self-registration for health and social care professionals. The regime will provide a formal legal framework and administrative infrastructure within which the quality of the services provided to the public and the future development of the professions can be assured. Work is also ongoing in developing a statutory framework for complaints in the health sector, which is a very important piece of legislation from a service user perspective.
You have an interesting day ahead of you, which you will have an opportunity to hear about and comment on the implementation of the Reform Programme. As I said at the outset, all of you have a role to play, whether direct employees within the system, voluntary providers or community representative groups.
I recognise that the Reform Programme is wide-ranging in impact and that it will be complex to execute. Communicating to allay concerns and to explaining the Government’s vision is vital. We have been working through existing interfaces, partnership structures and frameworks with stakeholders. But there is a wider and deeper engagement also required. Today is another opportunity to give feedback on emerging thinking and to influence the process of implementation.
I want to thank you for taking the time out to participate in today’s forum and other implementation structures. Your input is valued and will be documented for wider dissemination after today.