Address by Minister Power to 2006 IMO AGM
I wish to thank you for this opportunity to speak at your AGM, and I also wish to convey the good wishes of my colleague, the Tánaiste and Minister for Health and Children, Mary Harney.
This is one of the most important events in the health service calendar and it gives me an opportunity to summarise some of the progress made thus far, as well as the challenges ahead, in the continuing reform of our health service.
FUNDING INCREASES / ACHIEVEMENTS
Despite some reports to the contrary, the Irish health service is alive and well. Recent years have seen a substantial increase in public funding, an increase in staff numbers, many more patients treated, and a reduction in waiting times and waiting lists.
Current funding has increased by 10.2% from €11.9 billion since 2005 and by 251% since 1997. Capital investment in the health services in 2006 will reach €578.5 million. Public current and capital investment in health services has risen to over €12.75 billion this year, making Ireland one of the fastest growing OECD countries in terms of public spending per capita on health.
This funding increase has led to the enhancement of services on many levels. Today, almost 120,000 people work full time or part time in our public health services. Between 1997 and end September last, there was an increase of 33,672 staff (or almost 50%) in wholetime equivalent terms.
The number of approved consultant posts alone has increased by 720 (or by 56%) to 2,012 over this period. We now have 52 consultant posts in Emergency Medicine, a 270% increase from the 14 we employed in 2007. In our Mental Health Services, there are now 295 consultant posts – a 32% increase since 1998.
Similarly a cumulative investment of approximately €900m in the development of cancer services since 1997 has enabled the funding of over 100 additional Consultant posts in key areas as well as the appointment of over 300 additional clinical nurse specialists in cancer services.
There has been a substantial increase in the number of NCHDs in recent years. There are now 4,151 NCHDs – an increase of over 1,300 or 50% on 1998 levels.
Since 2003, the number of Public Health Directors and Specialists has increased to 62.
We have tackled long waiting times through the establishment of the National Treatment Purchase Fund. Since its establishment, over 38,000 patients have benefited. In 2005 alone, the Fund referred over 4,400 patients for out-patient appointments. This year we are devoting close to €80 million to maintain this high level of throughput.
In overall terms, the number of patients treated in public hospitals has increased to over 1 million in-patient and day cases treated in acute hospitals in 2005. Over half a million people were treated as day cases in 2005 – almost double the 1997 levels.
In addition to the substantial achievements from this increased level of public funding, and further planned investment next year, this Government is exploring the scope of the private sector to provide additional capacity in the health system.
Government policies/initiatives support the co-existence of public and private healthcare. Many important services are delivered by the private sector, not least of which are our general practitioner services. In 2006, we will contract services to the value of €400 million from over 2,000 GP contractors.
The decision of Government in 2005 for the delivery of 1,000 new public acute beds is a clear example of how private investment can benefit patients. Over the next 5 years up to 1,000 additional beds for public patients in public hospitals will be freed up through efficient, effective and best value partnership with the private sector.
There are now 13,255 beds in our public acute hospitals and 1,800 in private hospitals. Since 1997, the number of public acute beds has increased by 1,528. In the lifetime of this Government we have provided funding for 900 beds and most are in place now. Our future five year capital programme provides for 450 more beds.
SERVICES FOR OLDER PEOPLE
The increase in life expectancy is one of the great achievements of western societies in the twentieth century. However, as our population ages, new challenges in health care, housing, transportation and quality of life arise. This Government has made services for older people a priority. This means supporting older people in dignity, to live in their own communities, for as long as possible.
Since 1997 spending on health care services for older people is up by over €302m, and the 2006 Budget provided for an additional annual increase of €150 million, the largest ever increase in funding for this sector.
This funding will help to ensure that older people with a low to moderate dependency level will be supported if they wish to remain living at home longer and within their own communities.
Aside from funding increases, much has been done in the area of long-term care. This includes legislation to provide for the establishment of the Social Services Inspectorate function on a statutory basis, and the establishment of a registration system in respect of residential services for children, for older people and people with disabilities to replace existing registration procedures.
In addition, a Working Group to examine the standards in Long-Term Care Settings has been established.
ALCOHOL CONSUMPTION IN IRELAND
I am pleased that your conference is addressing the issue of excessive alcohol consumption. As you may be aware a Strategic Task Force on Alcohol was established in January 2002 in response to concerns regarding harmful levels of alcohol consumption in Ireland. The Task Force has produced two reports providing 100 recommendations. Significant progress has been made across Government Departments in implementing these recommendations but much more remains to be done.
These include; legislative measures; ‘Happy hours’ have been abolished and restrictions on the access of children to licensed premises have been introduced; planned improvements in breath testing, including random tests; Voluntary Code of Practice on Alcohol Advertising; research projects; training; awareness-raising campaigns; and the funding of Community mobilisation projects which are one of the most effective measures at reducing alcohol related harm.
Following research on the incidence of alcohol in injuries presenting to A&E Departments, resources have also been made available to the HSE to pilot a Screening and Brief Intervention programme in the A&E of an Acute Hospital.
I am confident that the continued implementation of these recommendations will contribute to a reduction in alcohol related harm. I am asking you today for your contribution, in your various professional roles, to this effort.
PERCEPTION OF HEALTH SERVICES
There is a tendency among some commentators to highlight the perceived flaws in the health system. This approach has helped to create the false impression of a health system in crisis. It ignores the excellent, efficient, and highly valued services provided every day in our services.
The true state of the Irish health service is perhaps reflected more fairly in the Irish Society for Quality in Healthcare’s 2004 survey. This survey showed that 93.7% of patients were confident about the treatment they received and 93% were satisfied with the services they received during their hospital stay.
ACCIDENT & EMERGENCY
Striving to maintain high performance and satisfaction levels, the Department and the Health Service Executive are continuing to work towards delivering sustainable solutions to improve service user experience of healthcare.
While this is important throughout our services, we are particularly focusing on our Accident and Emergency services.
In 2005, 1.25 million people were treated in A&E which constitutes over 3,400 people a day. A wide-ranging approach is being taken under the Accident and Emergency Action Plan to improve access to services, improve patient flows through A&E departments, reduce waiting times, free up acute beds and provide appropriate longer term care for patients outside of the acute hospital setting.
A particular focus of the Action Plan will be on those patients in acute hospitals who have completed the acute phase of their treatment and are ready for discharge to a more appropriate setting. A range of measures, including the provision of high dependency beds, intermediate care beds in private nursing homes, additional beds in public nursing homes, home care packages and enhanced subventions have already facilitated the discharge from acute hospitals of more than 1,100 patients.
The Health Service Executive will continue to implement system-wide measures to further improve the delivery of A&E services in all our hospitals. And we should acknowledge those hospitals where things work well – many of these are particularly notable for the collaborative working between community and hospital based clinicians when admitting and discharging patients.
While the survey’s positive feedback is welcome, it is necessary to ensure that further progress is made in order to meet new challenges. These include the dramatic upsurge in both the quantity and complexity of demand for health services; the need for greater risk assessment and management; the need to enhance patient safety and infection control, the expectation of higher performance and improved efficiency – and these create the imperative for modernization and reform.
It has become necessary to restructure the Irish health service in order to meet these challenges and to facilitate the creation of a more person-centred service.
This Government has established the Health Service Executive and is now in its second year of operation. For the first time we now have a unified, single health system. The Board of the Executive and its CEO have taken on the ambituous modernization and reform programme, and the Tanaiste and I fully support them in their work.
THE ROLE OF CLINICIANS
This reform programme will change, either directly or indirectly, the role of every health service professional. Change can be perceived as a threat or as an opportunity. You as medical professionals can play a key role in ensuring that the perception and reality of change is positive. As leaders in health care, doctors must act as active champions of change rather than as passive commentators.
The need for a new consultants’ contract has been well established. While some of you may not fully agree, the needs of a modern acute hospital service requires a modern contract . As you are aware, management tabled a position paper outlining proposals for such a contract. While the negotiation process will bring its own challenges, I believe that full engagement between management and the representative bodies can overcome all difficulties and lead to a mutually acceptable agreement which will benefit all patients. There are more than 2,000 Consultants working in our public health services and it is our objective to increase this number substantially in the coming years.
We have over 4,000 NCHDs working in Irish hospitals. NCHDs have a very important service delivery role and it is important that the new contract for NCHDs currently being negotiated enables an effective synergy between service requirements and the training and career objectives of our doctors.
A draft contract was tabled by management last November. Among the issues covered by this document are NCHDs’ reporting relationships, compliance with the European Working Time Directive, performance review and the working week. Talks are ongoing under the auspices of the Labour Relations Commission.
The discussions on the provision of an out-of-hours service by Directors and Specialists in Public Health are ongoing. The Government has signalled its belief that the provision of such a service is an important component in Ireland’s emergency planning. I urge that you continue to actively seek a solution with the HSE to this situation as quickly as possible
Following the recommendations of the Labour Relations Commission in June 2005, we are now involved in a fundamental review of all publicly funded GP provided primary care services. A lot has changed since the previous agreement in 1989, and the current review is consequently very wide-ranging and there are many issues to be considered and agreed.
Some of the objectives which the Government considers essential elements of a new agreement include: high-quality services which are user-oriented and offer increased hours of availability; a comprehensive . framework which will allow, over time, for the expansion of the range of care into the areas of preventative care and the structured management of chronic disease; flexibility of contractual arrangements so as to enable collaborative arrangements between GPs in order to provide the type of comprehensive service visualized; working arrangements that support multi and inter disciplinary working; underpinned by a remuneration framework that supports both the most appropriate delivery of care and the required performance levels.
I encourage you to continue in your dialogue with management on the new contract and I hope that the ambituous timetable set by the LRC will be realized in the coming months.
And there is one thing that I think we can all agree on – we must find ways for all appropriately qualified general practitioners who wish to do so to provide services for public patients.
I too support the Tanaiste’s view that investment follows reform and modernization. We believe that new contractual arrangements are a prerequisite to enhanced and improved public health services.
If we are all serious about our desire to create a more person-centred service, it is essential that progress is made on all of these fronts. I am confident, that by working together, no obstacle will be insurmountable as we all strive to provide those better services that our people deserve.
It may come as a surprise to learn that the greatest share of our health budget is invested in primary, community and continuing care services. In 2006, over €7 billion will be spent on these services compared to just under €4.7 billion on our acute services. We must gain maximum benefit and impact from the monies that we currently invest at primary care level.
Funding of €28m annually is now provided specifically to support the implementation of the Primary Care Strategy. Further funding of over €80m provided for development of Out of Hours GP services.
The HSE plans to build on experience gained to date in establishing and operating the ten initial primary care teams as it develops team-based primary care services on a wider scale. During 2006, 300 additional front line personnel in approximately 75-100 new primary care teams will be appointed. We are well aware of the commitment of our general practitioners to high quality primary care services and we are greatly encouraged by the positive response by GPs to the HSE’s invitation to participate in this new initiative which will provide the stimulus for further investment and development.
Provision will also be made for an additional 22 GP training places in 2006.
The Government has accepted the broad thrust of the recommendations in the recently published Fottrell and Buttimer Reports on undergraduate and postgraduate medical education and training and has approved funding to support their implementation.
The Fottrell Report recommends reforms in basic medical education including; a 50% increase in medical places for EU students; new under graduate and graduate entry arrangements; and the creation of new academic clinician posts.
The Buttimer Report recommends reforms in postgraduate specialist training, such as improved governance and accountability, graduate retention measures, protected training time, phasing out of NCHD posts of limited training value, and training in research methodologies.
The implementation of these recommendations will help to ensure that Ireland’s doctors are fully prepared to meet our future health needs. Safety of all, including healthcare workers and patients alike, is of paramount importance. All doctors must consider the interests of their patients and co-workers throughout their working lives.
In that context, I am very pleased that the report of the advisory committee on the prevention of transmission of blood-borne diseases in the health care setting was recently published. The report substantially updates previous guidance issued to health service employers on the approach to patient and health care worker protection from blood-borne infections.
As you will all be aware, recent events have served to highlight the difficulties with the current system of regulation of the medical profession for the Medical Council, the medical profession and the general public. Work on the forthcoming Medical Practitioners Bill is well advanced. The recommendations of the Lourdes Inquiry report, as well as the reports on medical education and training are being fully considered in the preparation of this crucial piece of legislation.
It is intended that the legislation will:
- underline the Medical Council’s role as the body in the State which acts to protect the public by way of regulation of the medical profession;
- modernise registration processes to allow for flexibility where required;
- integrate registration, education and training, ongoing competence and fitness to practice processes;
- clearly define the responsibilities of the Council in relation to education and training of medical practitioners;
- introduce more streamlined and transparent processes for the processing of complaints;
- provide for the first time a legal framework for the Medical Council’s implementation and administration of competence assurance
- make continuing medical education and professional development a mandatory requirement for medical practitioners.
The Tánaiste has announced her intention to make the Heads of Bill for the proposed new legislation available to interested parties in the coming months.
I urge you to contribute to this important consulation process. Following this period of consultation, it is intended to finalise the drafting of the Bill with a view to publication later in the year.
The Government continues to show its commitment to health reform. Working together, with energetic and enthusiastic commitment, the Government believes that the health service reform programme can be successfully implemented, leading to a better health service for our population and a better workplace for the professional.
Once again, I thank you for your invitation. I hope that your AGM has been both productive and enjoyable thus far and will continue to be so.