Address by Mr Micheál Martin TD, Minister for Health and Children at the Irish Hospital Consultants Annual Banquet
I am delighted to be with you this evening on the occasion of the Irish Hospital Consultants Association Annual Conference.
One year ago in Cork I told you that I saw my role as Minister as being firstly to measure the real need for additional services, taking account of public expectations as well as the “expert view” and secondly, as a member of the Government, working to bridge the gap between current provision and what is needed, as speedily and efficiently as possible.
Public Focus on Expectations of the Health Services
It will be immediately evident to each one of you that the public focus on and expectations of our health services have, if anything, increased over the past year. Nowhere is this more evident than in the acute hospital sector.
Hospital Activity and Waiting Lists
It is frustrating to note recent media reports suggesting that waiting list numbers are growing at 1,000 cases per week. This is totally unfounded and a misrepresentation of the situation. Significant progress has been made on reducing our waiting lists, and more importantly, overall waiting times have also been reduced.
Funding of £34.5m has been made available in 2001 under the Waiting List Initiative. The latest figures available (June, 2001) indicate that the national waiting list figures stood at 26,659, which represents an overall decrease of 16% in waiting list numbers since June 2000. Significant decreases have taken place in a number of target specialties:
- Cardiac Surgery down by 52%
- Gynaecology down by 35%
- Opthalmology down by 23%
- Orthopaedics down by 14%
- ENT down by 30%
Significantly, the public hospital system has continued to increase in productivity. In the period January to June 2001 an overall rise of 5.1% in activity was recorded (including a growth of almost 11% in day cases).
This higher level of activity means that an extra 22,000 people received treatment that would otherwise be on waiting lists. On my own behalf and on behalf of the Government I wish to thank all health care workers who contributed to this success, and especially the hospital consultants whose expertise and commitment are vital to the overall process.
Hospital waiting lists must be viewed against the background of a hospital system which discharged some 870,000 in-patients in 2000. The number of people currently on hospital in-patient waiting lists represents just 3% of all in-patient discharges in 2000. This Government will continue to focus on waiting lists and waiting times in order to ensure that services are available and accessible to those who most need them.
It is disappointing then to hear so many commentators say we are throwing money at health and getting nothing out of it. If you ask the 22,000 people who were treated as a result of the hospital waiting list initiative, or take into account the 1,200 additional places which were provided in the past year for people with disabilities, or the major improvements to services for older people such as:
- improving the nursing home subvention scheme,
- purchasing of additional nursing home contract beds in winter,
- increased home help staff and hours, and
- improved community support structures,
it will be seen that this is not just throwing money at health.
Growth in Consultants Posts
Staff shortages are still causing difficulties for service provision across a broad range of health services, again nowhere more so than in our hospitals. However, these problems are being addressed and recruitment and retention initiatives are having effect. In the case of consultant appointments the situation is in fact a lot more impressive than you may imagine. In December 2000 there were 1558 consultant posts in the public sector in Ireland. This represents an increase of 118 posts (8%) on the 1999 total. This is on top of 52 new posts in 1999, 61 new posts in 1998 and 35 in 1997. I still hear references to 1250 consultant posts in the public hospital system. As you can see, this is another fallacy – the real figure is currently 300 consultant posts (25%) higher.
National Development Plan (2000 – 2006)
2001 has seen a further substantial increase in the resources made available for the health care sector (26% increase in non-capital spending and 17% increase in capital spending over 2000). These figures are unheard of in other countries and while I acknowledge the gap in resources in the past, it should be acknowledged that this Government is now providing significant additional resources for our health sector – in fact almost £2 billion in the past four years. In this context it is appropriate to take stock of our other recent achievements. This past year has been a particularly busy one for us all, but we have much to show for our efforts.
The National Development Plan (NDP) represents the greatest level of investment in health capital infrastructure (£2 billion at 1999 prices). The objective of the plan is to create an infrastructure on a regional basis, that will result in a more patient-centred and accessible service. The Plan is also designed to give greater balance to funding between the acute and non-acute hospital sectors, thus complementing various service initiatives such as those relating to Waiting Lists, Cancer Strategy and Cardiovascular services.
Because hospitals are not getting most of these resources it doesn’t mean that they don´t have a high priority. I believe that funding these initiatives will take pressures off the hospitals in the long run.
A key feature of the NDP in 2000, the first year of its operation was to focus on the very important areas of re-equipping/re-furbishing throughout all health care programmes. In addition, various major development projects are now coming on stream such as the re-development of St Vincent´s Hospital, Dublin , Cork University Hospital, University College Hospital, Galway, James Connolly Memorial Hospital and Tullamore General Hospital, to name but a few. My Department will continue to work closely with the health boards and other service providers to ensure that the maximum benefits are realised from investment over the lifetime of the NDP.
The National Review of Bed Capacity
You will be aware that a national review of bed capacity in both the acute and non-acute sectors has been initiated on foot of a commitment by Government in the Programme for Prosperity and Fairness. The review is being conducted by the Department of Health and Children in conjunction with the Department of Finance and in consultation with the Social Partners. Work is currently at an advanced stage and I will be bringing the findings to Government with a view to agreeing an investment strategy for the hospital sector over the next 10 years.
The recently enacted Mental Health Act, 2001 will significantly improve existing provisions concerning the involuntary detention of persons for psychiatric care and treatment. The Act provides for the establishment of an independent agency to be known as the Mental Health Commission. The Commission´s primary functions will be to ensure that the interests of persons who are detained involuntarily are protected and to promote and foster high standards and good practice in the delivery of all mental health services.
Several other pieces of important legislation are currently in the course of preparation – preparation of a new Medical Practitioners Act, a review of the 1985 Nurses Act and the preparation of a new Health and Social Care Professions bill.
In relation to the medical profession, significant changes have occurred in the practice of medicine, in public expectations of the profession and in the attitude to continued self regulation since the current Medical Practitioners Act came into force in 1978. Extensive discussions have been held with the various stakeholders and a number of key issues have emerged which will be addressed in the drafting process.
Medical Indemnity and Enterprise Liability
Another issue which continues to concern all of us is the cost of providing indemnity cover for doctors and public liability insurance for hospitals. I’ve spoken about the issue before so I don´t intend to dwell on it at great length on this occasion. We are all well aware by now of the underlying problems which are driving up costs in this area.
Since I addressed you a year ago we have made considerable progress towards implementing the Government´s decision of December 1999 that in future indemnity cover should be provided for doctors and hospitals on the basis of what is termed “enterprise liability”. I know that your Association has been an active participant in the work of the Enterprise Liability Advisory Group. By the start of the summer the group had helped clarify the risks to be covered by the new scheme. This “scope of cover” paper has been sent to the two medical defence bodies and has been the subject of active discussion with them since then. That process has helped to further clarify the boundaries between what the new scheme will cover and the package of services to be offered by them to doctors after the introduction of enterprise liability. Work is also at an advanced stage on the legislation required to establish the new scheme and I hope to bring detailed proposals to Government in the coming weeks.
The two medical defence organisations will also continue to provide indemnity cover for private work not covered by the new scheme and to provide their full range of medico-legal services.
Health Research Strategy
In September I launched the new Health Research Strategy “Making Knowledge Work for Health”. This document is the result of intensive consultation over the past two years involving health providers, the universities and third level colleges, the research community, the voluntary sector and the health care industry. The analysis and proposals in the strategy are central to supporting a knowledge-based approach to health, guaranteeing better quality services to patients, ensuring more effective delivery of health care and creating a high quality training environment for young health care professionals. The resourcing of these proposals is currently under consideration.
National Task Force on Medical Manpower
We are faced with many major challenges in the health services, and none more so than addressing medical manpower requirements. We must oversee the provision of a safe, equitable and timely patient-centred service which is of high quality. It will require all the key stakeholders who will be affected by the proposed recommendations to work together in partnership, to prepare an action plan for a new hospital workforce structure. The new structure will be less dependent on doctors in training, more flexible and responsive and appropriately staffed to meet our requirements over the next decade and beyond.
The Report of the Forum on Medical Manpower has identified the key issues in this regard. You will recall that earlier this year the Forum Report and the Hanly Report on reducing NCHD hours were submitted to Government and circulated to all doctors working in our hospitals. It is now time to commence the process of implementing the recommendations contained in these reports and in order to do this a National Task Force is being established. I am pleased that Mr David Hanly has accepted the invitation to chair this Task Force, which will consist of a Steering Group, a Resources Group, an Implementation Group on NCHD Hours and an Education and Training Group.
Overall membership of the Task Force will be quite large. However, this is necessary both to provide appropriate representation and to facilitate rapid progress through a sub-group structure which will work on a programme of priority issues in parallel. I am not putting people on these groups just to please them. I want an input from a broad range of people who know what it is like to work at the coalface. No group is being shut out of the process and I am confident that this approach will ensure rapid results and, like everyone here, I am anxious to see the fruits of this process being introduced in our hospitals.
I thank your Association for your support to date and I look forward to your input and involvement in the Task Force, in a spirit of co-operation and partnership. In this regard, I intend nominating members to the Task Force in the near future.
The National Health Strategy
I have outlined some of the major challenges facing our health services and the range of initiatives and policy work currently being undertaken by my Department to tackle them. However it is recognised that both the challenges and the responses have to be approached within the context of an overall strategic framework. The forthcoming National Health Strategy will provide that framework. To be meaningful, a health strategy has to be both focused and comprehensive. As you all know, an extensive consultation process has been undertaken in order to ensure the maximum range of inputs. I know that quite a number of you have been involved and I thank you for your assistance. I am confident that this level of research and consultation will ensure that the strategy is one in which the public, providers, service users and staff will all have a sense of ownership. The Strategy will be submitted to Government in the near future and I attach the greatest priority to making the necessary changes to our health care system in order to improve people’s health and quality of life.
Continued Investment and Modernisation
The Value for Money Audit which has been undertaken points to some inefficiencies in the way we do our business and the way in which we organise ourselves.
The Government believes that combined investment in the health services must be accompanied by modernisation. This will involve reorganising the delivery of care to move away from a Monday to Friday 9.00am to 5.00pm provision of care to an expansion of the hospital service in line with changing our mindsets and gearing ourselves to what suits the patient.
A message coming through loud and clear is the necessity to develop a health care system which is “people-centred”. This means having a service that is planned and delivered on the basis of the best interests and needs of patients and their families. This may require changes to the way we deliver services. It will certainly mean giving clearer information to the public and to patients about their entitlements and the treatment they require or receive. In the case of health professionals it will mean increasing the level of openness and interaction with patients and/or family members. A well-educated and informed population is no longer prepared to accept that the health professional necessarily “knows best”. Every effort must be made to maintain the trust and confidence of patients and their relatives and this can only be achieved by having appropriate regard for the views and feelings of those who use our health services.
You are all only too well aware of the demands which the practice of medicine in your chosen specialties places upon you. These demands may change, but are unlikely to diminish in the future. These demands have implications for everyone working in the health sector. I readily acknowledge the significant and ongoing contribution by hospital consultants to the provision and development of our public hospital system. In turn, both the Government and I, are committed to making the necessary changes to and investment in our health care system in order to ensure the removal of inequalities and the provision of the highest standards of patient care. Many important issues are currently being addressed but further significant and co-ordinated action is needed to improve health status and to develop, reform and modernise our health and personal social services. This action will be implemented through the National Health Strategy over the next number of years. With your continued support we can achieve these aims and look to the future with confidence. Our combined efforts will help to ensure that the Irish health care system becomes a hallmark internationally for all that is best in health care provision.
May I wish you all an enjoyable and successful conference.