Speeches

Address by Mr Seán Power TD, Minister of State at the Department of Health and Children at the presentation of Report on Heartwatch – Initial Implementation Phase of a National Programme in General Practice for the Secondary Prevention of Cardiovascular Disease

Introduction

Good morning Ladies and Gentlemen,

I would like to thank you for inviting me here to formally accept this report on  the Initial Implementation Phase of a National Programme in General Practice for the Prevention of Cardiovascular Disease, known as Heartwatch. This programme, which was agreed by my Department, the health boards and the Irish College of General Practice was established on foot of recommendations in “Building Healthier Hearts”, launched by the Taoiseach in 1999.

Progress on the Cardiovascular Health Strategy

Historically, Ireland has reported one of the highest rates of cardiovascular disease in the European Union. With economic development, death rates started to decrease. Over the last five years through the implementation of the Cardiovascular Health Strategy, this downward trend has continued.  The Strategy addresses the common aspects of prevention of cardiovascular diseases as well as the treatment and rehabilitation of patients with coronary heart disease.  The following overall aims are identified:

  • to reduce the risk factor profile in the general population
  • to detect those at high risk
  • to deal effectively with those who have clinical disease, and
  • to ensure the best survival and quality of life outcome for those who recover from an acute attack.

With the decline in death rates and the implementation of the Cardiovascular Health Strategy

  • Irish people are living longer,
  • those with heart disease receive treatments more quickly and closer to where they live, and
  • people with established heart disease have better access to rehabilitation and preventative services.

As you are all well aware, we have taken a strategic approach to the development of cardiology services and the improvement of heart health for our population.  Our strategic approach to addressing our population’s heart health is now regarded as a model for other countries to replicate and learn from.

We are continuing to make progress on the implementation of the cardiovascular health strategy.  In the first five years of the Strategy €57 million has been invested.  This funding has supported Heartwatch and a wide range of new regional and local services and initiatives, which have already had a measurable impact on the diagnosis and treatment of patients with heart disease.

This year additional funding of €3 million has been allocated by the Government towards the implementation and enhancement of cardiac services, throughout the country and will allow for the appointment of two additional consultant cardiologists, bringing to 19 the number of extra consultant cardiologists funded by my Department since the launch by the Taoiseach of “Building Healthier Hearts” five years ago.

Role of General Practice

While it is important that the best quality of care should be provided in hospitals, the strategy recognises the important role that GPs have in preventing and treating illness.  It recommends that secondary prevention for most patients with cardiovascular disease should be provided in a general practice setting.

The Heartwatch programme was the mechanism agreed by my Department, the health boards and the Irish College of General Practitioners to satisfy this recommendation.  The overall aim of the programme is to reduce morbidity and mortality due to cardiovascular disease.

The interim objectives of the programme are:

  • To examine the baseline levels of risk factors and therapeutic interventions relevant to secondary prevention and their trends over time.
  • To examine the processes involved in implementing the programme including patient retention and referral.
  • To record the incidence of cardiovascular events in patients participating in the programme.

Lessons learned from Heartwatch and the results of the independent evaluation of Heartwatch will inform how we deliver secondary prevention to patients into the future.  I understand that this evaluation is currently being conducted by Capita Consultants and I look forward to receiving the evaluation report early in 2005.

Data collection and analysis

Data collection is an important element of the Heartwatch programme.  I understand that more than 10,500 patients have been enrolled in the programme, including 1,000 diabetic patients in the Midland Health Board area and that over 40,000 patent consultations have taken place so far.  This has enabled the development of the largest database on patients with cardiovascular disease in Ireland.

I understand that the data collected so far is of a high quality and will permit both cross-sectional and longitudinal analysis.  It will allow national and regional analysis to a high level of statistical reliability, according to the final SCRC report.  The data gathered through Heartwatch will be available for use in the future in areas of audit, epidemiology and population health, resource planning and delivery.

Future Challenges

The key challenges facing the future implementation of the Cardiovascular Health Strategy, as noted in the Second Report on the Implementation of the Cardiovascular Health Strategy, mirror those already identified in the National Health Strategy, Quality and Fairness and can be categorised as follows:

  1. Improve Population Health: by supporting intersectoral work for health promotion, to reduce risk of cardiovascular disease and improve quality of life.
  2. Reduce inequalities: by developing a robust approach to reducing inequalities in cardiovascular health and mortality.
  3. Ensure equitable access to services: by continued provision of resources and support to fully implement outstanding Cardiovascular Health Strategy recommendations to meet the needs of the growing numbers of older people and to provide new treatments for which there is evidence of effectiveness, and
  4. Improve the quality of services:  by developing and implementing practice guidelines, the implementation of cardiovascular health information systems, support for clinical audit and for research to enhance the quality of services.

We have already made progress in each of these categories and I am confident that we will make greater progress in the future.

Reform Programme

The Government decision to reform the health services is both radical and challenging. The reform provides us with the opportunity to change not just the structures but how we approach problems and decisions in the health services in the future. The high quality, commitment and dedication of all health service staff indicates capacity to change. The new structures will enable innovative approaches to be taken in the future. I look forward to working with health service staff in this new era.

I am confident that all elements of the Cardiovascular Health Strategy  will fit very well into the new structures and that implementation of the Strategy can and will continue to deliver into the future.  Much has been achieved over the last 5 years and it is important that we do not lose the momentum that has been generated so far.

Acknowledgements

I would like to acknowledge the important work that has been done by all parties in the establishment and running of Heartwatch.

First, I would like to thank Mr Chris Fitzgerald, Principal Officer of the Health Promotion Unit in my Department, and his team for their continued dedication and enthusiasm in implementing the Cardiovascular Strategy. In particular I would like to thank Dr Emer Shelley, National Heart Health Adviser, for her work   in establishing and implementing Heartwatch.

I would like to thank the GPs who are participating in the programme and Dr Fionán Ó Cuinneagáin and the Irish College of General Practitioners for their support and co-operation.  I would also like to thank the practice nurses who have been essential to the delivery of this service.  Thanks also to the GP co-ordinators and nurse facilitators who have worked in each health board area to ensure the smooth running of the programme.

Thanks are also due to Professor John Feely of the Department of Pharmacology and Therapeutics, Trinity College Dublin and all members of the National Steering Committee for Heartwatch who have overseen the implementation of Heartwatch.

Thank you also to Professor Jane Grimson of the Department of Computer Science, Trinity College Dublin and members of the Data Management Committee.

We are all very appreciative of the work done by the Dr Seán Maguire, Mr John Leahy, Dr Michael Boland and their team at the National Programme Centre and Independent Data Centre.

Finally I would like to thank all of you who are working in the health services and who have played such an important role in implementing this valuable part of the Cardiovascular Health Strategy.