Speech by Minister for Health, Dr James Reilly T.D. – “Transforming the Health System- Can we get it right?” – MacGill Summer School

Since the title of this paper asks a rhetorical question I’ d better answer it and get it out of the way.

Can we get it right? Yes. That’s the simple answer.

But then, some of the clever people who attend this summer school will be familiar with the comment made by that wise person, Anon, who said “There’s an answer to every question that’s simple, straightforward – and wrong.”

So maybe I should backtrack and amend. Just a bit.

We can get it right. If….

  • If we learn from the history of medicine.
  • If we move the focus from systems to end results.
  • If we concentrate on evidence, and not solely on beliefs.
  • And if – in the face of a perfect storm – we fight for the best, and never settle for the acceptable.

The perfect storm is new and unique.

Back in the days when a Minister for Health described his Department as “Angola,” healthcare had problems. What we now face is much more challenging.

For starters, we’re facing shrinking budgets – a billion Euro alone this year in health. Since the economic downturn in 2008, gross current health expenditure has gone down by 10%. And – in the coming year – that’s going to reduce further. Now, add the fact that we’re aging. Just four years ago, 11% of the population was over 65 years of age. Thirty years from now, that’ll have doubled, and those over the age of 85 will have quadrupled.

That’s great in many ways….especially for those of us in this room who hope to be among them. But it’s also costly. A recent study by my Department sees cost increasing by 2% each year over the next five years, rising to 4% per cent each year after those five years – purely due to the ageing of our people.

So: reduced money, increasing age. Two of the factors in the perfect storm. Third comes chronic disease. Chronic diseases account for 86% of our mortality. They absorb seven out of every ten Euro of our Health resources. They account for two thirds of emergency admissions to hospitals. So even if we didn’t have the disastrous economic legacy of the previous government to contend with we would still have to change the way we deliver healthcare.

The fourth factor isn’t medical at all. But it’s very powerful. That last factor is the constant build up of expectations. Every generation expects more than did the previous generation. Every generation has a greater sense of entitlement than did the previous generation.

They are the facts. That’s the reality. Put a dearth of money beside an ageing population afflicted with many chronic diseases with a rising set of expectations and you have a perfect storm.

Now, before anybody thinks this is surrender or resignation, let me lay it on the line. It’s neither. Yes, we have a perfect storm of negative circumstances.

But what drives many of us (and certainly many of us in this room) into action – into medicine into politics into a range of different areas – are the negative circumstances that we want to see change and we want to help change.

Ironically some of the greatest advances in healthcare came out of disaster and tragedy. After the Second World War, when Britain was still shell shocked and citizens still carried ration cards, there were still people with enough energy and vision who set up the NHS…the National Health Service which transformed access to health care for rich and poor alike.

Another example of that irony is that fact that many or our most advanced surgical techniques were developed in response to injuries received in war or violence. It’s often out of adversity that we make new discoveries, that we make new strides. So let’s not kid ourselves that because we’re in a perfect storm of negatives, we cannot set out to transform the health service. We can. We must. And we will.

I belief to achieve a fair and just society, we must have a universal, single-tier health service.

  • One that gives access based on need, not income.
  • One that is truly patient-centered.
  • One that’s based on universal health insurance for the whole population of Ireland. (That, alone, will be the most profound reform of our health service since the foundation of the State.)
  • One that significantly strengthens primary care and makes GP care free to the whole population within our first term.

It’s a massive task. A massive opportunity to improve the health of the nation. Even more – it’s an opportunity to return to the dream of a free Republic, where everybody is seen as equal and where we cherish the children equally.

Because – let’s be clear – there is no more accurate measure of a nation than how it treats the sick, the vulnerable, the damaged, the dying. No more accurate measure…

That’s one of the reasons I was delighted to accept the invitation to be here, today. Because a summer school offers the opportunity to move away from the policies, the finances, the structures, the systems — and focus, briefly, on the wider significance and the deeper values implicit in what we’re doing.

This is a statement about creating the fair society, the just society of Costello and Fitzgerald. This is a reminder of the vision of Wolfe Tone, Emmett, Connolly and Pearse: a vision of a proud independent republic whose pride derives from its respectful response to the needs of its own.

It requires that we don’t just look at structures, but at the individual lives affected by those structures. And I don’t just mean the lives of patients.

I believe many who work in the health service have been adversely affected too. People who work in healthcare should be able to proudly proclaim involvement – not have to mutter the name of their organization or their hospital and wait for inevitable negative comments.

I want people from all over the world to mention the Irish healthcare service as a global leader. I want every Irish healthcare professional applying for an overseas post to know that the minute someone looks at their CV, they say “Oh, this one’s from Ireland,” in a way that’s an even more immediate plus for the applicant than it is already. For Irish doctors and nurses are always sought the world over.

However we’re a long way off that vision right now, despite the excellence of the professionals within the service. But it’s something about which I feel very strongly. In whatever time I have in the Department of Health, I want to reform the system, yes – but reform it as a first step to creating a world-class service.

That’s why set up the Special Delivery Unit

  • to tackle the obscenity of our sick and often older citizens, lying on trolleys or sitting on plastic chairs with intravenous lines handing from their arms for days on days on end
  • to end the insanity of people out of work for months while they await surgery that could have them back in work in weeks
  • and to address the needs of the hundreds of thousands of people who wait worrying anxiously for an out patient appointment

I have declared on many occasions that this government’s health policy will be founded on evidence based information. And what Dr Martin Connor (the Senior Advisor to the Special Delivery Unit) has found, having analysed the data (which was extremely difficult to gather because of our current poor health IT systems) is very revealing.

You know that sudden increase in demand in our hospital emergency departments that’s a feature of every January and that leads to such high numbers of people waiting on trolleys and chairs – they call it the ‘Winter Surge – and we’ve always said “well its probably an increase in respiratory diseases and winter vomiting bug”.

Well the truth is quite different, the evidence shows otherwise. The fact is there is no increase in demand in January but rather a fall in capacity.

So why is this?

One can surmise that it may be the slow disorderly return of staff after the Christmas break……… but we’re not in the business of surmising.

But one thing is very clear, we can fix this. It’s within our gift.

And when it comes to our long waiting lists, people waiting years for service, and tens of thousands waiting for longer than six months…. again analysis reveals, that with proper organisation and management of the waiting list , this can be addressed – in particular if we deal with people as they appear on the list.

We have yet to analyse the out-patients list but I have no doubt that will be particularly instructive also.

I want to announce tonight, as part of the work of the SDU, significant changes in how hospitals will deal with long waiting lists and in the operation of the National Treatment Purchase Fund. There are three main changes:

First, all public hospitals are being instructed to ensure they have no patients waiting more than 12 months by the end of the year.

It is unacceptable that hospitals leave some patients on waiting lists for very long periods of time safe in the knowledge that the NTPF will eventually pick up the tab. I will no longer tolerate this attitude to patients – hospitals need to become accountable for the listing decisions of their surgeons. I am therefore requiring all hospitals to ensure that they have no patient listed as waiting over 12 months for treatment by the end of the year. Where they fail to do so, the NTPF will source the necessary treatments and the hospitals’ budgets will be reduced by a corresponding amount in 2012

Second, the NTPF will target particular backlogs rather than routinely accept referrals of patients waiting over 3 months. The NTPF will still provide treatments for patients but will target specific backlogs. Follow up treatments for existing patients will be provided as is the normal practice.

Third, I want a system where the patient and taxpayer get the greatest return on scarce resources consistent with quality and safety. That is why I am ending the requirement that the NTPF purchase 90% of treatments in the private sector. The NTPF will purchase treatments wherever it gets the best value in either the public or the private sector. I want the NTPF to drive a hard bargain on behalf of patients without regard to the location of the treatment.

The goal of these and other changes to come is very clear. To put the patient first and to create a completely new model for healthcare in Ireland. I fully recognise how difficult this will be for hospitals, at a time when the face severe financial constraints. But if we are to maintain the level of services, even as funding is cut, our only option is radical, fundamental reform.

Overseas, we’re known for our music, our literature, our scenery and lately of course for our golfers. Which is not bad. I want us to be renowned in healthcare also.

And if you tell me it’s not going to happen and not to have high aspiration, let me tell you why I believe you are wrong. I believe you are wrong because of an example that goes back twenty years.

A young mother, bothered about her toddler’s progress.

  • Told the child was mentally handicapped autistic.
  • Told to set aside her dreams for him.
  • Forget them. Not going to happen. Get real. Accept limitations.
  • That’s the way it is.
  • Except that she dug her heels in and refused to lie down, refused to give up.

The young mother showed dogged, relentless determination to achieve the impossible. And she did it. This year, her son was conferred with an honours degree by the NUI.

I learned a lot from that woman. I’m married to her…

Setbacks are part of the struggle on the way to great achievements. You must concentrate on the details but never lose sight of the big objective. That’s what I want to bring to the task of transformation. The details, the methodology are pretty much public knowledge by now, but I wanted you to know that the details and methodology fit within a wider view of Ireland as we come towards 2016, when we celebrate that a group of poets and dreamers set out to transform Ireland.

Our aim by the anniversary of 1916, is not to have a health service that just meets the health and safety demands of regulators, but a health service that is on its way to becoming a world leader in fairness, humanity, compassion, expertise and innovation.

In the middle of a recent crises in healthcare, a friend of mine who met me was puzzled that I wasn’t downcast. I was surprised, because while I know were facing into an autumn, fraught with difficulties, I have been honoured with a great privilege to generate change……

The opportunity to change the health system from self-servicing to patient centred

To put the compassion centre-stage in our health service

The opportunity to improve the health of a nation,

To put in, a key part in the foundation of a fair society

And thus restore an integral element of the fair society of a real Republic.

What’s there to be downcast about?

Our Republic which has matured to the point where it warmly welcomed the Queen of England to its shores

Our Republic which has the strength of character to rebuke the Vatican for its failures to deal with child safety.

I know we will succeed and that’s not arrogance. That is the belief I have in our people. The belief I have in our Republic.