Speeches

Minister Lenihan´s speech IHCA conference

Introduction

Good evening. I hope you have enjoyed the conference so far. Firstly let me thank your executive for the invitation to address your conference.Obviously, this is not an important day just for the IHCA, but also for the people of Ireland, who have just finished voting on the Nice Treaty. It is because of the Referendum that Minister Martin is unable to be here with you tonight. He extends his sincere apologies and his best wishes.

It has been an eventful year for the Health Services since your last conference. Ireland, like all other developed nations, has suffered from the global economic downturn of the past 12 months. Our rate of economic growth has slowed down but despite rumours of its demise, our Health Services continue to develop and progress. This Government is as committed as ever to providing the funding necessary to ensure not only the maintenance of the highest standards of health care but also to develop and modernise the Health Service to meet the increasingly complex demands of patient care in the 21st century.

But more than money is needed to continue the process of modernisation of our health services.

The view that I would like every health care provider to take is “how can I contribute to the enhancement of patient care”. To progress the development of the service we must examine what we do, how we do it, and, most importantly, how we can do it better. It´s about approach, attitude, motivation, determination, initiative – the will of all care providers, clinical and administrative, to find a better way. The tool to help us in this assessment and development is the Health Strategy – Quality and Fairness; A Health System for You.

The Health Strategy is driving the development of our Health Services. It is the way forward. It provides not just the impetus but the structures, the know-how and the much needed resources to allow for the enhancement of the patient-centred services we must deliver.

To say that your role as consultants is vital is an understatement. Your commitment, expertise and professionalism have never been questioned but now the Irish people demand even more.

Clearly your involvement in managing change in Health Care provision is now of the utmost importance. Initiatives such as Clinicians in Management, the National Task Force on Medical Staffing, the Primary Care Strategy and the Action Plan for People Management are the tools that can be utilised to reach our holy grail – the speedy delivery of a quality patient centred service.

Funding

The key element of any proposal for the enhancement of services is the provision of development funding.

This Government´s commitment to improving the health service has been clearly demonstrated by the substantial increase in funding since 1997. I make no apology for re-stating the details here tonight. This year´s health allocation – more than €8 billion – represents an overall increase of 125% on the funding provided in 1997. In addition to this revenue funding, capital funding of approximately €2.5 billion (at year 2000 prices) was provided under the National Development Plan for the years 2000 – 2006.

Such levels of funding and commitment to our health services are unprecedented and will be vital in progressing the development of all aspects of the Irish health services. For example, in the acute sector, major projects are now under construction at St Vincents, Elm Park, JCMH, Tullamore, Naas, Clonmel, Cork, and UCHG, amongst others. We are also stressing, under the NDP, investment in the important area of re-equipping and refurbishment generally of all health facilities.

This increase in funding has led to an increase in activity levels. For example, during the first six months of 2002, the number of day cases treated increased from 208,000 to 238,000 by comparison with 2001 ; an increase of 14.36%. In addition, there was a 5.28% increase in all discharges; from 534,000 to 562,000.

Implementation of Health Strategy

I was delighted to be asked to serve as Minister for Children. I now welcome the opportunity to work with the Department of Health and Children on the continued development of the health services as outlined in the Health Strategy, -Quality and Fairness; A Health System for You.

The implementation of this strategy is vital. Although our health services have been developed and modernised over the last number of years, we need to build on these achievements to meet the newer, and more complex, demands of the 21st century. I wish to re-affirm this Government´s commitment to the implementation of the Health Strategy. The strategy will be the engine used to deliver the improvements and restructuring needed to equip our health services to provide the highest quality health care. Already key elements of the Strategy have been implemented and other initiatives which will help to improve our service provision are well advanced.

Levels Of Activity / Additional Beds

A comprehensive review of acute hospital bed capacity needs has been conducted by the Department in conjunction with the Department of Finance and in consultation with the Social Partners. The review titled Acute Hospital Bed Capacity – A National Review, which was published on 16 January 2002, helped to inform the Government in its decision to provide a total of 3,000 additional acute beds for public patients over the next ten years. This represents the largest ever concentrated expansion of acute hospital capacity in Ireland. In tandem with the publication of the report, we announced the first phase of these additional beds with the commissioning of an extra 709 acute hospital beds at a cost of €65m. My Department has been advised by the Eastern Regional Health Authority and the Health Boards that, to date, 256 of these beds have been commissioned and that a total of 600 will have been introduced by the end of this year.

The increase in bed capacity will allow the hospital system to significantly increase activity levels for public patients in the current year. It is estimated that the increase in bed capacity will enable over 30,000 additional public patients to be treated in a full year. The additional beds represent further tangible evidence of the commitment by this Government to investment in the development of additional facilities for the treatment of public patients, and to the reduction of waiting lists and, more importantly, of waiting times.

Growth in Numbers

The five years to 31 December 2001 saw unprecedented growth in health service staffing with numbers increasing by 41% to over 92,000 wholetime equivalents.

This growth was spread across each grade category with

  • An increase of 6,845 in the number of qualified nurses bringing the total number to 31,429 (+28%)
  • An increase in the number of Health and Social Care Professions by 65% to over 9,000
  • An increase in Support staff levels by over 11,0000

I am sure that the growth in medical staffing levels is of particular interest to the delegates, I am therefore pleased to advise you of the following:

  • Consultant numbers are up by 363 or 30%. According to Comhairle na nOspidéal, these numbers have risen to 1,690 during 2002.
  • NCHD numbers are up from 2,652 to 3,727 – an increase of 1,075 or 41%

The significant increases in paramedical and support staff reflect substantial investment in a range of services such as childcare and disability.

Growth in frontline clerical and administrative staff working with clinicians and providing direct support/ patient contact, has freed up clinicians (medical, nursing and other health professionals) allowing them to focus on professional care.

Audit of Structures

The Department of Health and Children has engaged Prospectus Strategy Consultants to perform an Audit of the Structures and Functions in the Health System. The primary focus of the audit is to establish the organisational improvements needed to strengthen the capacity of the health system to meet the challenges of implementing the programme of development and reform set out in the Health Strategy.

The purpose of the consultancy project is to determine whether the structures in the health system:

  • are the most appropriate and responsive to meet current and future service needs;
  • constitute an adequate framework for overall governance of the health system;
  • achieve an effective integration of services across all parts of the system;
  • adequately represent the views of consumers in the planning and delivery of services;
  • focus sufficiently upon the principles of equity, accountability, quality and people-centredness and the national goals of the Health Strategy; and

It will also recommend any changes believed to be necessary as a result of the analysis, including an implementation strategy for any changes proposed.

The audit is critically examining:

  • the number and configuration of existing health organisations;
  • their interaction with one another and the Department of Health and Children;
  • the adequacy of governance arrangements; and
  • the scope for rationalisation.

The audit is now well underway and the consultative phase is due to commence shortly. The project is due for completion early in 2003. I can imagine that the report will be of interest to everyone working in our health services.

Primary Care Task Force

The Primary Care Task Force was established in April 2002. This multidisciplinary group has been charged with ensuring that the Primary Care Strategy, “Primary Care – A New Direction“, is correctly implemented. The partnership ethos has strongly influenced the approach adopted, with the Task Force meeting with the health boards to discuss such issues as human resources and training; quality and implementation; and services. The Task Force will be addressing the range of objectives identified in the Primary Care Strategy as necessary to support the progressive implementation of the new team-based primary care model in the years ahead. Earlier this month, we approved the establishment of ten implementation projects, in such locations as Dublin, Cavan, Donegal, Kerry, Laois, Limerick, Tipperary, Mayo and Wicklow. Funding totalling €8.4m is being provided for these projects in 2002 and 2003.This represents a major step forward in the process of implementing the Primary Care Strategy. The projects will involve putting in place, in each location, a primary care team, which will include general practitioners, nurses/midwives, health care assistants, home helps, an occupational therapist, physiotherapist, a social worker and administrative personnel. By bringing this wide range of service providers together in primary care teams, integrated services can be delivered in the community in the most appropriate and accessible way. As the ten projects are developed, more than 80,000 clients altogether will benefit from having direct access to an improved range of services provided by their primary care team. I look forward to the rapid progression of this work throughout 2003.

National Task Force On Medical Staffing

The National Task Force on Medical Staffing is preparing and costing a new approach to the provision of hospital services, based on appropriately trained doctors providing patients with the highest quality service. This involves analysing the implications and costs of a consultant-provided system of health care delivery and recommending improvements to medical education and training requirements. In order to assess the nature and practical implications of the changes required, the East Coast Area Health Board and the Mid-Western Health Board, as well as the hospitals located in these two health board areas, have been selected for a study. Since June, the Task Force has;

  • had over 170 consultative meetings;
  • received 40 written responses from pilot regions;
  • been engaged in detailed analysis of material from detailed questionnaires issued to each department of reach hospital in the pilot regions;
  • produced an internal interim report on postgraduate training for NCHDs; and
  • produced an internal report on NCHD working hours, medical staffing and relevant aspects of the organization of hospitals in EU member states, Australia, New Zealand, Canada and the USA.

The IHCA has contributed greatly to this process and I wish to thank you all for your involvement to date and for your ongoing commitment to improvements in service provision which ensure high quality patient care.

Enterprise Liability

The business of providing hospitals and doctors with affordable public liability and professional indemnity cover remains a challenge despite the successful establishment of the Clinical Indemnity Scheme in July. Consultants are not yet covered by the scheme and the Department believes that steps should be taken to have them brought into it as quickly as possible. When the Department of Health and Children began to look at this area some years ago the establishment of an alternative to the existing insurance and indemnity arrangements was simply a desirable policy objective. The intervening years have made it an urgent necessity as the domestic medico-legal environment and the international insurance market have combined to create a situation of great instability. It is clear that this instability is not in the best interest of patients, doctors, hospitals or the Exchequer which funds the bulk of the cost of insurance and indemnity cover.

In establishing the Clinical Indemnity Scheme based on the principle of enterprise liability we have two linked objectives. The first is to put the provision of insurance and indemnity cover on a more stable financial footing and eliminate the costs associated with having multiple defendants in personal injury cases arising from medical errors. Secondly we want to put in place comprehensive clinical risk management programmes which are focused on reducing avoidable errors.

I am satisfied that there is a significant degree of acceptance that enterprise liability represents the only safe way forward. However it is recognised that even inevitable change can be difficult to accept and that doctors have legitimate concerns in moving from having indemnity cover provided by mutual doctor-owned and doctor-operated bodies to a State-financed scheme.

Another concern is the possible effect of the introduction of enterprise liability on private practice. As you know the scheme will cover a consultant´s private practice in a public hospital. This is a significant and valuable concession as private practice is not covered by similar schemes elsewhere. There would be enormous difficulties in having off-site private practice covered. Minister Martin has said in the past that he is conscious of the risk of the introduction of enterprise liability having unintended consequences for the private sector. We will be monitoring this closely and will keep in touch with the Association and with other bodies such as the Independent Hospital Association of Ireland.

This is also an appropriate occasion on which to pay tribute to the work which is done on behalf of Irish doctors by the MDU and the MPS. Both organisations have provided assistance to their Irish members for over 100 years. Besides the high-profile activity of defending claims against doctors they provide a wide range of other services to their members and have helped in generating a well-informed debate on medico-legal issues in Ireland. I know that they both intend to continue in business in Ireland after consultants come into the Clinical Indemnity Scheme and we look forward to continuing to work with them.

E-Health – National Health Information Strategy

High quality information lies at the heart of all good decisions concerning health. This is a central theme of the Health Strategy: Quality and Fairness a Health System for You which recognises that information “must not be seen merely as an add-on” but as essential and integral to the provision and planning of health services. The Health Strategy also recognises current deficiencies in health information and signals the development of a National Health Information Strategy to progress the whole area of better information collection and use over the next decade. The National Health Information Strategy is now nearing completion and is expected to be published before the end of the year.

More specifically, the aims of the new Information Strategy will be to exploit information to the full in improving patient care at the point of delivery and in improving the quality of decision-making in health at all levels. This will be achieved through a number of important initiatives including the development of Electronic Health Care Records supported by unique client identification and the introduction of a secure communications infrastructure. It is only through the effective use of health information throughout the services that delivery of care can be optimised and effectiveness and value for money can be assured.

The National Health Information Strategy will introduce a framework for information governance including codes of practice for information sharing which will be supported and enabled by specific Health Information Legislation. Responsibility for the development and coordination of necessary information systems within the health sector will fall under the remit of the proposed Health Information and Quality Authority.

National Treatment Purchase Fund

Both the Health Strategy and the agreed Programme for Government highlighted the need for a reduction in waiting times for public patients. The National Treatment Purchase Fund (NTPF) has been established to assist in the reduction of waiting lists. The focus of the NTPF is on patients who have been longest on hospital in-patient waiting lists and initially the Fund is concentrating on adults who have been more than twelve months on waiting lists and in the case of children more than six months. Patients treated under this initiative have been treated to date in private hospitals in Ireland. In the case of children it has been agreed that treatment can take place in the public hospital system as well as in private hospitals. In addition, capacity has been sourced to treat both adults and children in private hospitals in the UK. More than 700 patients had been treated by the end of September last. I would like to thank the consultants whose support and co-operation has helped to ensure the effectiveness of this initiative. I expect the scheme to have significantly greater impact in 2003.

Competence Assurance Scheme

As I mentioned earlier, recent years have seen enormous advances in such areas as technology and medicine. It has become increasingly important to ensure that doctors stay abreast of these changes and that their skill levels are maintained. This can help to guarantee the patient´s safety and patient´s confidence in his/her doctor. The Competence Assurance Scheme, which is being developed by the Medical Council, can help to achieve these objectives. A Working Group and an Advisory Committee on Competence Assurance have been established, and I understand that the broad concept of Competence Assurance has secured a high level of support among the medical profession. The challenge now is to implement the proposed structures on a phased basis. To this end, the Working Group has produced a large set of proposals that will be submitted to the Advisory Committee within the next two weeks. I am hopeful that this system will bring many benefits to both the patients and the medical profession by ensuring that our doctors’ high standards of performance are maintained.

Conclusion

All of these developments will help to ensure that the Irish health service is capable of meeting present and future challenges. The negotiations on the new consultants´ contract, which are still in the early stages, will have to take into account these initiatives, while supporting the vision outlined in the Health Strategy; that of a supportive, fair and transparent health system.While on the subject of the consultants´ contract, I was pleased to hear during this week that agreement had been reached between management and consultant representatives on the revision of the grievance and dispute procedure. I am hopeful that this will help to accelerate the negotiations´ process. I would like to thank all participants for their good work in this area.

There is a greater sense of partnership in Health Services now than ever before and I believe that, with sincere commitment from each stakeholder, these initiatives will help to improve the environment in which we work and the service that we provide to the Irish public.

Medical developments in recent years have emphasised the enormity of the challenge to health service providers to provide timely, high quality professional care. The service we provide is unique in that not only does it hold the highest profile in terms of Government expenditure but it also touches the poorest and most vulnerable in our society. This uniqueness creates a pressure that at times can be difficult to bear. I have no doubt, however that, with the continued support of a committed Government, our highly skilled and motivated health service staff will continue to meet the challenges ahead.

I hope that the Irish Hospital Consultants Association had a very successful conference and we look forward to working with the Association, in partnership, over the next twelve months.