Speech by Micheál Martin TD, Minister for Health and Children – National Consultative Forum

Consultation was where the National Health Strategy began, and consultation is central to how it will be implemented.

From the very beginning, I wanted to involve as many of the stakeholders as possible in the re-design of our health system.

And, because of the openness shown and the optimism generated, I insisted that the Strategy as presented to the people of Ireland carry a list of targets: actions to be begun by a particular date.

You could call it “The stick to beat ourselves with” section. Because it makes it easy for anyone to check how we´re doing: you can establish almost at a glance where we’re on target, but also where we’re slower than we said we wanted to be.

It´s worth a lot more than a glance, though, because what’s been achieved is significant. Significant progress has been made over 12 months in one area after another, starting with bed capacity.

In the Health Strategy, we said we´d provide 450 public beds in this year.

In fact, by the end of the year, we´re on target to have 600 in place – all of them designated for public use only.

109 more will be in place early next year.

The money has been found.
The money has been allocated.

Each of the extra beds – and the concomitant increase in activity levels it represents – is tangible evidence of the Government´s commitment to the health service.

I mentioned that extra beds mean extra activities, so let me touch on that before I go any further.

One of the radical changes highlighted in the Strategy was the move to day casework. This is:

where a variety of routine and complex treatments can happen, where surgery and diagnostic tests can be performed, with the patient admitted and discharged from hospital on the same day.

Day casework makes sense.

  • Human sense.
  • Medical sense.
  • Economic sense.

Day case surgery now accounts for about 50% of all elective surgical admissions to acute hospitals.

One out of every two people checking into an acute hospital for elective surgery will be in their own home by the end of the day.

This increase has contributed to an increase in overall acute hospital activity of 17% over the last five years.

Now, hold it there for a second.

That´s a statistic that shouldn´t be allowed to stay being just a statistic.

If you were to look at any industry in this country and say “It´s increased its production by 17% over the last five years,” that would be a cause for justified recognition, particularly for those working at the coalface It’s an oddity of the health service that significant increases, not just in capacity, but also in delivery, don´t generate the same recognition. The fact is that an enormous increase in throughput has been achieved, with enormous credit to those delivering services.

The Health Strategy gives us the framework to go further, do more.

But shifts – in demographics and in needs – are happening faster, these days. And so we´ve a delicate line of tension to walk: we have to get the infrastructure right for the needs five years down the line, ten years down the line. But we can´t afford to get so attached to the totality that we fail to meet the needs right now.

For that reason, I have asked the Department and providers to put a sharp focus on items that´ll have

  • the biggest impact
  • as quickly as possible

on people´s everyday experience of the health system. And you´re going to hear details of some of those on-the-ground developments today.

I´m very proud of the Health Strategy. All of us here can be very proud of it.

But I do have to acknowledge that last November was not a brand new starting point for the health system. We didn´t start from scratch last November – what we did was redraw the map.

One of the major innovations – one of the most significant examples of our thinking outside the proverbial box, was the Treatment Purchase Fund.

In an area that´s both central and extremely complex, the innovation light bulb can go on, but it´s still going to take a while to get the various protocols established, the research done, the implementation team in place. Before we did anything, we looked at the best European models of approach.

Because I was determined that we would not create expectations that couldn´t be met.

So we got the nuts and bolts in place before we could go places – but we´ve now done some serious travelling.

  • 1,000 people waiting for more than 12 months have now had operations.
  • By the end of the year, more than 1,900 will have been treated.

This will contribute significantly to reducing hospital waiting lists in the next twelve months. They stood at 24,850 at the end of June of this year. This represents an overall decrease of 1,809 – that´s 7% – relative to the comparable figure for 2001. (Just to make it clear: that 7% reduction took place before the Treatment Purchase Fund was up and running.)

The total number of adults waiting for more than 12 months for treatment in the target specialties has fallen by almost a quarter in the period June 2001 and June 2002. Close to one person out of every four on waiting lists has been dealt with. Waiting lists on target specialties have dropped by 22%.

This is a significant improvement and I am confident that the impact of the initiative will continue when figures up to the end of 2002 have been compiled.

The Treatment Purchase Fund has provided a new impetus in the acute system to improve not just waiting times by providing treatment but also to ensure improvements in the validation of waiting lists and the better management of waiting lists generally.

It is just one of a number of major developments designed to put a whole new frame around this area.

A related development is the piloting of the Public Private Partnership initiative in the Health sector.

This is going to provide long stay accommodation for older people in Community Nursing Units, where there will be services like assessment, rehabilitation, respite and extended care.

The Public Private Partnership initiative is being piloted in the ERHA and SHB, the two areas with most acute need of additional long-stay beds. When the PPP pilot´s complete, it will have created 17 new Community Nursing Units and provided up to 850 new beds.

A PPP Unit´s been established in the Department to co-ordinate the pilot programmes, develop policy in this area and encourage innovation.

This initiative, over time, will have obvious benefits for our older people.

Which brings me to one of the things I want to hammer home, here today.

Yes, we´re in a tighter fiscal situation.
No, that doesn´t mean key elements of the Strategy are threatened.

On the contrary.

Innovation – like the Public/Private partnership initiatives I’ve just been talking about – can be both effective and cost-effective, in delivering new services.

Progress on proper complaints procedures in hospitals, which make a real and immediate difference to the experience of patients, doesn´t cost any extra money. Neither does it cost money to make sure outpatients are seen at the time their appointment says they´ll be seen.

It doesn´t cost money, but it makes a huge difference. Being one of a large number of patients instructed to turn up at 10 o´clock, only to find you´re not seen until noon, can be bitterly demeaning to an individual.

Ten o´clock should mean ten o´clock.

Of course, one of the most radical parts of the Strategy was Primary Care.

Radical in theory and radical in action.

The multidisciplinary task force was established by April this year.

Last month, I approved the establishment of ten implementation projects – in Dublin, Cavan, Donegal, Kerry, Laois, Limerick, Tipperary, Mayo and Wicklow. Funding totaling €8.4 million is being provided for these projects in 2002 and 2003.

The projects will put a primary care team into each of these locations. A primary care team including general practitioners, nurses/midwives, health care assistants, home helps, an occupational therapist, physiotherapist, social work and administrative personnel.

This is going to fundamentally change the nature of primary care delivery.

And this is an area where we can confidently and happily raise expectations.

Bringing this wide range of service providers together in primary care teams is going to allow us to deliver integrated services faster, more locally, in a more patient-friendly way.

You could look at it as a “continent of care.”

Presently, the individual patient often finds himself or herself like someone hopping from one island of care to another.

The ten projects approved are going to pull services together, reduce the amount of time, eliminate delays and phone calls. As these ten projects develop up to 80,000 clients will benefit from the direct access to an improved range of services.

What we´re looking at is a major first step in implementing the new model for primary care. We´ve provided funding for them, got them going.

There´s been a welcome taking on board of the primary care strategy with considerable interest from bodies across country. In addition to the pilot projects, we´ve seen significant expansion in GP co-ops in 2002, delivering the twenty-four hour coverage across the country.

The implementation of the full model is a long-term strategy but this is a strong beginning backed up by the development of GP Co-operatives all around the country.

Of course, improving primary care has implications for acute services also, both in terms of the potential to relieve some pressures on the system but also in terms of improving the interfaces between the two.

Another area where we have made very good progress is in Human Resource Management.

Additional intakes, work on overseas recruitment and processes to integrate workforce-planning studies – they´re all underway.

Last week I launched the Action Plan for People Management – on schedule.

This plan is vital if the Health Service is to become an employer of choice.

As I have said before, on many occasions, our workforce is our greatest resource and change will not happen without the efforts of all health service staff. It´s great that all health service employers and trade unions have worked closely with the Department in prioritising this project.

I wish also to draw your particular attention to the pioneering work of the National Task Force on Medical Staffing under the chairmanship of David Hanley. The Task Force is charged with examining the implications of introducing a consultant-provided service and of reforming the deployment of Non-consultant hospital doctors to meet EU requirements on working hours.

I want to pay a heartfelt and personal tribute to the Task Force. They´ve undertaken enormous and creative work, consulting widely and – I firmly believe – sowing the seeds for the revolution to come in Irish healthcare.

It is clear from the Task Force´s work to date that it will not be sufficient simply to look at the number of medical staff. It must also consider delivery of services throughout the hospital system and have full regard to the interactions with primary care and long-term care services.

Therefore, the Task Force is looking beyond the issue of hours worked by NCHDs to areas such as type of services provided, staff numbers, work patterns, on-call arrangements, skill mix of different professionals and a range of other areas. All of these factors will have an impact on medical staffing requirements in the future.

The complexity of this project is an excellent example of the interconnected nature of the health system. Changing one part of the delivery process is inextricably interlinked with more system-wide changes. This project shows how complex, apparently simple concepts become, when applied to a system as multifaceted as health.

The whole health issue is about a whole lot more than health services. It’s about improving health status – and this was very clearly stated in the Strategy. Improving health status by a multifaceted, constantly changing set of interactions, educational inputs, preventive measures (like the Public Health Tobacco Act, signed into law in March 2002) and services.

Ireland´s health system has held up well, given that it is a system which has stayed largely the same, at its core, for over 30 years. Thirty years on, however, the time has come to look critically at its structures.

We have to look critically at it in order to determine whether

  • It is geared up to meet current and future service needs;
  • It´s got good overall system governance;
  • It supports effective integration;
  • It adequately represents the views of consumers; and
  • It is focused sufficiently on the national goals of the Strategy.

If we want system-wide change this is the time to be reflective about the structures, functions and processes in the health system.

You are probably aware that the audit of the system has begun. The consultant´s report, expected in January, will outline :-

  • an analysis of key findings
  • recommendations for system changes
  • a high level implementation plan
  • and a timetable to take recommendations forward.

I have met directly with the project consultants to assure them of my personal commitment to consider radical reform, if that is what is required. I have asked them to genuinely critique the system and to seek out the best model for delivering on the agenda that we have set ourselves. I look forward with great interest to their report.

Before I conclude, I want to talk briefly about the economic situation.

We would not have been able to invest in our health system as we have in the last few years without a strong economy. Nor would we have been able to do the radical thinking manifested in the Health Strategy.

We still have a strong economy – one of the “growers” of Europe. Strong management of our economy by the Government gives us the best guarantee that the Health Strategy will be delivered on. Good fiscal responsibility will deliver the Strategy. The alternative would consign it to oblivion.

There´s no going back on this Strategy. We were always clear that we were going in a direction that would transform the way the Health Services are organised and delivered in this country.

  • At the moment, for example, there´s an unprecedented degree of capital building in the health system. Some of the biggest projects since the beginning of the state: a new hospital in Tullamore, extensions and major works at hospitals in Cork, in Dublin at St Vincent´s and James´s. Not to mention Mullingar, Galway and Ennis and a host of others across the country.
  • Spend is up in every area.
  • Numbers are up, too. We now have well over ninety three thousand people working in health compared to sixty eight thousand in 1997.

The system is ours to change.
The benefits of change are immeasurable.
And the key to change is people. People working within the service and changing the structures at the same time.

Today is about giving a flavour of what’s been achieved so far.

Close to 70% of the actions set out in the Health Strategy Action Plan have been commenced.

But, as the day progresses, you’ll also, I believe, be realising that there has never been a greater sense of partnership at work in the health system. This partnership is a partnership with all of the stakeholders.

Not only are we doing the right thing – we´re doing it in the right way.

We´re doing it through consultation, through innovation, through partnership.

Every single person in this nation is touched by our health service.

My aim – I believe our collective aim – is to make sure that in the months and years to come, they spot the tangible, visible evidence of the radical improvements which began with the Health Strategy, exactly one year ago.

Some of them will spot the improvements on a vast scale: big new purpose built facilities.

Some of them will spot the improvements on a small and personal scale: when they have a complaint, it’ll be dealt with properly.

But all of them will see the difference.