Speech by Minister Harris at the Health Management Institute Annual Conference
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I am delighted to be here this afternoon to address your annual conference. The theme you have chosen for your conference: “Innovative Disruption, changes that will make a difference”. could not be more apt given the challenges which all health providers are facing.
Let me begin by thanking HMI for organising this event. I recognise how much work goes into preparing for today and I want to thank everyone involved for their contribution. I would like to particularly thank Lucy Nugent, President HMI and all of the speakers especially those who have travelled from outside the country, Dr Axel Paeger and Sir Muir Gray.
This conference gives me the opportunity to acknowledge on one platform two really important messages. Firstly, the importance of exchange, and sharing learning about best practice and secondly, the importance of innovation in hospitals and healthcare as a driver of better health outcomes for patients through the delivery of more integrated, innovative and patient-centred services.
I would also like to take this opportunity to acknowledge the contribution you all make to the health service. Thank you for the dedication, value and commitment you bring across the spectrum of the health system. I know that you might often feel that your work goes unsung but I want to assure you that it does not go unnoticed.
You and your teams bring all the different parts of the system together to deliver services for patients. The health service needs capable, committed, motivated and experienced managers to deliver on day-to-day management and to provide the leadership and change management so critical to meeting the increasing demands on our health service.
I also welcome the announcement recently by the HSE of a new executive skills programme to recognise and address the training needs for current and aspiring clinical directors and also the new Health Service Leadership Academy which will commence its two flagship programmes next month. The role of a HSE manager is very challenging and we want to give as much support as we can to make sure that the role is effective in improving care for our patients.
I thought it would be useful to the take the opportunity of being with you today, to set out what I see as the strategic approach that we need to adopt if we are to develop the health service that our country and our people deserve.
Let’s start by agreeing on a couple of basic things.
Firstly, lets acknowledge that every day, up and down this country, the staff in the health service do amazing work.
Let’s agree that not everything in the health service is a crisis. Let’s not ignore the hard work, the dedication, the skill, the commitment and the sheer excellence that you can find in our health service on any given day. Let’s applaud the many examples of innovation and reform that can be found across the health service.
But let’s also acknowledge, that we are long way from where we should be. I see no contradiction between praising the positives, and being honest about what we all know to be true – that we still have a long way to travel.
No-one here believes that what we are seeing in EDs is acceptable.
I know no-one in the health service who would say that waiting times for elective procedures are where they should be.
I know no-one who will say that we are meeting all the needs that our fellow citizens have a right to expect can and should be met.
No-one wants a better health service more than the front line staff who work in it.
But let’s also be honest enough to acknowledge that the problems in the health service can’t be fixed overnight. There are no magic wands. There are no quick fixes. To build the health service that we all want, and that our people deserve requires us to have a strategy and a plan, and to work day and night to make the changes that we all know need to be made.
Let’s start with the plan. One of the first things this Government did was to establish the all-party Oireachtas Committee on the future of healthcare. Chaired by Deputy Róisín Shortall, the leader of an opposition party, this group worked together for almost a year to come up with a plan for the future of the health service. What is unique about their report – the Sláintecare Report – is that it enjoys support from across the political spectrum. That political consensus is a great achievement, and I for one don’t intend to waste it.
Sláintecare gives us a path to travel. It is the Vision document that points the direction that we need to take, to build a better health service.
President Eisenhower once famously said: ‘The plan is nothing: the planning is everything’.
What we have to do now, is to take the Sláintecare Report, and build around it a process of planning and implementation, that will start to translate the vision into concrete change, and the change into reality.
What we need to do is to take this overarching document, and break it down into a series of actions, which we can then roll out over a multi-annual period.
Here again, let’s be honest, that’s not something at which we excel in Ireland.
We are good at drawing up plans, but sticking to the hard work of implementation is not our greatest attribute. I don’t intend to let that happen with Sláintecare. To that end, we are going to create a Sláintecare Programme Office to drive forward with our reform programme. Many of you will have seen that we are currently recruiting a lead executive to manage that work – someone who will have a strong track record of implementing reform.
In the meantime, my Department is driving on with the work of preparing a Sláintecare Implementation Plan. I have promised the Taoiseach that I will report back to Government in October and again in December on the work we are doing on translating the Sláintecare report into a programme of action.
What are the core components of the Sláintecare Strategy?
At its heart is its stated objective – re-orientating the health service towards a high quality integrated system providing care on the basis of need and not ability to pay. A universal system providing the right care in the right place at the right time, provided by the right people.
To achieve that goal, the report sets out a wide range of recommendations. Some of them are things we are working on already. Some will require considerable work to get under way. I want to focus today on five of the main themes in the report.
The first core theme is the idea that the vast bulk of health services should be provided in a primary care setting. That’s not a new idea, and we are making progress in this area. But we have to do more, and do it more quickly. We need to develop a new contract with General Practitioners which promotes treatment of chronic conditions in a primary care setting. We need primary care teams to be at the heart of systems of integrated care. And we need to develop a new model of community nursing which will put some of the most skilled professionals in our health service – nurses – working directly in our communities. We have a number of pilot projects up and running in this area, and I am looking forward to getting the feedback from them.
Secondly, I am pleased that the Sláintecare report endorses my views on the need to achieve greater alignment between hospital groups and CHOs. Those of you who have been around the health service for a while know that different health service management structures have been put in place over the years. I don’t believe that finding the ideal structure will suddenly solve all our problems. Nor do I underestimate the challenges that changing structures can pose. But having the wrong structures will most certainly undermine our chances of successfully developing a coherent efficient integrated system. So, we have to find a mechanism to better align the hospital groups and the community health organisations.
Thirdly, the Sláintecare report points to the issue of private practice in public hospitals. This has been a feature of the Irish healthcare landscape for generations, and seems to be a uniquely Irish phenomenon. The Committee acknowledges that it would take time to change this system, and there would be a very considerable price tag attached. It also calls for an impact study to be done before this recommendation is implemented. But we can’t shy away from the core issue – that when the public system is under severe strain, when EDs are full and waiting lists grow, it is hard to defend an arrangement whereby private practice continues unquestioned in public facilities. Decoupling private from public practice is far from simple but it certainly is worth considering and I am committed to this impact study as a first step.
Fourthly, the Committee makes some interesting proposals on the configuration of services – including more active management of activity across hospital groups. Certainly, we have seen in recent months that shifting activity across the RCSI group has led to notable improvements. I am certainly open to the idea that we should look further at how elective-only facilities can contribute to improving throughput and the service we offer to patients.
Fifthly, Sláintecare report supports the idea that we need to look at the whole issue of capacity across the health service. Again, one of the core proposals in the Programme for a Partnership Government was that we would establish a review of health service capacity requirements. This review is underway and will report to me in the coming weeks. Unlike previous reviews, this is not looking solely at the number of beds in acute hospitals, but at health service capacity more generally.
The Capacity Review will set out the scale of the healthcare need that we will face in the years ahead, with an aging population and a growing burden of chronic disease. Indeed, it is no exaggeration to say that Ireland unique experience of migration and population change means that we now see a rapidly growing number of older citizens in our population which will have particular implications for our health services.
Taken together, the Sláintecare report and the Capacity Review present all of us here with a great opportunity, but they also confront us with a challenge. In Sláintecare, the Oireachtas is putting forward its consensus view of how we reform healthcare over a ten period – to deliver the service we all want and our people deserve.
As leaders of the healthcare system, the challenge to us is to respond in kind.
To build our own consensus about how reform can be achieved.
In agreeing the Sláintecare report, the members of the committee had to work hard to find common ground.
As we move to developing the implementation plan, armed with the findings of the capacity review, we must do the same.
By framing the capacity review to go beyond acute bed capacity, we are explicitly saying that things cannot go on as they are. The answer to building a better health service cannot simply lie in more resources to do more of the same.
The scale of the demographic challenge facing our country is such that we will need to invest more in healthcare. And I for one will make that case. But we won’t succeed, unless we are clear that the health service can reform as it grows.
That may sound like a harsh message after several years of difficult economic times. But it’s a realistic message.
If, as healthcare leaders, we all respond to these two reports by saying:
‘aha – I was right all along – put more money into what I do’,
then all the public will hear is discord and cacophony.
When what we need is unity of purpose and clarity of direction.
Few areas of our national life are as complex as health, and complex problems are not solved by simplistic solutions. What we need instead is an approach which recognises the healthcare system is made up of many parts, each with its role to play. The challenge in the next few months is not to see who can shout loudest, but how collectively we can come together around a vision of a better future in which all of us have a role to play.
If we are to reform our health services, we must bring people together to share and learn, to drive innovation and to deliver the best care for patients and their families.
I am hopeful and confident that the work of everyone in this room today will contribute to helping us deliver on this goal.
I look forward to working together with you all as we move to improve our health services and the provision of care to the Irish people. I wish you all a productive and enjoyable day.