Speech by Mr. Micheál Martin TD – Launch of Health Strategy

In every aspect of every individual´s life, health is pivotal. Health is also crucial to Ireland as a nation. Our healthcare system must reflect our national values: our concerns for equity, our commitment to diversity, our determination to end poverty and disadvantage. It must, as a major employer, provide a context for professionalism, growth and development at every level within the workforce.

Public health systems, worldwide, are going through unprecedented challenges in these, the early years of a new century.

  • Technology is changing by the minute.
  • Expectations are rising almost as quickly.
  • Changing demographics and lifestyles are creating new and different needs.

Our healthcare system is no exception to the international pattern. It´s under pressure, too.

But that shouldn´t make us miss two key points.

  1. Ireland´s healthcare professionals have adapted quickly and flexibly to the enormous challenges of the last decade, maintaining high standards under great pressure.
  2. The healthcare system is much more than an illness system. It´s where key steps in health promotion can be taken, where illness is prevented, where individuals and groups are put in control of their own health management, where personal and family development is supported and empowered.

Because of the complexity and scale of our healthcare system, and because of the challenges it faces – it´s vital that we have a new, over-arching Strategy at the beginning of the new century.

This Strategy is unique. Unique in a number of respects.

It´s unique, first of all, in the level of public consultation on which it´s based. Individuals, professional groups, disciplines, voluntary organisations and state agencies all contributed significantly to the development of the Strategy. And they´ll continue to contribute to the implementation of the changes they sought.

The second way this Strategy is unique is that it doesn´t just focus on the long-term. I believe that would be too easy, too safe. This Strategy contains short term steps, medium term measures and longer term plans.

Among the short term measures is the largest ever bed capacity expansion in the history of the health service. In the next twelve months, 650 new beds will go into the areas that most need them. 3,000 extra beds will go into the system by 2011. And all new beds will be designated for public patients.

A second short term measure is a new, dedicated Treatment Purchase Fund to buy treatment for public patients waiting more than three months from initial referral, so that:

  • By the end of 2002, no adult will wait more than 12 months, no child more than 6, for treatment
  • By the end of 2003, no adult will wait more than 6 months, no child more than 3.
  • By the end of 2004, no public patient will wait more than 3 months.

People with disabilities will also gain from the immediate measures in the Strategy, with the addition of significant day care places, respite care places and residential capacity.

Right around the country, people will gain from the expansion in the number of GP co-operatives during 2002 – a key move in our Primary Care plans.

Primary care is just one example of where there´s an immediate benefit, followed by even more radical change in the longer term.

Primary care is where more than 90% of health needs can be met.

A properly integrated primary care service can lead to better outcomes, better health status, better cost-effectiveness. It can prevent or reduce the impact of conditions that can lead to hospitalisation. It can facilitate earlier release from hospital.

That properly integrated primary care service is outlined in the documents published today. But we have taken it far beyond a vague concept – indeed, it has been worked through in such detail that we´re publishing a quite separate Primary Care document on Wednesday to allow the opportunity to explore the implications. All I´ll say at this point is that the implications are hugely positive. In addition to expanding the number of GP co-operatives, we´re planning to pilot Primary Care one-stop-shops where teams, including GPs, nurses, dieticians, dentists, chiropodists, community welfare officers, physiotherapists, home helps and several others, will work together.

These pilot primary care centres will allow patients to refer themselves to individual services. They´ll offer 24 hour cover, and, because of their inter-disciplinary nature, will have a major impact on reducing the demand for specialist services.

In Primary Care, what is planned is nothing less than a visionary innovation. A visionary innovation that will be piloted, monitored, evaluated and refined before it is rolled out nationwide. The resources are in place to commence these significant changes in the primary care infrastructure. Nobody can disagree with either the urgent need to address the Primary Care issue or the central place it occupies in this Strategy. It quite simply is central.

Be in no doubt: this is a comprehensive and ambitious Strategy: a blueprint to guide policy makers and service providers towards delivery of the articulated vision. It identifies overarching goals to guide planning and activity in the health system over the next 7 – 10 years.

The last four years have seen the biggest, most sustained increase in health services funding, starting with my colleague Brian Cowen. The increased funding has allowed new facilities to be built, old facilities to be refurbished. More professionals have been recruited. The bottom line is that – today – more people are using more services than ever before.

But service deficiencies and waiting lists remain to be addressed.

Underdeveloped services must be enhanced, demographic challenges met. Everything from preventive education to acute care can be improved. What we´re presenting today is the solution to those problems, the improvement to those services that is not scattered or ad hoc. The improvements are part of an integrated system built on four key principles: Equity, Quality, Accountability, People-centredness.

The issue of equity is simple – and vast.

It´s about treating people fairly. The current reality is that poorer people have poorer health. Measurably poorer. This Strategy sets out to tackle this problem, acknowledging that there are a number of determinants affecting health, some of them involving other Government Departments, and stating that these issues must be addressed in an inter-Departmental way.

In addition, the Strategy tackles health inequalities by planned widening of Medical Card eligibility, and by ensuring more equitable access to hospital services. Included are:

  • Initiatives to eliminate obstacles preventing disadvantaged groups from developing healthy lifestyles
  • Programmes to advance the health of the travelling community
  • Plans to improve the health and well-being of homeless people, drug mis-users and prisoners.
  • Methods to address the health needs of asylum seekers and refugees.

Underpinning these will be a programme to improve the availability of information on entitlements, including the use of information technology.

But poverty isn´t the only thing putting some of our citizens at a health disadvantage. Disability is another.

The Strategy sets out ways to ensure fair access to services.

Up to now, parents of a child with a disability had to find their way through the services available for their child. It´s been like trying to link up islands of service. In future, that´s not going to happen. In future, there will be Key Workers in every health board for children with disabilities. That Key Worker will link the islands of service for the child and the child´s parents. An integrated approach to care planning for individuals will become a consistent feature of the system.

The Strategy also proposes programmes to support informal caregivers through the provision of basic training and better availability of short-term respite care. In addition, it has been decided to extent the remit of the Social Services Inspectorate to include residential care for people with disabilities and to develop national standards for residential care for people with disabilities.

  • Equity.
  • Access.
  • Standards.
  • People-centredness.

All four principles are evident in what we´re planning for people with disabilities. For Primary Care.

They´re evident, too, in our approach to the health of older people.

The ageing of Ireland is central to the Strategy. Older people have been worst affected by long waiting lists for procedures that could contribute to their independence and overall well-being. So they will gain as the Strategy cuts those waiting lists and shortens the time between referral and treatment.

Recent widening of Medical Card eligibility will make a big contribution to health issues affecting older people, as will changes in Primary Care, which will bring care closer to home and streamline the supports older people need. The Strategy plans the recruitment of a multi-disciplinary range of staff to support the development of primary care services of particular relevance to older people. Those developments include:

  • 7,000 additional day centre places
  • Increased funding for aids and appliances in people´s homes
  • 1,370 additional assessment and rehabilitation beds
  • Additional geriatricians in the acute geriatric medical services
  • 600 additional day places covering specialist areas like falls, osteoporosis treatment, fracture prevention, Parkinson´s Disease, stroke prevention, heart failure and continence promotion clinics.

The Strategy´s first co-ordinated Action Plan on Age will be developed by the Department of Health and Children in conjunction with the Departments of the Environment and Local Government, Social, Community and Family Affairs, and Public Enterprise.

This underlines Government commitment to make integrated care planning a consistent part of the system. Just as Key Workers will be appointed for People with Disabilities, Key Workers will be put in place to ensure ´joined-up´ services for older people. Supporting this move will be the establishment, in all health board areas, of regional advisory panels to give a voice to older healthcare consumers and their carers.

The voice of the patient – of all patients – must be listened to.

For a long time now, outpatients have been saying “There´s something wrong with a system that gives us an appointment for 9 o´clock and doesn´t see us until 12. 30.” That voice has been heard and acted upon. Outpatient clinics, from next year, must provide patients with real appointment times.

But the determination to listen to the voice of the patient goes further. Coming out of this Strategy will be a statutory Complaints procedure, so that when the system is perceived by the patient to have failed, the patient will have a clear way to have their complaint formally dealt with. Furthermore, we plan to extend the role of the Ombudsman to include voluntary hospitals and other voluntary agencies in the health area. The legal implications of this are currently being examined – but the key message I want everybody to hear is that the Health System, in the coming decade, will start with you, hear you, listen to you and respond to you.

The Strategy is about powerful, wide-ranging reform within the system. At every level. For example, in acute hospitals, it isn´t just that more beds are going in or appointment times established in outpatients or complaints procedures made statutory.

A new National Hospitals Agency will be established, to oversee the re-configuration of the hospital system. An independent Health Information and Quality Authority will be established before the end of next year to drive quality right throughout the system.

Of course, organisational reform goes way beyond the acute hospitals. An independent review of the working of the Department of Health and Children will be complete by June of next year, and a new organisational structure will follow.

I´ve been outlining – in very skeletal form – how the new Health Strategy will impact, in practical terms, on patients, customers, clients. How, in short, it will genuinely be people-centred.

It will also be people-centred in regard to its own people.

Clearly, there will be more people working in the health service. A lot more people. Based on the Bacon Report, we´re now geared to do coherent, strategic Manpower Planning. That means educating more professionals, from doctors and nurses right through to speech and language therapists and physiotherapists.

Having recruited and educated these professionals, we´ve got to provide them with a challenging and rewarding career path. That means a new kind of Human Resource management.

The old style approach to the management of people has been a problem in the health service. It´s time for a new approach, and we´re already well on the way to establishing that new approach. A partnership approach that will change the health service from being a employer to being the employer of choice.

One final point.

In preparing this Strategy, we sought as much input as possible. We heard many voices, many ideas. We built on those ideas to create a vision for the future, a way to develop a superb health service for the next decade.

And then we went a step further.

We moved from the general to the specific. From theory to action. That´s why Chapter 7 of the main health strategy document and pages 35 to 46 in the executive summary are devoted to actions. Broken into four sections, effectively outlining:

  1. Here´s what has to be done
  2. Here´s how it will be done
  3. Here´s when it will be done
  4. Here´s who´s responsible for getting it done.

This one lists 121 specific individual actions, and, wherever it´s possible, gives a deadline for delivery of that action.

It says to the Irish people, all of whom, in one way or another, are affected by the health service: this is do-able. This is deliverable. This will effect changes for the better – changes you will be able to see and measure over the coming years.

At the end of this decade, Ladies and Gentlemen, the publication of this Health Strategy will be seen as marking the point from which a good health service was developed into a great health service, the point at which a systems-based system became people-centred, the point where a Government committed to equity, accountability, fairness and people-centredness embedded these principles in the way we plan and deliver Ireland´s health services.