Speech by the Minister of Health and Children, Mr Micheál Martin TD, to the 76th Annual Rotary District Conference, City Hall, Cork
I am delighted to be here with you this morning on the occasion of this 76th Annual Rotary District Conference, and I would like to take this opportunity to thank the Conference Chairman, Mr Robin O´Sullivan for inviting me. This is a particularly important occasion for Cork as such a Rotary event has not been held here since the mid-eighties.
I am aware that Rotary International has almost a century-long history of service in the community which involves its members in a wide range of activities and projects on critical issues of our time, not just here in Ireland, but internationally – including in some of the most under-developed areas in the world. The Rotary motto “Service Above Self” says it all. The community involvement undertaken by Rotary Clubs across Ireland and around the world is an essential sign of a society where people are concerned for each others well-being.
Rotary´s involvement in projects that strive to improve the quality of life for those in the developing world is well known to me. The Polio Plus campaign has made great strides towards the total irradication of polio. With Rotary International’s help, there has been a 99% reduction in the number of polio cases worldwide and I know your efforts are ongoing with the World Health Organisation to complete this work of eliminating polio.
I welcome the fact that associations such as Rotary exist, and are thriving in Ireland. I am aware that there are presently 73 Rotary Clubs that stretch the length and breadth of this island and which strive to serve to community in a non political, non religious and open manner. Rotary works to support the community in a wide range of ways. These include supporting the most vulnerable in our society, in particular children and young people at risk; environmental issues; promoting leadership and fostering a sense of community involvement and participation, not just by members but also by others.
Community Development in the Health Sector
Interestingly, it is now being found that communities have better health outcomes where there is a greater amount of local participation in decision making and planning. Here in Ireland, all of the health boards now have some community development health programmes and I believe we in the health sector have an important role to play in contributing to community networks and supporting local communities in analysing and defining their needs and working in partnership with them to provide services which best match these needs. The integrated services process which has been operating in a number of areas, including here in Cork, is an example of the kind of co-operation between agencies which is essential if we are to seriously address the many factors in our society which affect health. The Government´s RAPID programme and the CLÁR programme for rural areas also place emphasis on community participation and integrated working.
In April of this year I announced funding of €200,000 for a pilot project to establish two Health Action Zones in Cork City. The Health Action Zone concept involves focusing on particular areas of disadvantage and tailoring a range of health services to the needs of those areas, so as to tackle health inequalities and modernise services through local innovation. These projects also enable the local communities to be involved in the design and delivery of services. The Southern Health Board is proceeding with the establishment of Community Health teams in these areas and, in partnership with the community and service providers, they will develop strategies intended to address inequalities, deliver improvements in public health and health outcomes and in the quality of treatment and care. The projects will extend beyond just health service issues to address other factors that impact on people’s health and well-being in the community.
National Health Strategy
In the past twelve months there have been a number of important developments which address the needs of vulnerable groups. As you are all most likely aware my Department published a new National Health Strategy, “Quality and Fairness: A Health System for You”, late last year to address the major issues still facing the health system. The Strategy outlines proposed developments in the health system for the next seven to ten years and sets out radical ambitions for improving our nation’s health status. It is based on four principles: Equity, People-centredness, Quality and Accountability, and includes measures to ensure fair access to services. The overall objective of the strategy is to provide a timely, safe and quality patient-centred service on the basis of need.
The Strategy is unique in the level of public consultation on which it is based. The consultation process for the strategy was carried out in conjunction with the process of developing health targets to be included in the second phase of the Government´s National Anti-Poverty Strategy (NAPS). This exercise was carried out in 2001 in consultation with the Social Partners under the auspices of a Working Group on NAPS and Health established by my Department. The key health targets are to reduce the gap in premature deaths and low birth weight between the highest and lowest socio-economic groups by 10 per cent by 2007, and to reduce differences in life expectancy between Travellers and the rest of the population. The Government has included these targets in its Review of the NAPS and we have also included them in our National Health Strategy.
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 Strategy is also unique in that it doesn´t just focus on the long-term. This Strategy contains short-term steps, medium term measures and longer-term plans. Included, for example, is a pledge to introduce 3,000 extra beds into Ireland’s healthcare system by 2011. Earlier this year I announced that 709 of these will come on stream in the areas most in need within the next year. So far, 210 of these beds have been phased in, while the remainder will come on stream in the coming 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. The ageing of Ireland is also a central issue addressed in the strategy. Older people have been worst affected by long waiting lists for procedures that could contribute to their independence and overall well being. The Strategy commits to cutting those waiting lists and shortening the time between referral and treatment.
Alongside the National Health Strategy we launched a special strategy on primary care in a document entitled Primary Care: A New Direction. More recently, the Programme for Government re-inforced the commitment in this strategy to the development of a network of primary care centres where general practitioners, public health nurses, physiotherapists, chiropodists and other health professionals will work together to improve the care available to all groups.
The consultation process for the National Health Strategy told us, early on, that while people may not use the term “primary care” services, they certainly know what they want. They want community-based, well-integrated, round-the-clock services that are easy to reach. They want themselves, their family members and their communities put right at the centre of care delivery. Primary care is the first port of call for the majority of people who use health services. It can meet 90 – 95% of all health and personal social service needs. A Task Force and budget has been put in place to forward the implementation of the Primary Care Strategy in 2002. Stakeholder involvement is being secured through a broadly based Steering Group which includes the Community and Voluntary Pillar. It is intended to have a number of initial implementation projects commenced in 2002.
As part of the wider Primary Care Strategy, the number of GP co-operatives will expand during 2002. GP co-ops will contribute a key aspect of primary care service provision on an appropriate basis both geographically (in terms of the urban/rural dimension) and time wise (in terms of night time and public holiday availability).
Health Impact Assessment
I should add that the National Health Strategy recognises that, important though it is, health service access is just one of the determinants of health status and that efforts to improve access must take place against the background of health-supporting public policies in other areas. That is why the Strategy makes a commitment to the introduction of health impact assessment as part of the public policy development process and will seek to ensure that the Statements of Strategy and business plans of all relevant Government Departments will incorporate an explicit commitment to sustaining and improving health status.
Traveller Health Strategy
In February of this year I launched “Traveller Health – a National Strategy”. In preparing this strategy my Department relied heavily on the recommendations of the National Traveller Health Advisory Committee. For many years, and for a variety of reasons, the Traveller population in Ireland has experienced a level of health, which falls far short of that enjoyed by the general population. This has implications for our strategic approach to the planning and delivery of an equitable health service in accordance with national policy. The Traveller Health Strategy sets out a clear and practical response to these inequities, with firm proposals for action in line with the policy of social inclusion enunciated in the National Health Strategy. The Strategy recognises that Travellers have a right to appropriate access to Healthcare Services, which take into account their particular needs, culture and way of life. The involvement of Travellers themselves in the delivery of health services is considered crucial in bridging the gap between the Traveller Community and access to health services. This has been achieved to some extent through the involvement of Travellers and Traveller organisations on my Department´s Traveller Health Advisory Committee and in the Health Boards´ Traveller Health Units and Primary Health Care for Travellers Projects and will be further developed through the implementation of the actions proposed in the Strategy itself.
Mental health services
There have also been important developments to improve health and quality of life for another vulnerable group – people who experience mental health problems. The Mental Health Act, 2001 was enacted in July 2001 and will significantly improve safeguards for mentally disordered persons who are involuntarily admitted for psychiatric care and treatment. The Act will bring Irish law in this area into conformity with the European Convention for the Protection of Human Rights and Fundamental Freedoms. I appointed the members of the Mental Health Commission, established under the Act, earlier this year. The Commission is an independent agency, whose primary function will be to promote and foster high standards and good practice in the delivery of mental health services and to ensure that the interests of detained persons are protected.
There is a very impressive list of recent developments in mental health services in the Cork and Kerry area, including the opening of the Acute Psychiatric Unit in the Mercy Hospital; Corrig Mor Intensive Care Unit; a Day Hospital in Ballincollig; a community residence in Millfield House, Blackpool; the Castleisland Day Care Centre; and a High Support Hostel in Listowel.
On a broader front, the Southern Health Board has adopted a new strategy in this area – “Focusing Minds – Developing Mental Health Services in Cork and Kerry”. When considering how best to deliver mental health services it is essential to place users at the centre of the activity. I understand that the Irish Advocacy Network had an input into the Steering Group established by the board to lead the review of mental health services.
The outcome of the Review proposed a new “Model” of mental health service provision, which will provide a framework for the development of services in Cork and Kerry over the next number of years. This “Model” is a community-based, person centred one. It aspires to deliver a service that responds to the needs of the individual, their family and their carers. It recognises the wider influences in mental well being and it strives to provide a high quality service which seeks to empower its users, in a way that is both dignified and respectful.
The promotion of positive mental health will contribute significantly to combating the ignorance and stigma which often surrounds mental illness and will also be effective in the area of suicide prevention especially among young people. This approach enables people to talk about their feelings and emotional problems and to seek help without fear of being labelled a failure. Better understanding of mental illness encourages people to access professional help sooner rather than later, and this facilitates early recovery. The approach adopted in the Southern Health Board strategy is very much in keeping with our thinking at national level on the most appropriate way to develop of our mental health services.
Over the last five years we 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. €8.2 billion is being spent on our health and personal social services, including the health capital programme this year.
On last years out-turn there is an increase of 17%. This is a significant increase, particularly at this time of retraction within the economy. This level of funding will allow very significant service enhancements to be commenced this year.
The implementation of the NDP in terms of developing health infrastructure is now well under way throughout the country. The resources of health boards have been augmented to ensure the successful delivery of the Plan. Capital projects include, for example, development of facilities for acute hospitals, the disabled, older persons, mental health, community health, and the enhancement of services for children requiring care and protection. The Plan is also providing for significant new investment in the important areas of refurbishment/re-equipment, and Information & Communication Technology, for all services.
Referendum on Nice
I would now like to mention briefly some of the many ways in which initiatives which we in Ireland have taken to protect and promote health have been significantly strengthened by our membership of the EU. While Ireland as a Member State of the European Union has its own policies and organisation for ensuring these objectives are met there is no doubt but that our membership of the European Union has helped greatly in achieving many of these objectives for our own citizens as well as for citizens in other Community Member States.
Among the major EU initiatives are programmes such as “Europe against Cancer” and “Europe against AIDS” which began in 1987 and 1991 respectively. Various forms of Community level action to combat drug abuse were also initiated in the late 1980´s. Other health-related EU programmes have been aimed at older people and people with disabilities e.g. EU Programme for Older People, HELIOS, TIDE etc.).
EU rules have been introduced on the advertising, labelling and distribution of medicines. This legal framework is also extended to blood products and medicinal equipment. A proposed EU Directive setting standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components will probably come into force at the end of 2002. It is vital that systems dealing with blood and blood components are of the highest possible standards to prevent the transmission of disease. Working with experts from other EU Member States Ireland has been able to contribute to the development of this Directive, which should help guarantee that there are consistent standards in place throughout the EU. The most notable development has been the establishment of a European Food Safety Authority in the context of introduction of new Community regulations designed to guarantee the safety of food from the farm to the table. Every country needs an effective food safety programme in order to protect public health and to participate in the international trade of food. In the current global economy it is not possible, or desirable, for any one country to remain isolated from the changing demands of international food safety regulation. Within Europe the European Commission has identified food safety as one of its top priorities and in the White Paper on Food Safety set out plans for a proactive new food policy. Member States are currently engaged in the development and implementation of this legislative programme . I am proud of the role Ireland has played in the development of these proposals which, I believe, will ensure the highest level of protection possible for Irish consumers and will help underpin a confident and vibrant national food industry.
EU has introduced legislation in the area of Tobacco Control, notably concerning harmonised rules for the manufacture, presentation and sale of tobacco products. These provisions are, in most instances, reflected in the recently adopted Public Health (Tobacco) Act, 2002 which I was proud to have the opportunity to introduce as Minister for Health and Children.
A Decision setting up a network on epidemiological surveillance and control of communicable diseases in the Community was adopted in 1998. The Network provided an important base for public health involvement in response to the bioterrorist threats arising from the tragic events in the USA just one year ago. EU cooperation on public health matters has shown itself to be very effective in coordination of the Community response.
Health in other EU policies
The EU´s competence in health is not confined to specific public health actions. There is a specific requirement that “a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities”. This means that proposals in other key areas of Community activity (internal market, social affairs, research and development, agriculture, trade and development policy, environment, etc.) should actively promote health protection. The new health strategy therefore includes a number of specific measures to give effect to this requirement, for example by improving co-ordination arrangements and by demonstrating how activities are taking account of the potential impact on health.
There is no doubt in my mind that our involvement with the EU has provided added value for the Irish health system which has been to the benefit of Ireland´s citizens. In the light of these and other benefits in the areas of jobs and economic growth I am urging a Yes Vote in the forthcoming Referendum.
I would like to take this opportunity to thank you once again for the very real and significant contribution that the Rotary Club makes not just here in Cork, but also throughout this island and around the world. Particularly in this time of rapid change, we must work hard to protect and enhance the spirit of community involvement and voluntary participation which characterises Rotarians around the world. I wish you very well for the remainder of this conference, and indeed in all your future endeavours.