Speech Minister Varadkar at LABCON Ireland Conference
Check against delivery
Speech by Leo Varadkar TD, Minister for Health
I’m delighted to have this opportunity to speak at LABCON Ireland 2015 which has been organised by the Academy of Clinical Science and Laboratory Medicine in partnership with the Medical Laboratory Scientists Association. I want to give particular thanks to Irene Regan, President of the ACSLM and Bronagh O’Leary, Chair of the MLSA for inviting me to the event.
I want to divide my remarks into two parts:
Some general thoughts on medicine and the health service
And some specific words on medical scientists and the important role you play in our health service and society.
Our health service, as you know, has been through a very difficult period. We had three years of spending cuts under the last Government and a three year spending freeze under this one. That occurred against a backdrop of rising demand from a growing and ageing population and the development of expensive new treatments and interventions.
While we have secured the first Budget increase in seven years, we are still operating with about 12,000 fewer staff and a budget that is still more than €1 billion lower than it was at peak. That is, of course, reflected in things like excessive waiting times and ED overcrowding.
Needless to say, this makes it a real challenge to deliver the kind of health service we aspire to and that’s true from the frontline and back office, to Dr Steevens and Hawkins House. It’s a challenge that I welcome and I’m determined to meet it head-on.
Because of the enormous sacrifices that the Irish people have made and the decisions by government, all of which were tough on people, the country is now back on track. The economy is recovering and we can see it all around us:
- 90,000 more people back at work.
- Unemployment at a six year low.
- More cars and trucks on the road.
- Those reductions in USC and income tax in our pay slips in January.
The challenge now is to protect that recovery from those who would wreck it. We must sustain the recovery, make it real for more people, and ensure that all parts of the country benefit. That means more money in people’s pockets through further reductions in USC and income tax so long as the economy keeps growing, more investment in infrastructure including hospitals and primary care centres, and repairing our public services like health and education and children’s services.
If the first phase of the recovery was about repairing our economy, the second should be about restoring our society. That is our ambition and our vision.
I can, of course, understand why people sometimes feel overwhelmed by the scale of the challenge facing our health service. While there is much still to address, we should allow some space to recognise some of the real improvements that have occurred in recent years. Having returned to Health after a period away, I was pleasantly surprised by some of the positive developments. It’s worth highlighting them briefly.
Compared with four years ago and in spite of the financial crisis, we have more consultants and more NCHDs employed in our Public Health Service than ever before, along with more GPs with GMS contracts. If it has been possible to do that during a period of retrenchment, surely it is possible to do better again during a period of growth?
The number of consultants in many specialties remain much lower than international norms and we now need a new workforce plan to address that over the next decade, allowing people to prepare for jobs becoming available.
Compared to four years ago, we have a much better ambulance service. Rather than a mere transport service, paramedics now deliver care on the scene and in transit. We have a new National Control Centre in Tallaght with only one region left to transfer to it, and we now have an air ambulance.
We need to build on this by filling in capacity gaps where they remain and developing more bypass protocols to ensure patients are taken to the right place, whether it’s a minor injury unit or specialist trauma centre. The best care, as we know, isn’t always provided at the nearest Emergency Department.
We have the National Clinical Programmes making real improvements to pathways of care in areas like stroke, heart attack and COPD to name just three.
We have a major expansion in prevention and screening including the extension of Breastcheck to women aged 65-69, Bowelscreen, and screening for Cystic Fibrosis and deafness at birth, and diabetic retinopathy in later life.
We have improving cancer survival rates and rising life expectancy, more nurse prescribing, falling medicine prices, falling MRSA infection rates and a new primary care centre opening almost every month.
In public health and wellbeing, we have increased vaccine take-up rates, we are meeting our targets for childhood developmental checks, tobacco is no longer on display in our stores and sunbed use is regulated.
We have HIQA setting, raising and monitoring standards in hospitals, nursing homes and now care homes.
All of us have been shocked at the content of some of HIQA’s reports, particularly when it comes to hygiene in hospitals, quality of care in some hospitals, and the treatment of elderly residents and those with intellectual disabilities in some care homes. But truth be told, these problems cannot be new, they must have been going on for decades. The difference now is that they are made public and we can deal with them and deal with them we shall.
We should also recall that health is not just an expense, not a drain on the Exchequer but rather a huge provider of jobs and revenue for the economy. The HSE is the country’s biggest single employer. Over 100,000 people work in the Public Health Service and as many again in private healthcare, the pharmaceutical industry and medical devices. Let’s keep on making that point.
I am not, for a second, trying to make out that everything is rosy in the garden. It’s not. I know that.
But I am trying to point out that a lot of good things are happening in health that we should be proud of and a lot people are making them happen, many of them doctors, who deserve to be recognised. Let’s do that a bit more often.
I think the same applies to resources. Our health service is under-resourced without doubt. The evidence is there: the ratio of doctors to population, the ratio of acute hospital beds per person, the number of specialists, the amount of money we put into primary care. But the resources we do have aren’t deployed as efficiently as they ought to be. Co-operation in changing that is not always as forthcoming as it might be.
Hospital beds are not used as efficiently as they should and average length of stay, day of surgery admission and day case rates vary inexplicably from place to place. According to the OECD, which has no axe to grind, Irish doctors see fewer patients on average than their peers. There might be good reasons for all of this but it is still not as it should be and we need to change it.
Now that we are in a time of rising budgets again, I believe that it should be a basic principle that no additional resources should be provided to any service that cannot demonstrate that it is using its existing resources to maximum effect, whether that’s staff, beds or cash. The taxpayer deserves no less.
I also think the time has come for a ‘zero-budgeting’ exercise in health. Rather than starting with a base, adding on for inflation and then working out how much extra resource we need to do more, we should start with zero and work out how much we really need and what our priorities really are.
At the start of the year, Minister Lynch and I set out our work programme for 2015. It contained 25 actions. The good news is that I am not going to go through them one by one but I do want to outline the five major themes.
First and foremost always is Healthy Ireland. We need to improve our health as individuals and as a nation. This is the best way to ensure we live long and healthy lives and the most effective way to keep health costs under control in the long term.
The Healthy Ireland survey is well underway. It is the first measure of Ireland’s health since 2007 and will be repeated annually to monitor progress. Minister Reilly’s legislation on plain-packaging on tobacco is now through the Oireachtas and subject to court challenge, will be implemented next year. All things going to plan, I will bring the Public Health Alcohol Bill through the Dáil and Seanad before Christmas and it will come into force over the course of 2016. It is the first public health legislation on alcohol in Ireland and among the most far-reaching in Europe. It includes minimum unit pricing to eliminate cheap alcohol, structural separation in shops to reduce availability and visibility, health warnings and calorie labelling and the regulation of advertising, sponsorship and marketing.
We will also update our policies and strategies on obesity, sexual health and physical activity including new legislation on calorie posting.
The second theme is patient outcomes and patient safety. As you know, I have taken a personal interest in Emergency Department overcrowding and the Government has recently allocated more money to reduce delayed discharges by lifting the funding cap on the Fair Deal and funding 200 more convalescent and rehabilitation beds in community and district hospitals.
I do not think it this alone will solve the problem of overcrowding for a second. Money is only part of the solution. The really hard part is the rest – changing systems, pathways and practices. This will require some investment but it’s about a lot more than money. The Emergency Department Taskforce Report needs to be fully implemented and I am going to drive that personally. We will always have surges in demand, and all health services have patients on trolleys from time to time but trolley waits of 9, 12 and 24 hours represent a real patient safety risk and we all need to work together to alleviate it as a phenomenon in our hospitals. I understand the distress and hardship that it is causing to patients and their families.
Treatment delayed can be treatment denied and I share concerns about worsening waiting times for appointments, investigations and procedures. I have mandated the HSE to ensure than nobody is waiting more than 18 months for any of these by July and no more than 15 months by the end of the year. I know that may not seem very ambitious but within current resources, it is realistic and achievable in all but a small number of sub-specialties. I will continue to try to do better but any future waiting list initiatives need to be well designed and sustained. Some of the examples we have from the past are not to be followed and my strong preference is that we make maximum use of under-used capacity in our public hospitals, where it exists, and then turn to the private sector.
On patient safety, we will continue to develop and monitor the implementation on the National Clinical Effectiveness Guidelines and develop a better approach to the implementation of HIQA recommendations. In the Health Information Bill, we will legislate to protect open disclosure. Saying sorry is not an admission of liability. Open disclosure is health sector policy and I encourage all health service staff to observe it always.
The third theme is Universal Health. This summer will see the first phase implemented by extending GP care without fees to youngest and oldest in our society, those under 6 and over 70.
300,000 senior citizens and children, who currently have to pay their GP, will no longer have to. This will come as a relief to many young families and pensioners. These are parents and older people who work hard and have paid their taxes.
Education for children and free travel for senior citizens is not means-tested and healthcare should not be either. Means-tests and sickness test might appear fair on paper. In reality, they create many injustices and anomalies. There are always people just above the financial threshold no matter where you set it and there are always people who won’t satisfy the sickness test who are told to come back and apply again when you are sicker to submit more reports, more documents, bills and payslips. Let’s start putting a stop to all of that at least for children and senior citizens.
On Universal Health Insurance, I firmly believe that we need to make health insurance more affordable before we can make it universal. So, in the past few months, the Government, working with the insurers, has taken a number of actions to do that. These have included a reduction in stamp duty, the HIA levy, no further diminution of tax relief, discounts for young adults and this month, life-time community rating. It is already producing results. Some premiums have been reduced, others frozen and new affordable products are on offer. The number of people with insurance is rising again. I hope we can introduce further measures on affordability later in the year and my officials are already working on proposals in this space.
The work of the ESRI and HIA which is nearing conclusion, will allow us to develop a new road map to UHI, but it is clear that there is a lot of work still to be done such as the need for new financial systems in our hospitals and embedding activity-based funding. It’s not something to be rushed. If we have learned anything from the mistakes of the past it is that all health reforms should be thought through and change-managed and project-managed properly.
The fourth theme is reform. This includes greater investment in IT, which saw a 30% increase in budget this year to €55 million. Key projects include e-referral, putting waiting lists on-line and the issuing of the first individual health identifiers later this year. I am really enthusiastic about IHARP, the Irish hospital redesign programme being piloted in Tallaght. If it produces results, we will extend it to four or five more hospitals in the next phase.
I am also very much behind the Hospital Groups. The CEOs and their senior teams are now in place, the remaining boards will be in place by summer. Hospital Groups will be given legal status within the HSE this year and I will also publish legislation to establish the first hospital trust on a statutory basis – the Children’s Hospital Trust – before the end of the year.
The fifth theme is investment in modern infrastructure and facilities. The most important of these is the new Children’s Hospital. The planning application will be lodged this summer and subject to An Bord Pleanala we could have planning permission by Christmas or in the early New Year. That means construction commencing next year, the children’s walk-in Emergency Departments and satellite centres in Blanchardstown and Tallaght opening in 2017, and the main hospital opening in 2019.
The design is amazing. The Starship hospital in New Zealand and Alder Hey Children’s Hospital in Liverpool don’t come close. It’s the biggest single health infrastructure project ever in the history of the State and is very exciting.
I am hugely enthusiastic about the Government’s plans to commemorate the events of 1916 but I can think of no better way to mark the centenary of the Easter Rising than to begin construction of the new hospital on one of the sites of the rebellion, the South Dublin Union, in 2016 recalling the proclamation’s promise to ‘cherish all of the children’ of our nation equally. Bear in mind, the children who attend there from 2019 onwards will probably be alive to see the hundredth anniversary of the new hospital and the two hundredth anniversary of the rising. It is that sort of project. Temple Street and Crumlin do a fantastic job but they have outgrown their existing premises. We can afford no more delays.
Separately, the planning application for Holles St to move to St Vincent’s will also be lodged this year, we hope planning permission will be secured for the new Forensic Mental Health Campus in Portrane and the National Radiation Oncology project will continue to progress for St James and Beaumont. Needless to say, I could mention many other projects but these are the main ones.
As you know, this is conference season and the issue of pay restoration looms large at all of them.
Minister for Public Expenditure Brendan Howlin has announced plans to invite the public service unions to discussions on unwinding the FEMPI legislation, which reduced public sector pay. We promised to re-open talks after the Haddington Road Agreement. I understand those talks are likely to start in May.
The public sector, and especially medical staff, have played a pivotal role in the recovery. The talks will certainly be challenging. But the Government acknowledges the enormous contribution that the public sector has made, with FEMPI measures generating €2.2bn worth of savings.
Nevertheless, we are still borrowing to cover day to day expenditure. So any request for a reversal of pay cuts must be viewed from a cross-Government perspective. For example, in Health this year we have allocated €30 million to pay for new oral medicines which cure Hepatitis. We are expanding Acute Medical Assessment Units, providing funding for bilateral cochlear implants, and hiring more physiotherapists and occupational therapists in the community. That’s money that in years gone by might have gone into pay increases rather than services.
We cannot afford to repeat past mistakes. But regular pay rises are part of a normal economy. That’s why the Government wants to formulate a sustainable policy on public sector pay, which can play its part on the economic recovery over the next few years.
And that’s why we need to draft an agreement that delivers for health sector staff, for patients, and for employers, as well as for the expanding economy. Last year’s Budget took the first steps, by removing more low paid workers from the USC net and other tax reductions.
As a member of the Cabinet, I would find it very hard to support a pay deal that comes at the expense of public services.
There should never be a conflict between what is good for staff and what is good for patients and taxpayers but if such a conflict arises it is my duty to be on the side of taxpayers and patients and that is a judgment call I am ready to make.
I do think that any new pay round should take account of market conditions. While we struggle to get applicants for some posts there are hundreds of applicants for others. This is even true within the health service. We operate in an international English-speaking labour market and we need to take account of that. I also know that parity between new entrants and pre-crisis employees will also be an issue in the talks.
Health and Social Care Professionals
The potential of all Health and Social Care Professionals to contribute to efficient and effective service delivery is widely recognised and they have a central role in the achievement of the key aims of the Future Health Programme such as improving health and wellbeing and providing faster and fairer access to hospital care. HSCPs are also vital to the effective development of clinical care programmes, which bring together different clinical disciplines to share innovative solutions and deliver greater benefits to patients.
Medical laboratory testing is a significant aid to the treatment of disease. Between 60 and 70 per cent of all decisions regarding a patient’s diagnosis and treatment are based on laboratory test results, with lab tests helping to determine the presence of disease and monitor the effectiveness of any treatment.
So the role of skilled medical scientists is vital to any health service and to the delivery of effective healthcare services.
While physical examination of patients will always be necessary, doctors rely on laboratory test results to make informed patient diagnoses. Laboratory tests help to confirm diagnoses arrived at following an examination of physical signs and symptoms.
I know that one of the areas you will be looking at in your conference today relates to the extension of the scope of practice of medical scientists. The ACSLM has strongly argued that the advancement of highly qualified medical scientists to higher levels of practice, increasing their knowledge and expertise, will improve patient outcomes.
Obviously, this change in skill mix will bring benefits to taxpayers, but the ultimate goal is improved access to appropriate healthcare, delivered by the healthcare professionals most suited to deliver it. I believe that there are major advantages in unlocking the potential of well qualified professionals within the health service.
A 2009 report which proposed new systems of service delivery for laboratory medicine has led to a Laboratory Modernisation Programme within the HSE. I understand that interviews were held in the past month for the post of national project implementation manager for the laboratory modernisation programme.
In addition, the HSE’s Clinical Strategy and Programme Directorate has established a National Clinical Programme in Pathology. The objective is to implement a National Pathology Network and a Programme for Laboratory Modernisation, developing a national pathology network and a national network of specialised laboratory services.
The health reforms outlined in the Future Health Framework include a greater focus on “integrated care” where services are well co-ordinated around the needs of the patient. Future Health explains that integrated care means looking at processes and outcomes of care rather than at structural and organisation issues. The emphasis is on patients and families and the services they need. Medical scientists have scientific expertise which can be used on every step of the patient journey from primary to tertiary care and beyond.
My Department plays a central role in planning the shape and structure of our health workforce. As we address current issues relating to the recruitment and retention of health professionals, we must also recognise that the projected global shortage of health workers is an emerging challenge for health systems around the world. Indeed, the WHO predicts a global deficit of 1.29 million skilled health professionals by 2035.
In this context, in 2015, my Department will begin work to develop a national integrated strategic framework for Health Workforce Planning, bringing together key sectors with responsibility for Ireland’s health workforce, including health and education. While not wanting to prejudge the outcomes of this work, the expansion of the role of medical scientists in order to facilitate greater focus on patients by other healthcare professionals is something that will obviously come under consideration.
Another issue, which I know is close to the hearts of your profession, is the registration of medical scientists with CORU. The profession of medical scientist is one of the 14 professions designated under the Health and Social Care Professionals Act 2005. Registration Boards for nine of the professions have so far been established. The Medical Scientists Registration Board is due to be established next year.
The Registration Board will come under the umbrella of CORU, which is responsible for protecting the public by promoting high standards of professional conduct and professional education, training and competence amongst the professions designated under the Act. Only registrants can use the protected title of the profession and must comply with the profession’s code of professional conduct and ethics.
I am honoured that tonight I will be presenting the medal to the winner of the President’s Prize Competition. I understand that this medal is awarded annually to the best final year BSc research thesis from across three colleges. Some of the briefing that was supplied to me by the ACSLM in advance of this conference referred to a mantra of life-long learning. I think there is great value in this concept, as it enhances our ability to carry out our roles, but also reaffirms our commitment to our jobs. So I congratulate the winner on their achievement and encourage you to continue with your studies and enhance your skills throughout your career.
I want to conclude by wishing you well with your conference today and thanking the organisers again for the invitation to speak. I hope you derive great benefit from the day.