The Chinese are reputed to have a curse which goes “May you live in interesting times.”
And we do.
Very interesting economic times – that have a knock-on effect on every aspect of Irish life at the moment.
But those interesting times are not going to stop this Government from introducing a better and more efficient health system.
A single-tier health service.
Equal access to care based on need and not income.
And there’s a precedent. Our next door neighbours were standing in the rubble of the Blitz when they started to set up the National Health Service, and for all its faults, that’s one hell of a system. Signs on it – slap bang in the middle of the opening sequence of the London Olympics was the NHS. Because Britain is proud of how it handles healthcare.
That’s the way it should be in Ireland.
Correction.
That’s the way it will be in Ireland. We’re already on the way.
Legislation to reform the governance of the HSE is currently making its way through the Oireachtas. The new structures will focus on the delivery of key services and greater transparency around funding, service delivery and accountability.
Heading up those structures will be national directors, one of whom will have responsibility for Primary Care. The director of Primary Care will be tasked with establishing clearer service delivery structures and funding arrangements.
That’s the official version. What I want the director of Primary Care to do is to reposition the whole area within the health service. To hammer home, by action, that primary care is an essential component of the health reform process. A developed primary care system can meet up to 95 per cent of people’s day-to-day health and social care needs.
To date, the Primary Care Strategy ‘A New Direction’ has been the blueprint for the development of primary care services in Ireland and a key aim of that strategy is the development of Primary Care Teams.
The development of these Teams has taken too long.
Why? Well, let me quote a Tory prime minister, who said that all plans get disrupted by “Circumstances, dear boy, circumstances.”
But those circumstances have been changed and we’re fully committed to the further development of Primary Care Teams and Centres. For the very good reason that they are key to the effective provision of primary care services. Primary Care Teams will give people direct access to integrated multi-disciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists and others.
The health service is committed to having 485 operational teams in place by the end of this year. At the end of September, 417 Primary Care Teams were in operation across the country, providing services for over 3.8 million of the population, with over 2,850 staff and 1,636 GP’s working on these Teams.
Those teams will work in shared premises. International research shows that shared premises encourage and facilitate interaction across all health care professionals. That’s why we’re committed to developing a network of new Primary Care Centres.
The Primary Care Centre here in Mallow is the perfect example of what can be achieved. Perfect example of what can happen when vision meets determination.
Enhancing and expanding our capacity in the primary care sector is critical if we are to deliver a proactive, joined-up approach to the management of our nation’s health. This is particularly important in light of the very significant challenge posed to the health services in the 21st Century by the increase in the incidence of chronic disease.
Primary Care Teams allow structured approaches to chronic disease management, enhanced multidisciplinary team working, improved diagnostic capabilities in Primary Care and the integration of services between primary and secondary care.
The HSE is developing chronic disease programmes which are particularly relevant to primary care: Diabetes; Stroke; Heart Failure; Asthma; and COPD.
The Diabetes programme is due to commence in the coming months. The model of care for the Integrated Care Diabetes Package prescribes that:
1. Uncomplicated Type 2 Diabetes patients will be managed in Primary Care only.
2. Patients with complicated Type 2 Diabetes, as defined by the National Model of Diabetes Care, will be managed by both primary and secondary care.
3. All patients with Type 1 Diabetes, genetic causes of Diabetes (MODY Diabetes), secondary causes of Diabetes, post-transplant Diabetes and pregnancy and Diabetes, will be managed in secondary care only.
A National Steering Committee has been set up to oversee implementation of the Diabetes programme and it is working through a number of key issues, including
Progression of ICT Development; and Identification of Drug Savings.
The Department has also given approval to the HSE for the recruitment of 17 Integrated Care Diabetes Nurse Specialists to support the phased roll out of the Diabetes Programme. Interviews are being held for these posts next week.
One of the few aspects of the public health system where there’s a consensus is on the fact that public expenditure on drugs is way too high.
The cost of drugs provided to patients under the GMS and other community drugs schemes has increased significantly over the past decade in Ireland.
Year on year, our increase in spending on medicines is amongt the highest in Europe.
In 1998 we spent just under €400 million. By 2009, expenditure had increased to just over €2 billion.
That had to be tackled. And it has been. Expenditure reduced in 2010 and 2011.
Of course, a number of factors drive increases in expenditure on drugs.
The number of items prescribed has increased in the past decade from approximately 30 million items to approximately 70 million items in 2010.
GPs are prescribing newer, more expensive products; and, greater numbers of people are eligible for medical cards.
My Department and the HSE have started to control expenditure through on-going off-patent price cuts agreed with pharmaceutical manufacturers. The pricing mechanism for new products has been changed. And we now have a review mechanism that takes account of price reductions in other countries.
On Monday 15th October, I announced a major new deal on the cost of drugs in the State, following negotiations with the Irish Pharmaceutical Healthcare Association (IPHA).
The new deal, with a value in excess of €400 million over the next three years, will mean:
Significant reductions for patients in the cost of drugs;
A lowering of the drug bill for the State;
Greater access to new cutting-edge drugs for certain conditions; and
An easing of financial pressures on the health services into the future.
This new IPHA deal represents an important step in reducing the cost base of the health system. This is vital, given the scale of the financial challenges facing the health system over the next few years.
It provides for significant reduction to the State in the cost of drugs provided through the community drug schemes and the hospital sector, while also securing the provision of new and innovative drugs for the duration of the agreement in an exceptionally difficult economic climate.
This is a very important deal for both the State and the patient.
We’ve also met with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic drugs industry, and secured similar reductions in the price of drugs supplied by APMI member companies.
These price reductions mean that GPs can help us get through this difficult financial climate by prescribing generically, where appropriate, and by ensuring that the international non-proprietary name (INN) is written on prescriptions.
In addition, the Health (Pricing and Supply of Medical Goods) Bill 2012, currently before the Oireachtas, provides for the introduction of a system of generic substitution and reference pricing. It aims to promote price competition among suppliers and ensure savings for taxpayers and patients. It should lead to an increase in the rate of generic prescribing, thus generating further savings in drugs expenditure down the line.
The Programme for Government provides for the introduction of a new GMS contract with GPs, with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. It is envisaged that the new contract will focus on prevention and will require GPs to provide care as part of integrated multidisciplinary Primary Care Teams.
An adequate supply of GPs is crucial to the success of the Government’s health reform programme. Ongoing collaboration between the Irish College of General Practitioners and the HSE has ensured the continued availability of 157 general practice
postgraduate training places per annum.
The enactment of the Health (Provision of General Practitioner Services) Act 2012 (in operation since 12th March) has also been a positive measure in this regard. The Act provides for the elimination of restrictions on GPs wishing to obtain contracts to treat public patients under the GMS Scheme by opening up access to all fully qualified and vocationally trained GPs. By the 31st October, 91 GPs have obtained a GMS contract under the legislation.
One of the key commitments in the Programme for Government and a fundamental element of the health reform process involves significant strengthening of primary care services to deliver universal primary care with removal of costs as a barrier to access for patients.
Access to primary care without fees will be extended on a phased basis over the life of the Government. The introduction of free GP care will allow us to move away from the old hospital-centric model where healthcare was episodic, reactive and fragmented, and to deliver a more proactive, joined-up approach to the management of our nation’s health.
What we must do is treat patients at the lowest level of complexity and provide quality services at the least possible cost.
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The journey of reform is all about improving the patient journey.
Health needs change and evolve. Our health system must change and evolve to match those needs.
We’re now on the way to becoming the modern health service a modern society needs. We’re reforming the system for the benefit of the patients it serves.
I’ve outlined some of the significant reforms this Government has begun to implement and the progress we have made so far. Further debate and discussions like today are useful in advancing the health reform agenda.
That’s why I was delighted to be invited to join you. I hope you have a great day examining the challenges we face in Primary Care and come up with some brilliant ideas to help push forward the reforms that will improve the health of the nation.