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Speech by Minister for Health Simon Harris TD - Private Members Business: Dáil Éireann - Report of the Oireachtas Committee on the Future of Healthcare

Speech by Minister for Health Simon Harris TD

Private Members Business: Dáil Éireann
Report of the Oireachtas Committee on the Future of Healthcare


Introduction

I would like to thank Deputy Shortall for her contribution to this debate. She has once again spoken with passion and determination in pursuit of better health services for the citizens of our country. Her contribution as Chair of the Committee has been enormous and I would like to acknowledge that at the outset today.

I also want to commend all the members of the Committee for the time and effort they have dedicated to this process. There are many people, both in this House and outside it, that remain sceptical about the political make-up of the current Dáil and about what we can achieve together. The way this Committee went about its business and the near unanimity in support for its report provides a solid rebuttal to those critics. Members engaged in an open, respectful and positive approach to discussions, and understood the prize of achieving a consensus position. It behoves us all to continue in this spirit and do our utmost to act on the vision and strategic direction set out by the Committee.

Challenges and Opportunities

I won’t dwell for long on the challenges facing our health system. They have been recounted here and elsewhere with increasing frustration in recent years. We have a fractured system, an outdated model of care that is unfit for purpose, chronic access issues and growing sustainability concerns as we face into a period of significant population ageing.

These problems have been persisting for some years now and have unfortunately led to a real lack of public confidence in elements of our health service – particularly on the issue of access.

That is not to say there are not positives. Health outcomes continue to improve and services are continuously adapting to provide more effective care. People day-in and day-out are experiencing excellent care at the hands of extremely dedicated and qualified health care professionals.

Over the last year, I have had the opportunity to visit healthcare facilities across the country.

I know the difficult working conditions people face, I have seen first-hand the commitment and professionalism of staff and management that underpin our services, and most importantly, I understand the genuine hope and ambition that still exists across the system, despite the bad days, to deliver health services that we can all be proud of.

The Committee’s report demonstrates that this hope and ambition is shared in Leinster House.

Report

I have no doubt that the publication of the Sláintecare report will come to mark a critical milestone in the history of our health service and can provide us with a solid framework and guidance for health services development over the next decade. It is clear in its resolve that considerable change and transformation is required. This, I agree with. In the words of the former US President, Bill Clinton, “the price of doing the same old thing is far higher than the price of change.”

The report sets out a clear set of principles developed through political consensus. We should not overlook the importance of these eight fundamental principles. It is not possible to map out in advance all of the decisions that will be required over the next ten years. Inevitably some specific details may need to be revisited based upon experience. However, the principles set out in the report provide a basis for getting the important calls right throughout the implementation process. They also provide clarity in challenging resistance based upon vested interest.

I also believe that the ten year timeframe is a key strength of the report. We need to be realistic about the timelines required to plan and implement large scale system change in services as important as health care. It may be possible to make ad hoc changes over shorter timeframes but it is not realistic to introduce meaningful changes on a sustainable basis without proper planning, the building of support, clear accountability for implementation and the monitoring and evaluation of outcomes.

The report strongly advocates for a new model of integrated care, centred on comprehensive primary and community care services. We all know that this has to be the direction of travel. For one – our hospital system simply won’t cope with the likely levels of demand in the coming years if we continue with our current model of care. And even more importantly – health outcomes and patient experience can be much improved by developing greater services in the community and by bringing about deeper and more seamless integration across the health and social care system.

Proposals to develop capacity in both HSE primary care services and in contractor-provided services such as GP and community pharmacy, increased provision of diagnostics capacity, a greater role in the management of chronic conditions, and measures to support GP practice in rural and deprived urban areas all dovetail well with actions in the Programme for a Partnership Government and will be fundamental to supporting this shift to primary care.

A range of enablers and initiatives supporting integrated care are also given strong endorsement in the report including: the Healthy Ireland strategy, eHealth, integrated workforce planning, clinical governance, enhanced community nursing, integrated care programmes and current strategies in the areas of maternity care and mental health. The support for these initiatives can add greater impetus to their successful delivery.

I would like to pick eHealth as a particular example. Just as in all other sectors of society, the role of information technology in health cannot be overstated. We simply cannot achieve the responsive, integrated, effective system that we all desire without significant investment in information systems. We can all agree that we were coming from a particularly low base when the eHealth Strategy was first put in place. This is a prime example of a challenge that, at the time, may have seemed too daunting to even contemplate systemic change. But now we can begin to see what can be achieved when a clear strategy is put in place and an effective implementation plan and roadmap is defined.

I would also like to single out the Committee’s conclusion that our health structures are in need of change. In my own appearance before the Committee, I spoke on this issue. While I don’t for one minute believe that structural change will be the pancaea for improvement in our health services, I do firmly believe that our current structure is not best serving patients, or indeed staff within our health services.

I welcome the fundamentals set out by the Committee that should underpin structural reorganisation, including the establishment of a HSE Board, and the reconfiguration of the HSE to involve a leaner national agency retaining national level functions complemented by more devolved, responsive and integrated entities at regional level. I intend to move ahead with the establishment of a HSE Board and will publish the necessary legislation this year.

As we evolve our structures our over-riding ambition should be for policy, entitlements and standards to be set nationally but for these to be delivered locally to the greatest extent possible. We need to bring decision making closer to the point of care delivery and provide a counter-weight to unnecessary over-centralisation which impedes service responsiveness.

The report is also clear in its call for the establishment of a universal single-tier system where access to care is on the basis of need and not ability to pay. This is in accordance with the terms of reference for the Committee. To deliver on this aim, two fundamental policy changes are proposed by the Committee: (1) the introduction of universal entitlement to healthcare services underpinned in legislation and at no or a low cost, and (2) the removal of private activity from public hospitals.

These are fundamental changes. There is currently an inherent unfairness in our system when it comes to accessing care. Ability to pay does have an influence on access, and for many, accessing care comes at too high a price. This needs to be addressed.

Consideration and Implementation

The Committee’s report represents a very important step in the reform of our health services. It provides us with a vision and strategic direction that parties across this House have signed up to.

But it is only a first step. As recognised by the Committee itself – “mechanisms for implementation are as important as the report’s recommendations”. It is appropriate that we now allow time to reflect and deliberate on the findings of the Committee and consider how best the vision and spirit of the report can be realised. I understand the desire of many to move quickly on the recommendations and to demonstrate real momentum, but this needs to be balanced with the potential consequences of rushed or incomplete implementation plans. It is critical that we get this right.

As Minister, it is my duty to consider the challenges we are likely to face in delivering the scale of reform envisaged in the report. At the outset, I would like to stress that I do consider these as challenges with solutions, as opposed to immovable barriers. But they do require consideration.

The first obvious challenge, and one that is recognised throughout the report is that of current capacity. To be blunt – our starting point is not good. Since taking up the position of Minister over a year ago, I have been clear that we need more capacity, both physical and staffing. This is a problem that is being experienced right across the health system. And it is one that isn’t going to be remedied overnight.

A capacity review is underway which will report later in the year. It will give us a definitive assessment of capacity requirements across the system and will provide a platform for planning and delivering health services in the years ahead. There is also a concerted effort underway to recruit and retain staff. This is not without its challenges but the development of a more attractive working environment will go hand-in-hand with the roll-out of system improvements.

However, we must be realistic about our current capacity situation when we are considering a feasible timeframe for delivering on the report’s ambitions. It will take time to put in place infrastructure and a pipeline of trained healthcare professionals. Entitlement expansion and waiting list guarantees will be meaningless unless they are matched with increased capacity. It will be important to introduce sufficient increase in the supply of healthcare as we stimulate demand and utilisation through changes in entitlement or charging if we are to avoid exacerbating access issues for those most in need or reducing quality for everyone. We should also introduce changes in entitlement on a phased basis so that we can monitor and address the impact. We also need to be conscious of the ever evolving economic and fiscal environment and the range of demands across all public services for funding increases.

In saying all that, I don’t want to overly concentrate solutions on capacity increases. We are all agreed that additional capacity and extra funding cannot be the only answer. Fundamental changes in our model of care, as I have mentioned earlier, must be a central plank of long term reform plans. The report also points to fundamental policy changes in entitlements and in the mix of public and private activity within our hospital system and in GP practices. We are all aware of the realities in delivering reform in these areas. This process will require more than will and leadership from within the political sphere. It demands leadership and flexibility across the health service and within the health professions. Changes in contracts will not be easily achieved and this cannot be at any price.

It would be naive to consider that there will not be resistance to change in these and other areas.

Successive Governments have long advocated for a shift towards primary care. It is something upon which there has been genuine broad agreement for some time. But we must ask ourselves why it hasn’t been successfully delivered to date? And what measures can be taken to fully realise and capitalise on the potential primary care has to offer?
These will be important considerations for the implementation phase. To achieve integrated care requires much more flexible, organisational and professional practices than has been the norm to date.

The report quite rightly addresses the learning from the reorganisation of our cancer services but the reform of hospital services in cancer and other areas based upon quality and sustainability considerations has not always won support locally or in this House. I hope we can build upon the political consensus achieved in the report when it comes to addressing these and other difficult issues in health over the next decade.

Next Steps

In pointing to these challenges, I don’t intend to be defeatist – far from it. I firmly believe that the time is opportune to deliver the kind of change that we all know is needed. We now have a cross-party report which enjoys widespread political support. There is a desire evident at all levels both within the political system and across the health service to work together to deliver lasting improvements in our health services.

This desire is shared by the Government. The Taoiseach was very clear in his speech to this chamber last week that delivering real improvements in our health services is a key priority for this Government. He has tasked me with preparing a detailed response to the report including proposed measures and timelines. It is my intention to do so following this Dáil debate. I would hope to bring forward, not just proposals as to how we might gear up for implementation taking account of existing statutory responsibilities, but also some immediate decisions that we might be able to proceed to implement.

I have already had the opportunity to hear initial views from some members of the Oireachtas and from various stakeholders. I look forward to hearing contributions from across the House today. Following this, I hope to bring detailed analysis and proposals to Government.

I remain positive that we can make a real difference to the lives of individual patients and the health system as a whole and I have no doubt that the report will be an essential reference point for all Governments and parties in the fundamental reform of our health services over the next decade.