merrion street

I am delighted to be here this morning at your Annual Conference and in particular to be part of the discussion on resourcing and delivering high quality healthcare services following on from the publication of the Slaintecare Report. 

The Government is committed to developing and investing in our health services. The level of funding provided for 2017, €14.6 billion represented a 7.4% increase on the original Voted Budget for 2016, and a 3.5% increase on the 2016 outturn. This commitment will continue in the coming years. However, we must ensure that we get the best possible outcomes for the investment being made.

I want therefore to take the opportunity to set out what I see as the strategic approach that we need to adopt if we are to develop the health service that our country and our people deserve. 

Given current and projected increases in demand, with a growing and ageing population, the challenge is to ensure that the resources we provide, and the additional resources that will be required in the future, result in the delivery of high quality care for all. 

One of the first things this Government did was to establish the all-party Oireachtas Committee on the future of healthcare.  Chaired by Deputy Roisin Shortall, this group worked together for almost a year to come up with a plan for the future of the health service.  What is unique about their report – the Slaintecare Report – is that it enjoys support from across the political spectrum.  That political consensus is a great achievement, and I for one don’t intend to waste it.

Slaintecare provides us with a solid framework to move forward. What we have to do now, is to take the Slaintecare Report, and build around it a process of planning and implementation, that will start to translate the vision into concrete change, and the change into reality. This process is already underway. The Government has given its approval to move ahead with the establishment of a Sláintecare programme office.  This office will be led by a senior executive with a strong track record in implementing reform.  The recruitment process will commence very shortly.

In the meantime, work is underway in my Department to prepare a Sláintecare implementation plan.  I will report back to Government in December on the work we are doing on translating the Slaintecare report into a programme of action.

What are the core components of the Slaintecare Strategy?

At its heart is its stated objective – re-orientating the health service towards a high quality integrated system providing care on the basis of need and not ability to pay.  A universal system providing the right care in the right place at the right time, provided by the right people.

To achieve that goal, the report sets out a wide range of recommendations.  Some of them are things we are working on already.  Some will require considerable work to get under way.  I want to focus today on five of the main themes in the report.

The first core theme is the idea that the vast bulk of health services should be provided in a primary care setting.  That’s not a new idea, and we are making progress in this area.  But we have to do more, and do it more quickly.  We need to develop a new contract with General Practitioners which promotes treatment of chronic conditions in a primary care setting.  We need primary care teams to be at the heart of systems of integrated care.  And we need to develop a new model of community nursing.  

Secondly, the report gives support for a range of enablers and initiatives that will support the development of integrated care across all aspects of the health service including: the Healthy Ireland strategy, eHealth, integrated workforce planning, clinical governance, integrated care programmes and current strategies in the areas of maternity care and mental health.

I am pleased that the Slaintecare report endorses my views on the need to achieve greater alignment between hospital groups and CHOs.  Those of you who have been around the health service for a while know that different health service management structures have been put in place over the years. I don’t believe that finding the ideal structure will suddenly solve all our problems. But having the wrong structures will most certainly undermine our chances of successfully developing a coherent efficient integrated system.  

Thirdly, and I appreciate this has particular relevance for you, the Slaintecare report points to the issue of private practice in public hospitals. While the proposals on the removal of private care from public hospitals would affect the majority of consultants, the Committee acknowledges that it would take time to change the current arrangements. There are work practice and contractual issues to consider. The report calls for an impact study to be done before this recommendation is implemented.  But we can’t shy away from the core issue – that when the public system is under severe strain, when EDs are full and waiting lists grow, it is hard to defend an arrangement whereby private practice continues unquestioned in public facilities. Decoupling private from public practice is far from simple but it certainly is worth considering and I am committed to this impact study as a first step.  

Fourthly, the Committee makes some interesting proposals on the configuration of services – including more active management of activity across hospital groups.  Certainly, we have seen the work that Hospital Groups continue to do to shift

activity across the Group is leading to improvements, as recently seen in the RCSI group.  I am certainly open to the idea that we should look further at how elective-only facilities can contribute to improving throughput and the service we offer to patients. I would be very interested in your views on this.

Fifthly, the Slaintecare report supports the idea that we need to look at the whole issue of capacity across the health service. This review is underway and will report to me in the coming weeks. Unlike previous reviews, this is not looking solely at the number of beds in acute hospitals, but at health service capacity more generally. I know that the Association has made a detailed submission to the review and I would like to thank you for this.

Putting in place the right organisational structures is key to the development of high quality services. 

Hospitals are now starting to work together to support each other, providing a stronger role for smaller hospitals in delivering less complex care and ensuring that patients who require true emergency or complex planned care are managed safely in larger hospitals. 

Through reconfiguration and consolidation of services, demonstrably better outcomes can be achieved for patients, as already shown and broadly accepted by the public in the case of cancer treatment.

The establishment of Hospital Groups also offers an increased potential to address some of the staffing challenges our hospitals, in particular the current difficulties that some Model 3 Hospitals are experiencing. Hospital Groups can provide a platform for development of shared services, and to support the staffing requirements of hospitals across the Group.

As part of the overarching policy framework for the implementation of Hospital Groups, my Department will continue to develop national policy direction in relation to a number of key national and supra regional services.  One of the areas identified as a priority was the trauma services.

Considerable work has been done over the last two years by the Trauma Steering Group on the development of a Trauma Policy for Ireland. The Group reported in July and set out a series of significant and important recommendations all aimed at significantly reducing death and disability from major trauma. My Department is currently examining the report and I hope to move forward quickly on it.

The building of the new National Children’s Hospital and two OPD and urgent care centres is a key development and a priority for the Government that will facilitate the provision of high quality tertiary paediatric care. When complete the hospital will transform paediatric services in Ireland and deliver care of the highest quality to children in Ireland as part of a national integrated model of care. 

I have been clear that access to services is a key priority. Consequently, Budget 2017 allocated €20 million to the NTPF and this will be increasing to €55 million in 2018.  

The Inpatient/Daycase Action Plan is being delivered through a combination of insourcing and outsourcing initiatives utilising NTPF funding. The Inpatient/Daycase Plan has seen over 24,600 patients come off the Inpatient/Daycase Waiting List since February.

The NTPF has advised that so far this year just over 9,000 patients have been authorised for treatment, with almost 3,400 patients accepting an offer of treatment and just over 1,500 of these patients have received their procedure. 

It is important to remember that this year's waiting list initiative is not just focussed on outsourcing work to private hospitals, public hospitals have also participated in insourcing initiatives. Nearly 3,000 patients have been identified and authorised for treatment in public hospitals under insourcing initiatives, nearly 1,000 appointments have been accepted, and almost 350 patients treated to date.

Under the Outpatient Plan, since early February, in excess of 87,000 patients have come off the Outpatient Waiting List.

The September 2017 Inpatient/Daycase Waiting List figures, published yesterday, are showing the positive impact of these initiatives, with the total number of patients waiting for inpatient/daycase procedures nationally having fallen by 909. The outpatient waiting list in the same period has fallen by 1,982.

Last week, I gave approval for the HSE to put in place capacity to drive a national waiting list validation project. This funding will provide for dedicated capacity within the HSE to support systematic and regular waiting list validation and continued focus on scheduled care. In order to be able to plan patient treatment better and address our waiting lists, we need to know who is actually waiting.

I also announced funding of €700,000 for a new National Treatment Purchase Fund initiative to provide diagnostic endoscopy tests to an extra 700 patients who are waiting for scopes.  I am determined to use the NTPF and capacity in the private system to get patients off waiting lists. 

In relation to Emergency Care, firstly let me say that we continue to see an unacceptable level of overcrowding in Emergency Departments and I recognise that they are a very challenging environment to work in for all staff. 

HSE data for the end of August indicates that overall trolley numbers have actually remained relatively static this year, as compared to the same period last year. 

It is important to remember that this is in the context of ever-growing demand, with increased attendances at EDs, including by older persons.

ED attendances are up 2.6% overall this year and ED attendances by those over 75 is up 5.5%.  Despite this context, there has been a slight improvement in most of the patient experience targets.

I think it is also important to acknowledge that some hospitals have significantly improved their trolley performance. 

In addition, there is a considerable amount of elective work going on in hospitals both through the HSE’s Action Plan and NTPF’s Waiting List Initiatives. The September 2017 Inpatient/Daycase Waiting List figures, published yesterday, are showing the positive impact of these initiatives, with the total number of patients waiting nationally having fallen by 909.  The outpatient waiting list in the same period has fallen by 1,982.  

This issue continues to be a priority for the Government, and my Department continues to work with the HSE to identify measures to improve access for patients in the short to medium term, both in terms of emergency care and waiting lists.

I am very cognisant of the effort that has been made across hospitals this year to address waiting times for scheduled care, reduce trolley numbers and improve patient flow throughout the hospital. I want to acknowledge the continued leadership that consultants show in driving and enabling this work to meet the needs of patients.

Pivotal to the delivery of high quality care is the safety of the patient. Last December, I was pleased to be able to launch the National Patient Safety Office (NPSO). 

This new entity is an integral part of the Department of Health; it will drive new developments in patient safety policy and legislation; establish a patient safety surveillance system, and promote the clinical effectiveness agenda.

We are already seeing a number of new patient safety initiatives that are starting to bear fruit, with the publication of monthly Maternity Patient Safety Statements since December 2015 by all maternity hospitals and units now being followed by similar monthly reports from all hospitals. I am also pleased to note that Ireland’s first ever National Patient Experience Survey took place during the month of May, the findings of which are due to be launched at the NPSO Conference later this month. This 2 Day Event in Dublin Castle brings together and builds on the first such conference in 2016. It will promote synergy between the focus on safe care using evidence in practice to improve quality through clinical guidelines, audit and focused patient safety initiatives.

The programme of legislation is also an ambitious one. In November 2015 the Government gave its approval to the drafting of provisions to support open disclosure of patient safety incidents. These provisions have now been included in the Civil Liability (Amendment) Bill which is currently making its way through the Dáil. 

I have also recently approved The National Standards for the Conduct of Reviews of Patient Safety Incidents, which were developed jointly by HIQA and the Mental Health Commission. I also look forward to launching these standards at the NPSO Conference. 

As you are all no doubt aware, we are now in a time when healthcare associated infections and antimicrobial resistance represent significant challenges to patient safety.

The World Health Organisation’s 2015 Global Action Plan on Antimicrobial Resistance expects that countries will develop their own ‘One Health’ national action plans on antimicrobial resistance in line with its Global Plan.

On foot of this responsibility an Interdepartmental AMR Consultative Committee, chaired by the Chief Medical Officer and Chief Veterinary Officer, has overseen and guided the development of Ireland’s first National Action Plan on Antimicrobial Resistance which was approved by Government in July.   I intend, along with the Minister for Agriculture, Food and the Marine to launch the National Action Plan at the NPSO Conference.

The Conference theme this year is 'Teamworking for Patient Safety'. I will be opening the conference on Wednesday 25th October.  I hope to meet some of you in Dublin Castle. 

Unfortunately things sometimes go wrong in the delivery of health care and mistakes happen which can lead to claims for clinical negligence. I recognise that clinical indemnity is important to you. The Government is committed to addressing the rising cost of clinical claims. I am optimistic that tort reform and patient safety legislative measures currently underway should result in the reduction in the cost of clinical claims and the length of time taken to settle cases, leading to lower indemnity costs in the future. 

The Tort reform measures currently underway include specific legislation sponsored by the Department of Justice and Equality and also by my Department. These include work currently underway on the use of pre-action protocols in clinical negligence as part of the regulations to be put in place under ‘The Legal Services Regulation Act 2015’.

Finally, the Medical Practitioners (Amendment) Act 2017 will be commenced in early November.  This will make it mandatory for all medical practitioners in Ireland to provide evidence on registration or on renewal of registration with the Medical Council, of the levels of medical indemnity cover held. 

The implementation of Healthy Ireland, the National Framework for improving the health and wellbeing of our population, continues to be a priority for us and, as already noted, will be into the future. A suite of national policies and strategies have been published in recent years, and are currently being implemented. These include the Obesity Policy and Action Plan, the National Physical Activity Plan, Tobacco Free Ireland and the National Sexual Health Strategy. 

Healthy Ireland clearly identifies the need for ‘whole of government’ and ‘whole of society’ support as critical success factors in its implementation. 

However, health professionals, such as yourselves, have a vital leadership role in terms of effecting sustainable improvements in health and wellbeing for everyone living in Ireland.   

Earlier this year, the new Brief Intervention Model, “Making Every Contact Count”, was published by the HSE. This approach recognises that, with 30 million contacts made by the population with health services annually, there is an opportunity to effect behaviour change where necessary. Implementing “Making Every Contact Count” in all parts of our health services will be a significant step towards achieving that fundamental shift to prevention, health promotion and patient empowerment which is required to achieve a healthier Ireland.

Staff health and wellbeing has been identified as a key priority in the implementation of Healthy Ireland in the health services. As Doctors, you have a key role in promoting health and wellbeing, however, looking after your own health is also critical for the quality of service you provide and for your own work life balance. 

Therefore, following extensive consultation and collaboration with key stakeholders in the medical profession, the HSE Workplace Health and Wellbeing Unit are currently finalising a Strategy for Doctors’ Health and Wellbeing.  The Strategy, which will span the duration of a doctor’s career, from student entry level through to retirement, will be launched in Q1 of 2018.

Retention of young doctors is pivotal for the future. We train a sufficient number of doctors to staff the health service we require. We must ensure that we can retain them and that if they do go abroad that they will see their long term futures here.

I appreciate that many of the push factors that cause some Irish trained doctors to emigrate are issues which you cannot control. But there are issue where you can have significant control, and I wish to mention two of them today. I know from my engagement with doctors in training that the provision of protected training time is a key issue for them. I would ask that you focus on ensuring that ringfenced arrangements are agreed for the provision of protected time for trainees. I know that service demands will always have to be met, however it should be possible to both.

I understand that the Forum of Irish Postgraduate Medical Training Bodies and other key stakeholders are exploring options of expanding the availability of mentoring in medicine, in order to better meet the needs of trainees. I encourage you all to support these initiatives, to become a mentor and share the wisdom and experience that you have accumulated over the years. Our health system will benefit, and I truly believe you will find it a worthwhile activity.  

Finally, getting back to the theme of this morning’s session.

I do believe we are at a historic juncture for Irish healthcare. The Oireachtas has developed a consensus view of how we reform healthcare over a ten period – to deliver the service we all want and our people deserve.  But at this point it is only a vision. The Government must now play its part and I am committed to harnessing this opportunity. But everyone in this room today, and across all aspects of the healthcare workforce, has a vital room to play in ensuring that it isn’t a historic missed opportunity.

Few areas of our national life are as complex as health, and complex problems are not solved by simplistic solutions.  What we need instead is an approach which recognises the healthcare system is made up of many parts, each with its role to play.  

The challenge in the next few months is not to see who can shout loudest, but how collectively we can come together around a vision of a better future in which all of us have a role to play.

If we are to reform our health services, we must bring people together to share and learn, to drive innovation and to deliver the best care for patients and their families. I am hopeful and confident that the work of everyone in this room today will contribute to helping us deliver on this goal.