Ladies and Gentlemen
I want to start by thanking the organisers for the invitation to speak at this event this afternoon.
The purpose of this two-day learning event is to bring senior managers and leaders in the Irish health service, and wider business, together to facilitate shared learning. So, it is very fitting for me to attend today in my first week as Minister for Health, to avail myself of this opportunity to hear first-hand about the complexities and challenges of healthcare delivery.
If perhaps you’re a little surprised to see me here, then you’re not alone – I’m a bit surprised myself!
When I woke up last Friday morning, I never expected to find myself being appointed as Minister for Health. Clearly, I wasn’t alone in that regard. By Saturday morning, I had been inundated with a deluge of messages – some congratulatory, some rueful – some in a quite different vein. And quite a few that mentioned a certain Southern African country that shall remain nameless…
So, yes I was surprised, but I was also delighted. And honoured. And, keen to take on the challenge.
Yes, of course, we all know that health has its political challenges. But it’s a thoroughly worthwhile challenge. It’s hard to think of a Ministry which has a more direct impact on the lives of our fellow citizens. Everyone, no matter their means, at some point in their life interacts with the health service and so a well-functioning health service is ultimately a matter of importance for everyone.
So, there are challenges, but also great opportunities to make a positive impact.
And while I don’t underestimate the political challenge, neither do I underestimate the challenge that faces everyone else who works in the health service.
But before we start focusing on the difficulties, let’s stop for a moment to acknowledge some successes – your successes.
Because, yes, we all know that the health service has problems, and that these have been made more difficulty as the country clawed its way back to solvency. The health service has been through a very difficult period. But there are also lots of things in our health service that are going well or are even getting better.
One thing that strikes me, as someone coming to the sector having watched closely from within Government in recent years, is that it has become normal to only portray the service in negative terms. If we don’t acknowledge our successes when we do have them, then we won’t know recognise progress when we see it.
So, let’s look at some of the things that have been achieved. Things which are factually true.
• Since 2004, life expectancy in Ireland has increased by two and a half years and is above the EU average.
• Between 2005 and 2014 mortality rates for all circulatory system diseases fell by 31.5%, for cancer by 7.9% and for respiratory system diseases by 20%
• Between 2004 and 2013, there has been a 40% reduction in the in-hospital mortality rate following admission with a heart attack.
• Between 2000 and 2013, the average length of stay in Irish hospitals has decreased by 19%
• Huge progress has been made in reducing tobacco consumption, with Ireland currently ranked currently ranked 2nd out of 34 European Countries in relation to tobacco control initiatives.Tobacco control measures introduced in Ireland over the last 15 years include: the work-place smoking ban, a ban on the point of sale display and advertising of tobacco products and a ban on smoking in cars where children are present. Since 1999
o the percentage of adults smoking has fallen from 33% to 23%,
o the percentage of children (aged between 10 and 17 years) smoking has fallen from 21% to 8%
• The first two phases of universal GP care were introduced in July and August 2015. These two phases cover all children under 6 and all persons over 70 years. Approximately 800,000 children and older people are now automatically covered for GP care without fees, and without the need for a means-test. The service for under-6s includes health checks and also a new cycle of asthma care, for which 20,000 children have been signed up. In addition, over 62,000 adults with type 2 diabetes have been registered by their GPs for a new programme which facilitates enhanced management of the illness through primary care.
• In 2015, some 23,000 people were supported under the Nursing Homes Support Scheme (Fair Deal). Funding of approximately €126m in 2016 will provide home care packages for more than 15,000 people who need medium to high care support at any one time.
• As part of a new way of approaching mental health, a total of 19 older psychiatric hospitals have either been completely closed or have closed to new admissions.
• Healthy Ireland, the Framework for Improved Health and Wellbeing 2013 – 2025, the national framework for action to improve the health and wellbeing of the country was launched on 28 March 2013. Healthy Ireland takes a ‘whole of government’ and ‘whole of society’ approach to tackling the major lifestyle issues which lead to negative health outcomes (smoking, alcohol, poor diet, physical inactivity, obesity) as well seeking to address the wider social and environmental factors that impact on health and wellbeing (e.g. housing, education, transport, physical environment).
• An Bord Pleanála has recently granted planning permission for a new national children’s hospital at the St James’s Hospital campus in Dublin, which represents the culmination of a long period of hard work and commitment and is a massive milestone for Irish children, young people and families.
Let me say again, I’m not trying to say that all is well. It isn't. But what I am saying is that we should recognise achievement – your achievements - when we see them, so that we can build on them.
Of course, we still need to do more and, and working with the Oireachtas, my job now will be to plan ahead for the needs of our conscious of the fact that we have an ageing population who are living longer, whose needs will be become greater and more diverse, and that we also have the highest birth rate in Europe.
I know I am preaching to the converted when I say prevention is the paramount factor in preventing and reducing incidences of secondary care - the need for proactive care, rather than just reactive care. Facilitating lifestyle change and early detection and treatment is critical. We’ve made great progress on smoking and now we need a similar focus on alcohol misuse, obesity and physical inactivity. This Government has a number of public health interventions and strategies that it is committed to delivering on, in the interest of our nation’s health, including:
• Enacting the Public Health (Alcohol) Bill
• Making Ireland Tobacco free by 2025 (less than 5% of the population smoking)
• Implementing a national physical activity plan, a national obesity plan and a sexual health strategy
• Putting in place a programme to improve the quality of food in our hospitals
As a country, we took tough decisions in the past few years. Tough decisions still have to be made – in terms of managing resources, addressing performance and ensuring accountability – but the difference now is that those decisions can yield real benefits that we can use to improve our health services.
Efforts to increase access to safe, timely care, as close to patients’ homes as possible will be a priority for the new Partnership Government. Too many patients across Ireland are still spending far too long in our Emergency Departments, waiting to be seen, to be admitted, or to be sent home. This causes difficulties and distress for patients and families and makes working conditions more difficult for staff. That is why dealing with this problem is a key objective for the Government.
It is my intention as Minister to reduce numbers coming into hospital by developing primary care services and integrating primary and secondary care services, to expand hospital capacity, to support timely patient discharge from hospitals and to address hospital responsiveness to increased demand. Resources will be set aside each year to reduce waiting lists with the funding targeted, in particular, at those most urgent cases and those who have been waiting longest.
I am keen to implement a decisive shift of the health service to primary care, with the delivery of primary care in every community. It will be necessary to build GP capacity, to respond to patient’s needs as well as the expansion of chronic disease management in general practice. We will continue to support the provision of mental health and disability services within the community, where appropriate. The more intervention we can have for patients at the earliest possible stage, the more likely a better outcome is for patients.
This Government will request an Oireachtas All-Party committee to develop a single long-term vision for healthcare over a 10 year period. One of most important aspects of the health service is the funding required. Too often discussions about health have come down to funding - does the service receive a big enough allocation, are there different ways in which it can be financed and is the funding it does receive spent properly. The 2016 Health Budget is €13.1bn and increases in the health budget have been possible both in Budget 2015 and 2016. It is the Government’s intention to work with the Oireachtas to sustain these annual increases going forward, basing health expenditure on multi-year budgeting supported by a 5 year Health Service Plan.
I’m aware that changes announced in the Programme for Government in relation to the HSE structures will be of particular interest to health service staff here today.
I want to reassure everyone that the only goal of this process is to facilitate the HSE to move to new structures that will devolve more decision making to the level of the hospital or the community, and to ensure greater accountability.
I started by pointing out how the quality of the healthcare service is a matter of interest to everyone at some point in their lives. The services delivered must be of the highest quality to ensure patient safety.
We must get best value from our resources through strong corporate and clinical governance, sound resource and financial management. Care must be delivered in the right setting with high quality clinical treatment delivered consistently and on an integrated basis.
Over the coming years, I believe we have an opportunity to do exactly that.
Thank you