merrion street

Ladies and Gentlemen,

I know I am in distinguished company. Globally distinguished company. But I suspect I can claim a unique point of differentiation.  I figure I’m probably the newest Minister for Health here today.  I took over the job exactly 35 days ago.  I only know the number of days because one of my officials just told me.  I’ve been so busy I haven’t noticed the passing of time… 

And yet I have a deadline.  What I’m setting out to do is guarantee equal access to healthcare for everybody in our country as quickly as possible but absolutely within the next 10 years.  Equal access.

Meaning that your problem, your illness, your disease, your need is what gets attention for you.  Not how fat your wallet is.  That’s the way it should be, in any decent society.  That’s the way it is, at an individual level.  By way of an example, I should tell you that – last weekend – I was driving on the motorway in Ireland when traffic began to slow and move to one side.  Accident up ahead?

Yes. Car on its side, extensive crushing of the frame – had clearly overturned at some speed.  I figured this was the time to be a doctor, rather than a Minister. Pulled in on the hard shoulder and walked back. A by-stander said the accident had happened about two minutes earlier.  But a man & a woman were already working on the injured driver. Two doctors had immediately got to her. And the ambulance siren could be heard in the distance, getting closer. I was redundant.

Nobody had checked whether the injured driver was rich or poor, insured or uninsured. Everybody had professionally snapped into action, giving the care that was needed, not the care that could be afforded.  That’s what we do, as individuals

It’s not always what systems do, though.  Particularly healthcare systems like that in Ireland, where the 2 tier system may work beautifully if you’re insured but not if you’re uninsured.  I’m determined to create a single-tier healthcare system in Ireland.  One that gives access based on need – not on ability to pay.  I’m committed to making Universal Health Insurance available for the whole population of Ireland.

But we can never forget that the health status of any population is largely determined by factors outside of the health sector.  According to the World Health Organisation, 7 leading risk factors cause roughly 60% of our disease burden: Tobacco; Alcohol; Cholesterol; Obesity or being overweight; High blood pressure; Poor diet and physical inactivity.

The reality is that behaviour changes can greatly reduce the prevalence of most of the common chronic health conditions.  Now, Ireland, like most European nations, has a number of phrases or slogans that go back a long time, and that sum up national beliefs around particular issues.  We call them “Sean Fhocail.” Old words.

Like “Is fear an tsláinte ná na táinte.”  Meaning: “Health is better than owning herds of cows.”  We say it. We believe it.  But just four years ago, a national Survey of Lifestyle, Attitudes and Nutrition established a poor risk profile for our general population.  That was confirmed last year by another comprehensive survey.

We have to address the adverse lifestyle factors causing these increased risks.  My Government will take a more holistic approach to health because we want to make it easier for people to lead healthier and more active lives.  Increased life expectancy in the developed world has been mirrored in Ireland, due to better control of the major diseases.  But – and it’s a big ‘but’ -- in Ireland, as in other countries, chronic diseases are on the rise.

Put an ageing population together with unhealthy behaviours, and you get a higher level of chronic disease.  That’s a reality.  But it’s not an inevitability.  A small number of preventable risk factors are – lethally – in play. We must find ways to reduce them.

Now, of course, while prevention is the ideal, chronic diseases are always going to be with us. Ireland’s chronic disease management framework, introduced in 2008, focuses on treating and delaying the onset of complications for anyone with a chronic condition.  It empowers patients to take an active role in the management of their own condition. 

And what I like most about the framework is that much of what it recommends can take place in the primary care setting.  I like that, because I passionately believe the axis of healthcare needs to be shifted: that the emphasis must be on providing treatment at the lowest level of complexity: primary care.  Where the right levels of support are in place, we can avoid unnecessary hospital admissions. Just as important, we can improve the quality of life for patients with chronic conditions.

I mentioned earlier that we’re seeking a more holistic approach. But that’s more than promoting healthier lifestyles or ensuring intervention at the lowest level of complexity.  It’s also about improving the environment where we live and work.  And it’s crucially about patient safety and delivering quality and excellence in our own healthcare.

We’ve already got the Health Information and Quality Authority (HIQA) and the Office of the Chief Inspector of Social Services in place, to bring about a safer health and social services system where quality is a priority at all levels and in all settings. A measurable priority.

A Commission on Patient Safety and Quality Assurance started – back in 2007 - to look at the overall system from a patient safety perspective and to develop clear and practical recommendations to ensure that quality and safety of care for patients is paramount throughout the healthcare system.  We’ve already implemented that Commission’s recommendations.

Our Programme for Government will introduce free GP care to the whole population within our first term.  That’s an enormous and radical change.  It cannot happen overnight. It has to be phased in. First, we’ll support the sector to prepare for this major initiative. This will give us time to deal with issues like GP workforce levels and registration.

Primary Care Teams are one of the central components for the creation of a modern, integrated health service.  In turn, one of the central components for the creation of successful Primary Care Teams is the development of primary care centres.

International research shows that shared premises are a key enabler for successful team working in the primary care setting.  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.  All of these future plans might give you the impression that healthcare in Ireland has not been a big focus of investment in recent times.

That’s not the case.  We have invested heavily in healthcare over the last decade.  In theory, that investment should have led to a matching improvement in services for patients.  It hasn’t. Not everywhere. In some places, that matching improvement is there to be seen, to be experienced, to be measured. In others, it hasn’t happened at all.  That would be a problem even if we didn’t face major pressures on the cost of healthcare in the immediate and long-term future.

But that’s where we’re at.  Firstly, because of demographics.  Demographic changes are going to put huge pressures on our health system.  In 2006, 11% of the total population was aged over 65 years.  This will rise to 22% (at least) by 2041, according to our Central Statistics Office.  The number of people aged over 85 years will quadruple over the same period.  As you know, older people have more complex chronic illnesses, visit GPs more often and attend outpatient departments more frequently.  We must plan for that.

In addition to demographics, the health sector is, by its nature, labour intensive.  So medical inflation and employment costs are significant issues within the health environment.  Those are just some of the problems and the challenges we face.  Not to mention an aspect of the context about which you might have heard: that my Government has inherited an economy in serious difficulty.

In that context, it may seem naïve to state that my objective is to ensure that Ireland gets one of the best health services in Europe, if not the world. But that’s the objective.  That’s the plan.

Ireland has a new government. A new way of doing business. We’ve always been an outward looking nation. We’ve always been an industrious people. We will again be self-sufficient, not just in our health service, but in our economy.  We’re going to fix our health service, using a mix of revolutionary methods, drawing heavily on the successful aspects of other healthcare systems around the world.

Take the insurance issue. Having examined a number of European health insurance models, we decided to introduce a Universal Health Insurance scheme.  This development is going to be the most profound reform of our health system since the foundation of our State.  And as with any real and worthwhile reform, it’s not going to be easy.  The needs of the patient will be our constant priority and guiding principle.  That is the critical point.

Under the new Universal Health Insurance system, everyone will have health insurance from their choice of insurance company.  This insurance will guarantee every citizen equal access to a comprehensive range of hospital and medical services.  The core purpose of universal health insurance is to achieve equity of access to healthcare.  Similarly, the concept of equity will inform the internal design of the insurance system, be based on community rating and a robust risk equalisation scheme, governed by a new Regulator.

I’m talking a lot about the future, mainly because it’s where we all plan to live.  But I  should also state that Ireland’s recent progress in areas such as prevention, screening, diagnostics and surgery, has been substantial.  It’s given countless numbers of our people the prospect, not just of life, longer life, but also of fulfilling life where none previously existed.

We want to build on these gains whilst managing our current significant resource challenges.  Notwithstanding the economic and fiscal problems that must be overcome by many countries, continuing expenditure has to go into protecting, maintaining and improving the health of our population. And that’s true of all populations.

How the Health Technology Assessments (HTAs) community goes about its work, and any adjustments it should make to take account of changed global circumstances, is the very essence of the discussions you’re going to have at this conference.  The remit of Ireland’s Health Information and Quality Authority (HIQA) includes HTAs.  HIQA’s role is to provide advice to me as Minister and to our Health Service Executive.  HTA is the assessment of both the clinical and the cost effectiveness of medicines, devices, diagnostics, procedures and health promotion programmes.

Healthcare policy making is very often about making choices and HTA helps us make informed choices.  It provides policy and decision makers with the costs of a known quantum improvement in health status using a given treatment or approach.  It can help ensure we’re getting the best value for our money.

We’ve tended to see HTA in the context of new investment.  But its principles can equally be applied to existing technologies to see where investment should reduce or stop.  This is particularly important in ensuring that superseded practices are fully discontinued once the new approach has been proven.

A national policy and a series of guidelines are currently being developed in Ireland to set down roles, responsibilities and principles and practices to be followed for HTA.  Evidence. That’s what it’s all about. Evidence and value for money.

HTA is a key tool when we want to make decisions strongly grounded in evidence of efficacy, effectiveness, impact and value for money.  Clinical Effectiveness should drive investments in health systems of the future.  We’ve got to use evidence- based guidance, developed internationally but adapted for local country situations.  That’s the best way to enhance our collective ability to continuously improve the quality and value of the care we provide and the overall health of the populations we serve.

I’ve looked at some of the changes specific to Ireland, but of course, one the biggest changes in healthcare have been caused by the Internet.  In the past few years, when patients came to my clinic, they were in a different frame of mind. An informed frame of mind. They’d googled their symptoms, done a bit of self-diagnosis, and then researched the possible treatments.  That’s just one of the obvious changes delivered by the Internet.  The most exciting aspect of those changes is what’s called “connected health”.  Connected health allows the remote delivery of health care.

eHealth offers channels of communication to provide enhanced access to information, streamlined organisational processes and improved quality, greater efficiency, reduced costs and greater patient satisfaction.  We must make the most of it, just as we must re-examine traditional roles and boundaries, whether between doctors and patients, managers and clinicians or operations and governance activities.  When considering the quality of care from patients’ perspectives there are two main aspects: its effectiveness (outcome) and its humanity (experience).  We all want to receive, and indeed deliver, effective care in a humane way.

We now face a period of change.  Across the globe governments are facing enormous financial pressures to maintain, let alone develop, their health services.  Ageing populations, the growing burden of chronic disease, lifestyle-related risk factors, rising costs, increasing public expectations and medical and technological advances all contribute to the challenge of providing sustainable health services.

A clear benefit of discussions like today’s is the opportunity it gives us all to hear from others so that best practice can be applied when it comes to designing systems of excellence.  Good care can make the difference between enduring life and enjoying life and that instinct to offer care is one of our finest and noblest human attributes.

I had the pleasure of the company of some of you, my fellow EU Health Ministers last week in Budapest at an Informal meeting hosted by our Hungarian friends.  It was reassuring to know that we were all on the same page in terms of addressing our very similar problems.  The solutions we seek in common are more patient safety centred services especially in the community with an emphasis on chronic illness care and treatment based in general practice.

We have other problems that are Europe wide and will require Europe wide solutions- the greatest of these are economic issues that we face in the Eurozone.  We in Ireland have had a lot of shared experience with Europe in addressing our health service challenges.

Similarly there are enormous challenges facing Europe economically and these must be addressed collectively in the spirit of mutual support and solidarity that underpins the European project. The new Govt. in Ireland wants to end our 2 tier Health Service.  We equally want to end the possibility of a 2 tier economic Europe.

Thank you.