2015 was a challenging year in the health sector amid rising demand for health and social services with capacity stretched. Various issues arose during the year, some foreseen, and many of which could not be foreseen but which were dealt with. Though a lot went under the radar, much important and tangible progress was made which gives us a good base to build on in 2016.
HEALTHY IRELAND
The only way we can take control of the longer-term issues in the sector is by improving our health as a nation, and as individuals. The biggest changes can be brought about by individuals taking responsibility for their own actions, but the Government always has a role to play. That is why the Department of Health has initiated the Healthy Ireland programme, which runs right across the public, private, community and voluntary sectors.
Healthy Ireland survey
In 2015 the first Healthy Ireland survey was published, giving us a clear picture of the nation's health for the first time since the 2007 Slán survey. It will be repeated in 2016 and subsequent years so that progress can be monitored and measured.
Sunbeds
This year saw the tighter regulation of sunbed use and new laws to protect children from sunbed use.
Sexual Health Strategy
Ireland’s first Sexual Health Strategy was published along with a 15 month Action Plan.
Public Health Alcohol Bill
After years of debate and discussion, the Public Health Alcohol Bill was published and has already passed second stage in the Seanad. The Bill aims to reduce alcohol intake in Ireland to the average for the developed world through minimum unit pricing, health and calorie labelling, reducing availability and visibility in stores, and restrictions on marketing, sponsorship and advertising. The Bill and its enactment will be a priority for the Department in 2016.
National Physical Activity Plan
The National Physical Activity Plan will be published shortly and the Obesity Strategy and Action Plan will also be published early in 2016.
PATIENT OUTCOMES
Delayed Discharges
Due to an increase in resources for the Nursing Home Support Scheme (Fair Deal), community beds and home care packages, the number of Delayed Discharges (patients in hospital waiting to go to a nursing home or home with support) fell from a high of 840 in December 2014 to 542 in December 2015, the lowest levels since records began. This will need to be sustained and improved on throughout 2016 with a particular focus on the North Dublin, Louth, Midlands and South-East regions.
ED overcrowding
Emergency Department overcrowding worsened during the year until mid-November. Since then it has been running significantly lower than last year and on many occasions has been running 20%-25% lower. This is a result of implementing the ED Taskforce Report including changes to process and patient flow, additional funding for Fair Deal, community hospitals and beds, home care packages, the expansion of community intervention teams and the provision of about 200 additional hospital beds. Another 200 are scheduled to open or re-open in December or January. This is an area that will require sustained focus through 2016.
Long waiting times
€50m was provided to reduce long-waiting times for public patients with a particular focus on those waiting more than 15 months. The total number of people waiting any amount of time for an out-patient appointment fell from 395,000 in January to 385,000 in November. A further fall is anticipated in December. The numbers waiting more than a year fell from 67,000 in January to 48,000 by November. The numbers waiting for any amount of time for a procedure/operation rose from 64,000 to 69,000, but there has been a significant fall in those waiting over a year, down from over 10,143 in September to under 7,779 in November. The HSE Service Plan for 2016 sets targets for further modest improvements in waiting times in 2016.
Life-saving medicines
The law was changed to give people easier access to life-saving emergency medicines like adrenaline, glucagon, salbutamol and Naloxone.
Strategies
A new Maternity Strategy will be published early in 2016.
The new Cancer Strategy will also be published.
Staffing
The health service took on 4,000 more staff in 2015 with the number of doctors reaching record numbers and the midwife/birth ratio at its best ever. There was a significant fall in agency costs in the hospital sector. Recruitment of nurses, paramedics and consultants, among others, remains a real challenge in a very competitive international labour market. The focus in 2016 will be on filling vacancies, replacing locum and temporary consultants with permanent ones, increasing the number of GP trainees, and further reducing the agency spend.
National Ambulance Service
The Air Ambulance was made permanent and the National Emergency Operations Centre in Tallaght opened without a glitch. There will be further investment in ambulance fleet, staff and community first responders in 2016 with a budget increase of €7 million (excluding capital).
Decongregation
Decongregation continues apace with 104 residents moving from an institution to a home in the community. The target for 2016 is 160.
Connecting for Life
Connecting for Life, Ireland’s National Strategy to Reduce Suicide 2015 – 2020, was published and seeks to reduce the level of suicide and self-harm by 10% over its lifetime.
Mental Health Act
Important changes were made to the Mental Health Act 2001 to ensure that in future, where an involuntary patient with capacity refuses ECT or administration of medicine over three months, that refusal will be respected.
Child & Adolescent Mental Health Services
In 2015, the National Service Plan objective for improved performance for the year is for >72% of accepted referrals to Child and Adolescent Community Mental Health Teams to be seen within three months, together with an overall 5% reduction in the waiting list (2,632), and minimising or eliminating the over 12 months list by year end. Significant progress has been made on reducing CAMHS Waiting Lists, with a drop in the numbers waiting over 12 months and a continuing reduction overall. This has been greatly facilitated by a new HSE Standard Operating Procedure for CAMHS at local level. For example, for those waiting over 12 months, the figure was 479 in March and 222 in October – representing a 55% decrease. The HSE envisage reducing further the over-12 month list by year end in most areas, except where particular staff recruitment/retention difficulties require special attention. The Department and the HSE continue to monitor progress to reduce CAMHS Waiting Lists for those over 12 months, through specific local initiatives.
Reviews
Reviews of the Mental Health Act and the Fair Deal were completed and published.
Legislation was passed on Advanced Healthcare Directives.
PATIENT SAFETY
Patient Safety Package
A comprehensive patient safety package was agreed by the Government and presented at the Annual Patient Safety Conference. €3 million in extra resources has been provided in the HSE Service Plan for 2016 to drive forward the patient safety and quality programme.
National Healthcare Quality Reporting System (NHQRS)
The National Healthcare Quality Reporting System (NHQRS) annual report was published for the first time allowing us to compare health outcomes from hospital to hospital and region to region. It will be published again in 2016 allowing us to identify improvements and disimprovements.
Guidelines
A series of new National Clinical Effectiveness Guidelines were published, along with the heads of the Health Information and Patient Safety Bill.
Drugs
Emergency legislation was drafted to prepare for a potential court decision to strike down aspects of the Misuse of Drugs Act allowing us to re-instate the prohibition on certain illicit drugs in less than 48 hours. The Government approved the drafting of new laws to allow for a supervised injection room and work will conclude in 2016 on a new Misuse of Drugs Act and a new Drugs Strategy.
UNIVERSAL HEALTH CARE
GP care without fees
The first concrete steps were taken towards universal health care, with GP care without fees being extended to 219,451 children under six and 50,559 seniors aged 70 or more. The under six programme includes health checks and also a new cycle of asthma care for which 19,911 children have been signed up. 62,436 adults with type 2 diabetes have been recruited for a new programme to enable it to manage it in a primary care setting. 2016 will see significant progress on a new GP contract and funding has been set aside in the HSE National Service Plan for developments in rural practice, minor surgery, access to diagnostics and the extension of GP care without fees to children aged 6-11.
Medical Cards
In November 2014, the guidelines for discretionary medical cards were relaxed to take greater account of medical costs and needs where an applicant is above the income threshold. Despite an overall fall in the number of medical cards due to the economic recovery, the number of discretionary medical cards rose by 28% from 76,665 in January 2015 to 97,562 now. The Clinical Advisory Group will continue its work in 2016 and make further recommendations on how the guidelines can be modified.
Young Adult Discounts & Lifetime Community Rating
Young adult discounts and Lifetime Community Rating was introduced and the VHI secured authorisation from the Central Bank. The decline in the number of people with health insurance was reversed with an increase in the number of people covered of approximately 100,000.
Further research on funding models
The Government decided not to proceed with the particular universal health insurance model as proposed in the White Paper and re-stated its commitment to universal health care. Further research is being conducted by the ESRI on the costs of various models, how to meet these costs, and how best to address unmet need in the health service, before we move to a new funding system. This work will allow the next Government to make a final decision on the best way forward as to which insurance model is best suited to Ireland.
REFORM, INFRASTRUCTURE and ICT
Health reform
The development of post-HSE structures continued with the recruitment of CEOs and management teams for the Hospital Groups and Community Healthcare Organisations. The plan is to operate and develop these new structures on an administrative basis in advance of detailed legislative provision.
Activity-based funding
Activity-based funding was further developed and 2016 will be the 'conversion year' for hospital budgets.
Individual Health Identifiers
The technical capacity to assign and issue Individual Health Identifiers is now in place.
IMPROVING INFRASTRUCTURE and ICT
€3bn was secured for health in the new National Capital Programme 2016-21 allowing the annual capital spend to rise from about €400 million in 2016 to €600 million in 2021.
ICT
The budget for ICT was increased to €55 million and this will be sustained in 2016 with an increased capital envelope available through to 2021.
New Children's Hospital
The planning application for the New Children's Hospital was submitted and the oral hearings have concluded. A decision on planning permission is expected in February 2016 and work will then commence on the site subject to this.
National Forensic Mental Health Campus
Work has commenced on the new National Forensic Mental Health Campus.
National Rehabilitation Hospital
Work will begin in 2016 on the new National Rehabilitation Hospital in Dun Laoghaire.
National Maternity Hospital
Work is continuing on preparations for the development of the new National Maternity Hospital on the campus of St Vincent’s University Hospital.
Primary Care Centres
Nine new Primary Care Centres have been provided in 2015.
BUDGET
The budget for Health increased from €12,372 million (2014 outturn) by €588 million or 4.8% to €12,960 million (2015 expected outturn) and will rise again by €235 million or 1.8% to €13,195 million in 2016.