Introduction
I see this motion today as real evidence of the new Dáil responding to the message the people delivered at the election.
I heard loud and clear that, for me, that message is to put the benefits of economic success to work for the people to deliver the services that matter to them.
But the people also gave us the challenge of finding a new way of working together and I believe responding to that challenge presents a historic opportunity.
The new Dail is diverse but need not be divided - and together we can achieve the one thing that has never happened in health policy before – a long-term consensus on its fundamental principles.
I am excited about this and grateful to everyone who has agreed to this motion.
The public and the people who work so hard in our health service have no lack of appetite for reform but they are certainly fatigued by piecemeal reforms that don’t really change anything and by the shifting priorities that come with political change.
The work of this committee can mean that the public and those working in the service can have a sense of certainty that there is a long-term strategy agreed by political consensus, and hopefully, societal consensus, that will not change no matter what the makeup of the next Dail.
We all know that the health service faces many challenges. Moreover, the Programme for Partnership Government acknowledges that we have an ageing population who are living longer, whose needs will become greater and more diverse, and that we also have the highest birth rate in Europe. All off us, as citizens, at some point in our lives, will need to access our health services, and so we have a common interest in finding a common way forward in improving and developing our health services.
The Government comes to this motion with a clear objective in sight. As set out in the Programme for Partnership Government the Government is committed to the goal of universal healthcare, which is a concept endorsed by the WHO, the UN, the OECD and the EU.
As an overall goal to improve our health services, universal healthcare involves four main objectives:
(i) reducing unmet health needs;
(ii) reducing inequalities in access to health goods and services;
(iii) improving service quality; and
(iv) improving financial protection - this means that patients do not face catastrophic or impoverishing levels of health spending as a result of seeking healthcare.
The World Health Organisation notes that no country fully achieves all the universal health coverage objectives, for 100% of the population, for 100% of the services available, and for 100% of the cost – and with no waiting lists. But it does believe that every country can improve efficiency, reduce waste, and increase value from its health spend. By doing so, we can advance the cause of universal healthcare.
In striving for the optimal single-tier health service for Ireland, there are inevitable policy trade-offs to be confronted. These trade-offs often involve tensions between efficiency and equity or between comprehensiveness and cost control. In all countries - not just Ireland - the trade-offs centre around three basic dimensions of the health service which must be confronted when designing a health service: (i) the proportion of the population to be covered, (ii) the range of services to be covered and (iii) the proportion of the total costs to be met.
We also know that there are factors outside of the health service which affect universal healthcare including housing, employment and education. This requires a whole-of-Government “health-in-all-policies” approach and this is echoed in the Healthy Ireland framework.
So, there are tough policy choices, trade-offs and decisions to be made, especially in terms of managing resources, addressing performance and ensuring accountability.
The Programme for Government 2011-2016 committed to a major programme of health reform, the aim of which was to deliver universal healthcare, with access to quality services based on need and not ability to pay. In April 2014, the White Paper on Universal Health Insurance was published. It proposed a competitive, multi-payer model of universal health insurance as the means to achieve universal healthcare.
Having reviewed the results from the UHI costing project, it was concluded that the high costs associated with the White Paper model of UHI were not acceptable and that there was a need for further research and cost modelling before definitive conclusions could be drawn in relation to the best means to achieve universal healthcare.
Whatever approach we adopt, I believe that there is a need for consensus on the direction of health policy, and this Committee represents a great opportunity to try to achieve that consensus.
Funding
One of most important features of any country’s health service is how it is funded – both in terms of the amount of money required and the manner in which it is financed. These are difficult questions to answer, and will clearly be central to the deliberations of the All-Party Committee. Making changes to funding levels and financing methods take time, and require careful managment, not least to avoid disruption to what are vital existing services. That is one reason why it is important to take a long-term view of how the health service can be developed.
The 2016 Health Budget is €13.1 billion and increases in the health budget have been possible both in Budgets 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.
Shift to Primary Care
One aspect of the motion which I think we can all support, is the need for a decisive shift within the health service towards primary care, and the effective delivery of primary care in every community. The more intervention we can have for patients at the earliest possible stage, and as close to home as possible, the more likely a better outcome is for patients.
To do this, it will be necessary to build up 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.
Developing primary care services and integrating primary and secondary care services is also a vital component in any strategy to address the issues facing our hospitals, and in particular Emergency Departments. In developing models of person-centred, coordinated care we can draw on the work of the National Clinical Programmes and, in particular, the pilot Integrated Care Programmes.
Successes and Improvements
While the new Committee will have many health service challenges and difficulties to examine, and these should not be underestimated, we should also acknowledge that the health service has been changing. It would be wrong not to acknowledge successful reform where it happens. For example:
· 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 decreased by 19%;
· Huge progress has been made in reducing tobacco consumption, with Ireland currently ranked 2nd out of 34 European Countries in relation to tobacco control initiatives.
Since 1999 the percentage of adults smoking has fallen from 33% to 23%, while the percentage of children aged 10 - 17 years smoking has fallen from 21% to 8%. I was delighted to recently sign the European Tobacco Products Directive into Irish law;
· 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.
· 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 Fair Deal Nursing Homes Support Scheme. 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;
· Activity Based Funding is a new model for funding public hospital care. It went live in January this year for inpatient and daycase treatment in the 38 largest public hospitals. ABF involves moving away from inefficient block grant budgets to a new system where hospitals are paid for the volume and quality of care they provide.
· 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 in 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, such as smoking, alcohol, poor diet, physical inactivity, and obesity;
· 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; and
· A major programme of health reform is underway, the aim of which is to support the delivery of universal healthcare.
There is much more to do, especially on prevention and integrated care. But there are important changes already underway on which we can build.
Universal healthcare is not just something to implement but is a direction and a journey. Ultimately, how far and how fast we proceed in the direction of universal healthcare is a question of choices and how we make them. But we do need a routemap, and a clear sense of direction so that we can stay the course, on what will inevitably be a long journey to a better health service. So, there are challenges, but also great opportunities for the proposed Committee to make a positive impact.
I commend this motion to the House.
Thank you.