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A programme for Health

21 Jan 2016

Critics felt the area of continued crisis for the Government — Health — barely got a mention at all in An Taoiseach Enda Kenny’s launch of the Programme for Government and Restatement of Priorities, writes Lloyd Mudiwa. Not quite so.

While political opponents feel health was overlooked in An Taoiseach Enda Kenny’s speech at the launch of the Programme for Government and Restatement of priorities for good reason, a perusal of the full progress report has some pleasantly surprising results.

Chronic crowding in hospital emergency departments and long waiting lists, and the commitment to replace a two-tier health system with a universal healthcare model are just some of the alleged failures that have been cited by the Opposition.

While, the trolley crisis seems to have been ignored in the report, universal healthcare is somewhat addressed.

A White Paper on Universal Health Insurance (UHI) was published in 2014 with a report on the potential costs of the White Paper model published in November 2015, the progress report points out in a section addressing some of the major individual health reform commitments made by Fine Gael and Labour coalition in its Programme for Government.

The Economic and Social Research Institute reports underpinning the initial costing exercise for UHI, published in November, concluded that more research was needed in this area before definitive conclusions could be drawn about the best type of model to implement universal healthcare in Ireland.

Nonetheless, some first steps towards the introduction of universal healthcare have been taken through the rolling out of the free GP care for infants, according to the progress report.

Health reform
Since the publication in 2012 of Future Health, which sets out a roadmap of major healthcare reforms, significant progress has been made — according to the Coalition — on the implementation of significant measures towards transforming the Irish health system.

Seven new hospital groups have been established as a first step to independent hospital trusts, activity-based funding (ABF) has been rolled out in 38 public hospitals, and an ABF Implementation plan 2015-2017 was published last year.

Huge advances have also occurred in general practice, the Government believes, with the introduction of free GP care, wider access for GPs to the GMS lists, work beginning on a new GP GMS contract, and the restructuring of the health service with the Board of the HSE abolished and replaced by a Directorate, which was described as being “more accountable” to the Minister for Health.

The Vote of the HSE has also been disestablished and funding of health services is now provided through the Vote of the Office of the Minister for Health.

GP care
GP care without fees for children under six years of age was introduced in July 2015 and by the late December more than 219,000 children and 93 per cent of GMS GPs had signed up to the scheme.

Free GP care at point of access for all persons aged 70 years and older commenced one month later (August 2015), and by late December more than 50,500 older people had registered for the service.

These initial steps towards universal healthcare mean, for the first time, some 800,000 of the eldest and youngest in our society are now able to access GP care without being charged, the Government’s review notes.

Furthermore, Budget 2016 announced the plan to extend universal GP care to all children aged 11 years and under, subject to the negotiation of a comprehensive new GP contract for the provision of services with the IMO.

In relation to the contract negotiations, a Memorandum of Understanding has already been signed with the medical representative body to develop a modernised contractual framework focused strongly on strengthening GP services and the role of primary care.

Progress on the 2015 pilot initiatives to expand capacity to manage patients in primary care include: providing GPs direct access to ultrasound at eight primary care sites in the South and West, which is expected to deliver 13,000 ultrasounds in the initial 12-month period, and the provision of additional minor surgery services with 24 GP surgeons in 20 practices across 11 counties performing a wide range of surgical procedures.

In a bid to prioritise the public’s access to primary care, a suite of actions have been implemented to improve the operation of the medical card system, and since mid-2014 the number of discretionary medical cards has increased by 87 per cent — from approximately 52,000 in mid-2014 to nearly 98,000 at the beginning of December, more than at any other time before.

The HSE Clinical Advisory Group is working on developing guidance on the operation of a more compassionate and trusted medical card scheme and based on a recommendation by the Group, since June last all children under 18 years with a diagnosis of cancer are being awarded a medical card.

In total, more than 2.1 million people, or 46 per cent of the population, are covered by a medical or GP visit card, states the progress report.

And the regulation underpinning the new European Fund for Strategic Investments (ESFI) was agreed in June.

The Department of Health’s Public Private Partnership (PPP) project involving 14 primary care centres across Ireland was one of the first projects to be supported by the EFSI.

Improving health services
A National Carers Strategy was published in 2012 setting the strategic direction for future policies, services and supports for carers.

Also a new 34-bed cystic fibrosis unit in St Vincent’s University Hospital (SVUH), Dublin opened in August 2012; while other specialist units have opened in Beaumont, Cork University Hospital and University Hospital Limerick.

A catch-up programme for Human Papillomavirus (HPV) vaccination of all girls in secondary school was implemented, and the National Breast Screening Programme, BreastCheck, was extended to women up to age 69 years with screening commencing in 2015.


An Taoiseach Enda Kenny

The Pharmacy Needle Exchange Programme target of recruiting 130 pharmacies was exceeded with 133 recruited in total, while the law was changed allowing life-saving rescue medicines, such as adrenaline and glucagon, to be administered by trained members of the public in emergency situations.

Other legislative reforms, undertaken since March 2011, that reportedly have improved the health services were the enactment of the Protection of Life during Pregnancy Act 2013, with related implementation guidelines published in 2014, and the passing of the Protection of Children’s Health (Tobacco Smoke in Mechanically Propelled Vehicles) Bill providing for a ban on smoking in cars and plain packaging.

Hospital groups

Funded on a ‘money follows the patient’ basis, the hospital groups have been established in line with the Government’s programme for reform of the health service, initially on a non-statutory administrative basis, pending the establishment of Hospital Trusts with the focus now turning to the development of Hospital Group Strategic Plans, the report notes.

During the summer of 2015, the ABF Implementation Plan 2015-2017 was published, which provides a roadmap and comprehensive list of 34 actions to ensure this new method of funding becomes fully embedded in the acute hospital system over the coming years.

ABF budgets for inpatient and day-care services are being introduced for the 38 largest public hospitals.

The progress report reveals that the development of ABF budgeting for other areas like outpatients will continue in 2016.

Mental Health
Some €160m of additional funding has been provided for mental health services since 2011, when the coalition Government came into power.

Approximately 1,150 additional posts have been filled or offered, with further recruitment progressing to strengthen community mental health teams and to enhance specialist community mental health services.

The general adult, and child and adolescent teams have also been reconfigured for an integrated recovery-focused model of care.

“Progress has been made on reducing waiting lists for child and adolescent mental health services and new standard operating procedures at local level,” reads the report, which also recalled that the review of the Mental Health Act 2001 completed in March 2015 led to the drafting of new legislation.

Some three months later, a new Suicide Prevention Strategy, Connecting for Life 2015-2020, which set a target to reduce suicide and self-harm by 10 per cent over the five-year period, was launched.

And a substantial increase in budget for the National Office for Suicide Prevention from €3.7 million in 2010 to the current level of €11.55 million, with an extra €2.75 million provided this year for additional suicide prevention resource officers, has also been underscored.

Yet another success in health for the Government, according to the progress report, is that it secured planning permission and construction work is currently under way to replace the Central Mental Hospital with a new forensic facility in Portrane.

Other highlights
Among several other highlights flagged in the progress report was the submission of the planning application for the new national children’s hospital at the St James’s Hospital campus and the satellite centres at Tallaght and Blanchardstown in August 2015.

In relation to maternity services, a National Women and Infants Health programme is being established to lead the management of maternity services and a National Maternity Strategy is close to finalisation.

Also being finalised is the planning application for the redevelopment of the National Maternity Hospital on the SVUH campus.

Also highlighted is the single national ambulance control and command system and a permanent Emergency Aeromedical Service, along with Healthy Ireland, the national health and well-being initiative, launched in 2013, which is focused on keeping people healthier for longer through targeted preventative strategies, including grappling with obesity, alcohol cessation, tobacco cessation and promotion of physical activity.

The Public Health (Alcohol) Bill, 2015 has also been published setting out measures to address alcohol misuse.

Another piece of legislation, the Health Identifiers Act, 2014 provides for a national system of unique identifiers to streamline information for patients and health service providers.

In respect of promoting exercise, this week’s publication of the first National Physical Activity Plan is envisaged in the progress report. While another first was the publication of the first National Sexual Health Strategy in October 2015, which is aimed at tackling the rising incidence of sexually transmitted infections, with a focus on improved sexual health education and services.

The progress report also highlights the “major package of patient safety reforms” announced in November 2015, including the creation of a National Patient Safety Office and a patient advocacy service.

The previously highlighted deal agreed with the pharmaceutical industry in 2012 reduced the cost of the State’s bill on existing medicines by €400m over three years, while the Health (Pricing and Supply of Medical Goods) Act 2013 provides for cheaper generic drugs and reference pricing, were once again raised.

A permanent risk-equalisation scheme to support community rating in the private health insurance market keeping it affordable for older and less healthy people in society was now in place, along with measures introduced to help stabilise the sector, including special lower premiums for young adults and the introduction of Lifetime Community Rating.

The Government has decreed that Vhi Healthcare is to be kept in public ownership, with the process of authorising the insurance firm completed by the Central Bank in 2015.

Technically delivered
However, while the Government has technically delivered on a lot during its five-year term of office, judging by this listing of achievements, a good few of these successes — for instance the first National Physical Activity Plan, which was only launched last week — have not yet become operational.

Perhaps most disappointing of all has been the failure to achieve significant movement on UHI, with access to care still not equal access for all, and more particularly the ED crowding crisis and the stubbornly high trolley numbers that are still released daily.

Lloyd Mudiwa

Click here to view the full article which appeared in Irish Medical Times