Health reform update

eolas summarises Leo Varadkar’s reform priorities for health in 2015. Free GP services will make a tangible difference for citizens but extra finances need to be tightly managed to deliver results.

Minister Leo Varadkar has set out his immediate budgetary and reform priorities for health reform in 2015 in his post-Budget speech to Seanad Éireann. In a frank address, he explained how extra spending will be accompanied by further reform with a view to improving services.

The Exchequer allocation increased by €305 million compared to 2014 and the department has identified one-off increased projected revenues of some €330 million and savings and efficiencies of €130 million.

Health was now entering a two-year process to stabilise the budget and the Department of Health’s spending ceiling for 2016 has been increased by €174 million.

Varadkar explained: “This does not mean that all areas of concern across the health sector can be addressed immediately but it does make the funding situation more manageable. It also means that the cycle of cuts in health has come to an end.”

Costs

That said, the cost pressures on the horizon for 2015 were “enormous” and driven by a rising and ageing population, the increasing incidence of chronic conditions, and expensive advances in medical technology.

“Our progress in diagnosis and screening for cancers and chronic diseases means more people require treatments,” the Minister noted. The Health Service Executive’s 2015 National Service Plan will operate strictly within the resources available, deliver existing levels of service, and provide for a number of targeted improvements.

Where further savings or efficiencies are achieved over and above the €130 million mark, these will be retained and reinvested back into the Health Service rather than going toward deficit reduction.

With the end of the recruitment moratorium, the HSE will also have more autonomy on staffing and human resources. Recruiting more in-house staff can be a less expensive alternative to agency contracts.

Varadkar added: “Greater autonomy and capacity to reuse savings for services must be accompanied by an even greater responsibility for cost containment and avoidance on the part of everybody working in health care.” Managing health spending will require “an exceptional management focus, with strict adherence by all services and budget holders to their allocations.” Budgets needed to be “put in place without delay” so that monitoring of monthly expenditure can commence in January.

Structures

A person’s experience of the Health Service should be “safe, caring and pleasant” and a greater focus on the personal care and attention received by patients was needed. This collective effort needed to be made across acute, community and residential care settings.

“The reorganisation of public hospitals into hospital groups is designed to deliver improved outcomes for patients,” he explained. “Each group of hospitals will work together to provide acute care for patients in their area integrating with community and primary care.” The objective is to maximise the amount of care delivered locally while ensuring that highly specialised and complex care is safely provided in larger hospitals.

The proposed activity-based funding model will pay hospitals for the work carried out in terms of case loads and quality outcomes and will be introduced in phases in 2015. Community health care organisations will provide better and easier access to services, closer to where people live.

Varadkar was “very impressed” with the work of the national clinical programmes in improving stroke and cardiology services. Thirty such programmes currently exist and these will be reorganised into five integrated care programmes. “While structural reform is never an end in itself,” he commented, “it is a valuable tool that can help us do more and better with the additional resources we now have.”

Services

The Minister pledged to honour the Programme for Government commitments on mental health investment (€35 million per annum on community services) and extending BreastCheck to 65-69 year old women.

In the first phase of universal healthcare, 240,000 children aged six years and under will be able to access a free GP service. This accounts for 57 per cent of that age group as 43 per cent are already covered by medical cards or GP visit cards. The same service will also be extended to 10,000 older people aged over 70. Forty-nine per cent of the population will have access to GP services without charges by the end of 2015.

An extra €25 million will tackle delayed discharges. “They are often elderly people and should not be left in hospital where they are at a higher risk of falls, infections and medication errors by doctors and other staff,” the Minister remarked. “While there will always be delayed discharges, current levels are resulting in more people on trollies and more people having their elective admissions or surgery cancelled.”

The funding will go towards nursing homes and also community and hospital services which meet the specific needs of those people and help to improve the timelines for admissions from emergency departments and waiting lists.

Public health

The Department of Health had just commenced the latest Healthy Ireland Survey – the first since 2007. Varadkar commented that more people are aware of the importance of diet, lifestyle, health, well-being and fitness but the nation now faced greater public health challenges in those areas. The survey will provide a snapshot of key indicators which influence public health, including nutrition, alcohol consumption, smoking, physical activity, weight management and general well-being.

Patient safety needed to stay as an “overriding priority” across the Health Service with all staff taking responsibility for the quality of service that they provide. Priority areas will include medication safety, healthcare associated infections, and the implementation of the national early warning score.

Individual health identifiers are “designed to make sure that the right information is associated with the right patient at the right point of care” and will also enable more efficiency and reform e.g. making sure that the money follows the patient. The system will managed by the HSE and its roll-out will start as soon as possible in 2015.

Infrastructure

Forty-two primary care centres had been delivered since March 2011, around 30 projects were under way and a further 50 were at earlier stages of development. The relocation of the National Maternity Hospital from Holles Street to St Vincent’s Hospital was on schedule.

A design team for the new children’s hospital had been appointed and planning permission will be lodged by next summer. A planning decision on the new mental hospital at Portrane is expected early next year.

The HSE purchased the Mount Carmel campus during 2014 and hopes to refurbish and reopen it to provide transitional, step-down and long-term care for elderly people. That service “has been missing for a very long time in Dublin but present in all other parts of the country.”

In conclusion, the Minister paid tribute to healthcare staff who served across the State. “It is due to their hard work, commitment and dedication that the Irish Health Service has survived the most challenging period in its history,” he stated. “We still face many difficulties but there is every reason for optimism and believing that things can become more manageable next year.”