Speech by Minister for Health, James Reilly TD, to 44th plenary

Introduction

I am very pleased to be here today to address you on the broad topic of the "potential of shared services in the area of health provision". In order to explore what can be shared, we must understand each others respective systems and goals, I hope in the next number of minutes to outline briefly some of the key transformations that are occurring in the Irish health system.

I fully appreciate the importance of fora such as BIPA, which afford us the opportunity to reflect on the challenges facing all of us in Britain and Ireland, and across these islands. For example, an extremely productive discussion on the misuse of drugs took place at the last British Irish Council meeting at Dublin Castle in January

Our health systems face many similar challenges and dialogue and discussions such as this can only assist our mutual learning, leading to concrete solutions that benefit our health systems and most importantly our citizens.

Health Reform
The Irish Government is embarking on a major reform programme for the health system. It aims to deliver a single-tier health system, supported by universal health insurance, where access is based on need, not on income. This reform programme will provide for a more efficient health service where the appropriate care is delivered in the appropriate setting.

There are a number of important stepping stones along the way and each of these will play a critical role in improving our health service in advance of the introduction of universal health insurance. I am pleased to say that significant work is already underway in relation to these initiatives which include:

 the strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients,
 the work of the Special Delivery Unit in tackling waiting times,
 the introduction of a more transparent and efficient "Money Follows the Patient" funding mechanism for hospitals, and
 the introduction of a purchaser / provider split, whereby hospitals will be established as independent, not for profit trusts.

Once these key building blocks have been put in place, the health sector will be ready for the introduction of universal health insurance. This system will give patients a choice of insurer and will guarantee that every citizen has equal access to a comprehensive range of curative services.

The scope of reform envisaged is such that careful planning and sequencing are vital. In February, I established the Implementation Group on Universal Health Insurance which is charged with helping in delivering detailed implementation plans for universal health insurance and in actively driving implementation of various elements of the reform programme.

The Group has already met twice and is currently involved in developing a work plan with a particular focus on a number of key workstreams, including hospital financing, hospital structures, the private health insurance market and the overarching UHI design.

The Group will remain in existence throughout the reform process and will oversee different elements of the reform programme as they are being put in place. It will also consult widely as part of the reform implementation process. In conjunction with the Implementation Group, the Government has established a Universal Primary Care Project Team to oversee the introduction of universal primary care.

Hospital Trusts

Reflecting briefly on the issue of a purchaser/provider split one of my priorities for the Special Delivery Unit in 2012 is to begin work to transform public hospitals to independent hospital trusts. The establishment of hospital trusts will require the development of the necessary corporate governance, management and clinical capacity to ensure that these hospitals are equipped to function efficiently and effectively, once established as independent service providers.

The first step is the setting up of initial hospital groups on a non statutory basis and work on this is underway. The hospital groups will have a single clinical governance model, one budget and one employment ceiling. In addition, the introduction of hospital groups will provide further opportunities for inter site co-operation.

Primary Care
As part of reform agenda, the Government is committed to introducing Universal GP Care within the term of Office of this Government. This will be achieved on a phased basis, allowing time to deal with issues such as GP workforce levels and registration.
It is envisaged that the first phase in the Programme will provide for the extension of access to GP services without fees to persons with illnesses or disabilities to be prescribed by regulations under the new legislation.

The Programme for Government provides for the introduction of a new contract with GPs with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. It is envisaged that the new contract will also focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary Primary Care Teams.

In working towards this objective, we must aim to achieve more efficient and effective delivery of services. Fundamental to this is ensuring that appropriate care is provided in the most appropriate setting.
Patient Safety
One of the key initiatives in this Government's reform programme is the establishment of a Patient Safety Authority (PSA). The Department is continuing to formulate proposals on the options and possible organisational structures of the PSA taking account of the international experience and the existing structures and organisations in the Irish system. At the 2nd National Patient Safety Conference which took place in February; international speakers from Canada and Denmark shared their experiences and knowledge on patient safety structures in their countries. The international experiences of other countries is further informing consideration of an appropriate structure for the responsibilities that will be assigned to the PSA.

I am a firm advocate of evidence-based policy. In progressing our reform agenda we took the opportunity to learn from the experiences of others, including the UK.. We also made use of our membership of the European Observatory on Health Care Systems and Policies to assist in increasing our knowledge base, learning from the experiences of other countries and informing our policy options.

Chronic Disease Management

A key challenge for future healthcare provision in Ireland is chronic disease management. I believe this challenge is not merely a financial one but also an organisational one that requires a health system with a greater focus on prevention, co-ordination, continuity, integration and information flows which follow the patient.

Approximately 80% of the overall disease burden in Europe is due to chronic diseases and the pattern in Ireland is similar. It is estimated that three quarters of healthcare expenditure relates to chronic diseases. Chronic conditions will generally increase by around 40% over the next 10 years due to our aging population and the impact of lifestyle factors.

This trend is not sustainable - from a cost or hospital capacity perspective. A new model of structured integrated care involving primary care with an emphasis on prevention will be required. We need to shift our health systems away from a medical curative model of healthcare and encourage patients to actively participate in the management of their condition. There is evidence that patient empowerment improves health outcomes. Knowledge of the disease and its treatment not only improves quality of life but reduces dependency on heath services.

Our health system has developed a number of clinical programmes to manage the care of people living with long term conditions. Part of this involves completing a framework for self management of long term conditions.

It is important that we share our experiences of best practices in this area and learn from these. I welcomed the opportunity at the EU Informal Meeting of Health Ministers in Denmark a couple of weeks ago to discuss these developments and give Ireland's support to the European reflection process on innovative approaches for chronic diseases and in particular the important role of patient empowerment as a key element in managing chronic diseases. I would also add that Health & Wellbeing will be one of the themes of the Irish Presidency of the EU.

The HSE intends to commence a national roll out of chronic disease management for diabetes during 2012 and it will also progress preparations for the roll out of similar initiatives in relation to other chronic diseases, including stroke, asthma, and heart failure.

Rare Diseases

Between 5,000 and 8,000 rare diseases have been described, affecting about 6-8% of the population in the course of their lives. Approximately 80% of rare diseases have a genetic origin and the life expectancy of patients with rare diseases is significantly reduced. Many of these conditions are complex, severe and debilitating.

My current priority is focussing on the development of a national plan for rare diseases. Ireland has been supportive of the EU proposals on rare disease which concluded with a council recommendation in June 2009. The end point is that countries are recommended to develop plans or strategies preferably by the end of 2013. We are now well advanced in developing this work.

By their very nature it is not feasible to expect that rare diseases can be managed on a stand alone basis by individual jurisdictions. There are significant advantages both from a quality and economies of scale perspective to widening out the discussion beyond borders and there has been some exploration at official level of the potential for accessing services on a North South basis. I think its important for this type of engagement to continue so that we can all share very valuable knowledge and experience in this issue.

‘Your Health is Your Wealth'

I would like to see more emphasis on disease prevention rather than intervention. To this end, ‘Your Health is Your Wealth: a Policy Framework for a Healthier Ireland 2012 - 2020' is a policy framework that will be Ireland's vision for a healthier population that is protected from public health threats, living in a healthier and more sustainable environment, with increased social and economic productivity and greater social inclusion. A working group, chaired by my Department, has been set up to review and assess the current state of public health in Ireland and internationally. It is envisaged that a final report to accompany a memo to Government will be prepared by the end of Q2 2012.

It is clear to us all that the current model for provision of healthcare is not sustainable in the context of increasing demand, reducing budgets and scarcity of professional workforce. The existing system is not meeting current or future needs. Reform is not just an option. It's an imperative.

Hospital services

I would like to particularly mention organ donation services. I am aware that because of the favourable organ donation rates in Ireland at present, preliminary discussions are being held in relation to cooperation around organ transplantation between NHS Blood Transfusion and the Health Service Executive's Organ Donation and Transplantation Office. The focus will initially be on liver transplantation. In addition, with increasingly sophisticated medical technologies becoming available for rare lung disease increasing numbers of Northern Ireland patients are seeking consultation in regards to treatments and lung transplantation in Ireland.

Heart and lung transplantation programmes are based in the Mater Hospital Dublin. There is already a formal agreement with the Freeman Hospital in Newcastle for transplantation procedures.

Of course both jurisdictions must transpose Directive 2010/53 on standards of quality and safety for human organs intended for transplantation into national legislation by 27 August this year. Compliance with this legislation will ensure a high level of protection for patients receiving the gift of life through a new organ. It will also facilitate the sharing of organs, not just between our two countries, but also between other Member States of the EU, in the knowledge that a system based on common quality and safety criteria has been established and that centres are authorised in accordance with these criteria.

Cancer Services

In relation to cancer services, the Irish Government is committed to working in partnership with colleagues in Northern Ireland on the development of radiotherapy facilities at Altnagelvin Hospital.

The number of newly diagnosed cancers is increasing by 6 - 7% annually and unless a major reversal of trends occur in the near future, the number is likely to double in the next 20 years. For this reason we must have the capacity to manage cancer patients effectively and to provide this life-saving therapy.

The new facility, which will become operational in 2016 will serve the needs of Irish patients in the Donegal area in the North west, who until then had to travel long distances to either Dublin or Galway for their treatment.

Paediatric Services

Co-operative and collaborative sharing of resources has consistently taken place between paediatric services in the Republic and Northern Ireland.

For example, Our Lady's Hospital Crumlin in Dublin has for the past number of years been providing paediatric congenital cardiac surgery services to patients from the North. In 2011, for instance, 9 such patients were cared for at Crumlin. This cooperation is being formalised in 2012 / 2012 with the establishment of an All Ireland Paediatric Congenital Cardiac Surgery Clinical Network, with up to 30 such patients from Northern Ireland being treated at Crumlin.

Other potential areas for future collaboration include paediatric neurology and metabolic services.

These examples underline the value of sharing healthcare resources - clinical infrastructure, capacity and skills base - to deliver the best possible services.

Professional Qualifications

With regard to the modernisation of the EU Directive on the mutual recognition of professional qualifications, the proposal to amend the current provision regarding the duration of basic medical training is of mutual interest to my Department and to our UK colleagues. I am pleased to note that contact has been initiated between both Departments in relation to the Directive proposals

North/South Co-operation

In terms of developing good models of working, where practical and valuable initiatives can be brought forward in an effective way, it is worth looking at some of what we have achieved in the Health and Social Care field with our colleagues in Northern Ireland. I have already mentioned some ongoing work in the cancer and paediatric areas. I'd like to the opportunity to also mention the important work of CAWT, which by the way, celebrates its 20th anniversary this year.

CAWT was established as a network for co-operation between the then four Health Boards which straddled the Irish border area with a population of 1.5 million people. This was a voluntary partnership of statutory organisations with senior personnel from each organisation participating. CAWT has been hugely successful in forging working relationships between hospitals and institutions and between clinical and management personnel from the health services in both jurisdictions in the border corridor. Over 50 collaborative projects have been completed or are underway; currently 12 major projects with over 20,000 beneficiaries North and South are being implemented with the vital assistance of €30m EU Interreg funding; successful pilot projects in the past have paved the way for some services which are now mainstreamed on a cross-border basis. The initial successes led to greater confidence and more initiatives. I am satisfied that we have a very positive environment created in which Health Departments and Health Services, North and South, can continue to work in this collaborative way, supported by organisational structures such as CAWT and the working model which it has developed.

Conclusion

We live in interesting times. I am excited about the future of the Irish health services and I look forward to working with colleagues in Northern Ireland and Britain. Britain has always been Ireland's most important partner. Over many years, Irish people have moved to Britain to build successful lives, and vice versa. We share more than a common history; we share many of the same values and aspirations. And we also share many common challenges.

Thank you