Bernard Allen
Question:271 Mr. Allen asked the Minister for Health and Children the plans, if any, he has to carry out a major restructuring of services and staffing in peripheral hospitals. [27039/99]
Written Answers. - Hospital Services.
In my term of office as Minister for Health and Children, I have undertaken a number of sub stantial initiatives in the acute hospital sector with a view to ensuring that services are reformed, re-organised and properly geared to meet the needs of our population. They include the recently launched cardiovascular health strategy which is aimed at achieving an integrated approach to the prevention and treatment of cardiovascular disease; the investment of £4.9 million in 1998 and £5.5 million this year in cardiac services, including cardiac surgery, to support the objectives of the wider cardiovascular strategy; the continuing implementation of the national cancer strategy which is already improving the availability of cancer treatment services throughout the country; the preparation, currently in hand, of a plan for the development of renal services, which will involve an investment of £20 million over the next three years, £6 million of which will be spent in 2000; the establishment of a medical manpower forum to review key aspects of medical staffing in public hospitals; the opening of a major new hospital in Tallaght; a range of other initiatives in such areas as acute hospital governance and management development, clinicians in management, hospital accreditation, laboratory accreditation and health technology assessment; and the continuing implementation of a co-ordinated waiting list initiative.
In terms of the future direction, I have recently comprehensively outlined my vision for achieving further progress in the development of acute hospital services. Against a background of the unprecedented increases that I have secured in day to day spending on health, the £4 billion barrier will be breached for the first time in 2000 having exceeded the £3 billion mark for the first time as recently as 1998, I recently announced the provision of £1 billion for infrastructural improvements in the acute hospital sector under the national development plan.
The developments that will be taking place will be underpinned by a number of key principles, as follows: equitable access to care, which does not place public patients at a disadvantage; availability of prompt treatment within a reasonable period – this means achieving very considerable reductions in the waiting time for public patients in all specialties, where measuring performance based on average waiting times is far more relevant than measuring the numbers on waiting lists; provision of the most appropriate form of care in the correct setting; a service that is organised and delivered in a patient-centred and very flexible manner, i.e. a longer core working day; flexible shift patterns, optimum use of expensive plant and equipment, implementation of pre-admission protocols for all elective cases, and much better synchronisation of the contributions of various professionals; comprehensive integration of services across all traditional boundaries, between and within hospital and community-based services, so that patients receive a seamless continuum of care – this requires speedy and reliable communication of infor mation at all levels of the system; customised attention for patients, in which their dignity and right to clear information is observed by all in the hospital service who come in contact with them, as well as structures that allow patients to feed their experience of the services back to providers; and an emphasis on measuring the real outcomes of our hospital services for patients, so that only the most effective treatments using best practice and evidence-based medicine are provided.
In terms of the future configuration of services, I have expressed the view that, following on the rationalisation of hospitals in the 1980s and early 1990s, we need to now use all of the facilities at our disposal. In this regard, trends towards the clustering of hospital services across two or more sites have offered a valuable opportunity to reconfigure selected services to the benefit of patients and ensures that all hospitals can discharge their own role to the fullest degree. This approach can secure the future of smaller hospitals while helping to ensure that requirements of quality and sufficient caseload are met as part of an overall drive for high quality services based on best practice.
Staffing issues are central to this overall quality drive, with particular regard to the need to continue to produce, attract and retain a sufficient number of well qualified and committed people to staff our hospitals. The deliberations of the medical manpower forum, the Commission on Nursing and the ongoing reviews of the work of paramedical staffs have been conducted against the background of these considerations.