Written Answers. - Health Services.
John McGuinness
Question:
178
Mr. McGuinness
asked the
Minister for Health and Children
the audit structure in place to review, from a national perspective, the efficiency or otherwise of the health services; his views on whether there is a need to have such an independent authority; and the plans, if any, to enhance the structure already in place.
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There are a wide range of structures in place to review the efficiency of the health services at both national and health board levels. These structures include various health strategies, programme expenditure reviews, service plans, performance indicators, audits by the Office of the Comptroller and Auditor General and OECD reviews. My Department's strategy statement of 1994 also emphasises the need to attain the highest standards of efficiency and value for money in the delivery of health care.
The 1994 health strategy set a framework for reorienting the health services to achieve health and social gain with a particular emphasis on improving the situation of people in the lower socio-economic groups. In 1998, my Department commissioned the first nationally representative survey of lifestyle practices, the National Health and Lifestyle Surveys, to provide baseline data to plan future interventions and this now forms the basis of my Department's new health promotion strategy for the years 2000 to 2005. The strategic aims and objectives of this strategy will contribute to reducing health inequalities.
In regard to specific objectives for key areas, the national cancer strategy set a target of reducing the proportion of deaths from cancer in the under 65 age group by 15% in the ten year period 1994-2004. A number of improvements in relation to service developments were also identified such as addressing regional imbalances, varying approaches to treatment regimes and the development of effective screening programmes.
The recently launched cardiovascular health strategy has set two targets for 2010. The medium term objective is to bring Irish levels of premature deaths from cardiovascular disease in line with the EU average at a minimum. The longer term goal is to reduce Irish rates to those of the best performers in the EU. The recommendations will be implemented in a planned and structured manner over five years. Funding will be linked to implementation of specific recommendations and appropriate monitoring arrangements will be put in place.
The Government decision of 25 March 1997 approved proposals for a process of expenditure reviews aimed at providing a systematic analysis of what is actually being achieved by expenditure in each programme and providing a basis on which more informed decisions can be made on priorities within and between expenditure programmes. Reviews of the intellectual disability programme and the dental treatment services scheme have been completed. A review of the nursing home subvention expenditure scheme has recently commenced.
Under the Health (Amendment) (No. 3) Act, 1996, health boards are required to submit an annual service plan to my Department setting out the level of service they will deliver for the financial determination they have received. The service planning discipline and structures now in place in health agencies and the continuing developments in this area will lead to enhanced efficiencies throughout the system. Part of this process includes the continuous refinement and development of a set of performance indicators to assist in the management and evaluation of health services and of improving health services delivery.
There is an ongoing development of information communications technology aimed at enhancing delivery and cost effectiveness through integrated care processes. These developments are contributing to the efficiency of service provision and the provision of better management information to assist in the pursuit of further cost effectiveness. I will be making significant investment in modern information systems. The national development plan provides for increased investment and development of these systems.
My Department's case mix programme collects information in relation to both hospital activity and its associated costs. It involves the monitoring and comparison of costs and activity between hospitals, classifies patients into discrete classes or groups which share common clinical attributes and similar patterns of resource use. The system uses clinical information which is derived directly from clinical practice in hospitals participating in the programme. Case mix budgeting ensures that cost effectiveness considerations are taken into account in determining hospital budgets. Also, the hospital in-patient enquiry, HIPE, programme collects and codes inpatient and daycase activity data and allows data to be classified into diagnosis and procedures.
The remit of the Comptroller and Auditor General includes carrying out value for money audits across the public sector and in relation to the health sector make recommendations on energy and the emergency ambulance services which are being implemented by health agencies.
The OECD in its review of the Irish health care System in 1997 said that the system had resulted in good provision of health care at relatively low cost to the taxpayer. The latest OECD report, 1999, reaffirmed that the Irish health care system continues to work well.
More recently, the Government in its review of the Action Programme for the Millennium announced its intention to retain consultants to carry out a comprehensive value for money audit of the health services to examine the trend in resource inputs versus the trend in service outputs to clients over the last ten years; the trend in demand for health services over the last ten years; the difference, if any, between the trend in the level of contribution to cost of public and private patientsvis-à-vis service levels to each category; and differentials in output costs across health boards and hospitals including specialities.
The consultants will also be requested to make recommendations on the development of a management information system for the health service which will allow monitoring of the above matters on an ongoing basis. My Department is currently engaged in the tendering process to appoint consultants to carry out the project and it is expected that this project will commence shortly.
I believe that the structures in place ensure that the delivery of health services is carried out in the most effective manner. The issue of an independent authority can best be addressed when the value for money audit by management consultants is completed.
