Priority Questions. - National Health Strategy. – Dáil Éireann (28th Dáil) – Wednesday, 24 Apr 2002

Mr. Martin

The Government's health strategy, Quality and Fairness: A Health System for You, is the most comprehensive health sector strategy in the history of the State. It represents a whole system approach to the issue of health in Ireland and goes beyond the traditional concept of health services. It accepts that although much has been achieved, more remains to be done. The strategy has a wide-ranging agenda encompassing matters such as cross-sectoral working to influence the wider determinants of health and the development of specific services. It also encompasses a wide-ranging and ambitious agenda for change.

A number of items have been prioritised this year. The Government showed its commitment to the health strategy through the funding provided in this year's budget, which amounted to €209 million revenue and €40 million under capital expenditure, including new initiatives and development of certain existing services described in the strategy. In addition to the budget package, a further €161 million is available in 2002 for the development of existing services under the strategy.

One of the key strengths of the health strategy is the inclusion of a detailed action plan and a monitoring and evaluation framework. The mechanisms and structures provided for in the framework are essential if we are to meet the deadlines set out in the action plan. The first of these structures is already in place. The strategy's goals and objectives have been embedded into the Department's business plan to ensure that the Government's commitments are given appropriate priority in the context of a wide-ranging brief. The 2002 service plans of health boards reflect the many actions which must be advanced at health board level in the next year. The inclusion of a detailed action plan has helped to focus the key actors on the priorities of the strategy and has clarified responsibility for implementation. I am happy to provide the Deputy with a list of the specific actions which have progressed this year.

Additional informationIn terms of implementation structures, the departmental health strategy implementation team is in place. A vacancy at assistant secretary level has been filled in recent weeks and the primary care task force has been established. Nominations for the steering group are currently being sought and Professor Ivan Perry of University College Cork has agreed to chair the group. A team to manage the treatment purchase fund has been established, which is interdisciplinary and led by independent consultant, Ms Maureen Lynott, who has been appointed as project director. The Crisis Pregnancy Agency has been established and Ms Olive Braiden has been appointed as chairperson. The national committee on breastfeeding has been appointed and will be chaired by Miriam Wiley of the ESRI. The Health Boards Executive was established on 15 February.

The following documents have been published: The primary care document, "Primary Care: A New Direction" in November 2001; the consultation document, "Your Views About Health" in January 2002, and "Traveller Health – A National Strategy 2002-2005" in January 2002. The Public Health (Tobacco) Bill has been signed into law, and scheduling of the implementation process, including the making of commencement orders and regulations is under consideration. Progress is also being made on the following key actions – finalisation of the national environmental health action plan; review of medicines legislation; licensing of alternative medicines; information and education campaign on the strategy's goals and objectives; commissioning of over 700 additional acute hospital beds; preparation of an action plan for people management; restructuring of the Department of Health and Children and audit of functions and structures in the health system.

The health strategy published in November is an ambitious plan and its implementation will require sustained effort over the next seven to ten years. There will be challenges for everyone working in the system along the way. I am very pleased with the progress that has been made to date.

ActionNumber	Action	Deliverable	Progress to Date
2	Statements of strategy and business plans of all relevant Government departments will incorporate an explicit commitment to sustaining and improving health status.	Departmental statements of strategy to include commitments to sustaining and improving health status [With immediate effect]	The Secretary General of the Department wrote to all relevant Government Departmental Secretary Generals in November 2001 following the launch of the Health Strategy. This letter drew their attention to specific initiatives in which it is envisaged other Departments would play a significant or lead role; and also referring specifically to actions that will require co-ordination between more than one Department. This included reference to the need to embed an explicit commitment to sustaining and improving health status in departmental strategies and business plans.
3	The National Environmental Health Action Plan	Plan submitted to Government [June 2002]	Specialist staff in the environmental health area from health boards are working in liaison with the Department's Chief Environmental Health Officer on formulation of a plan for submission to Government in June 2002. Specialist expertise/advice from the European Region of the WHO is also being availed of in formulating the plan.
4	A population health division will be established in the Department of Health and Children and in each health board	New division established [March 2002]	The establishment of a population health division within the Department forms part of the exercise to restructure the Department.
6	The Public Health (Tobacco) Bill will be enacted and implemented as a matter of urgency	Enactment of Bill [Passed by Easter 2002]	The Public Health Tobacco Act, 2002, (Number 6 of 2002) was signed into law by the President on 27 March 2002. The scheduling of the implementation process including making of Commencement Orders and Regulations is under consideration.
9	Measures to promote and support breastfeeding will be strengthened	National breastfeeding committee appointed [December 2001]	The National Committee on Breastfeeding was established in December 2001. The Committee, chaired by Miriam Wiley of the Policy Research Centre at the Economic and Social Research Institute, held its inaugural meeting on the 20th of March of this year.
20	The health of Travellers will be improved	Travellers health strategy published [Published 2001]	“Traveller Health - A National Strategy 2002-2005” was published in February 2002. The Government has approved total additional funding of €8.2m for the implementation of the Strategy over the period 2002-2005. The Department is currently drawing up a plan for implementation of the Strategy, outlining for each action approved the target date for implementation and who is responsible for its implementation. Health Boards are drawing up plans for implementation of the Strategy at regional level.

ActionNumber	Action	Deliverable	Progress to Date
28	A comprehensive strategy to address crisis pregnancy will be prepared	Crisis Pregnancy Agency established [Immediate]	The Crisis Pregnancy Agency was established on 2 October 2001 under the Health (Corporate Bodies) Act, 1961. Ms Olive Braiden has been appointed as Chairperson to the Board of the Agency. Two staff have been seconded from my Department to enable the Agency to become operational as soon as possible.
			The Agency has already met with a number of key agencies for initial consultations. The Agency intends to conduct a wide-ranging process of consultation leading to the drafting of a national strategy to address crisis pregnancy. For this purpose it placed advertisements in the national press yesterday inviting submissions from Departments of State, service providers, interested parties and the public on all relevant issues. A sum of €6.5 million has been provided for the Agency in the current year. The Agency will be considering the allocation of this funding in the course of the year.
30	An action plan for rehabilitation services will be prepared	Working group on rehab. Services established [Working Group established end 2001]	The Report of the National Committee on Medical rehabilitation is currently being reviewed by the Department in consultation with the health boards. A small Working Group will be established shortly to prepare the proposed Action Plan within the time-frame specified in the Health strategy.
64	A review of medicines legislation will be undertaken.	Review commenced [End 2001]	Preliminary work has commenced on the review of medicines legislation.
65	Licensing of alternative medicines will be examined	Submission of recommendations to the Minister [End 2001]	The Irish Medicines Board has submitted proposals to the Department for an interim national licensing system for traditional and alternative medicinal products including herbal medicines. An information seminar on the implications of its proposed new licensing system for such products has been organised by the IMB, at the request of the Minister, and will take place on 2 May 2002.
69	An information/education campaign will be undertaken for all decision-makers in the health system on the Strategy's goals and objectives	National, regional and local communications programme [Commencing immediately]	A comprehensive information-education campaign was carried out in each health board in the weeks following the launch of the Strategy. The communications strategy was aimed at reaching each member of staff. Copies of all of the documents have been made available widely. In addition, the Department's implementation team have been responding to specific requests for briefing on the Strategy and have already responded to requests from over 20 organisations.
74	A new model of primary care will be developed	Primary Care: A New Direction published [Immediate]	Primary Care: A New Direction – the document which outlines a new model of primary care for the Irish health system was published on the 28th of November - two days after the launch of the main document.
75	A National Primary Care Task Force will be established	National Primary Care Task Force established [January 2002]	The Primary Care Task Force has been established and has already begun work. The Task Force will have responsibility for leading the implementation of the changes and developments set out in the Primary Care Strategy.
			The Task Force will report to a wider steering group, which will include representatives from primary care professional groups, the community and voluntary sector and other relevant stakeholders. The steering group will be chaired by Professor Ivan Perry, Department of Epidemiology and Public Health, University College Cork.
			The Department has sought nominations from a wide range of bodies, to the Steering Group.
81	A comprehensive set of actions will be taken to reduce waiting times including the establishment of a new ear-marked Treatment Purchase Fund	Additional Bed Capacity Fund established Treatment Purchase Team appointed [Ongoing]	The Government is committed to providing an additional 3,000 beds in acute hospitals over the next 10 years. A €65m investment package was announced in January for the commissioning of 709 of these 3,000 beds in acute hospitals in the current year. The Department has been advised, by the ERHA and the Health Boards that 98 of these beds have been commissioned, that an additional 23 beds will come on stream by the end of April 2002, with a further 49 beds by the end of May 2002. The balance will be introduced on a phased basis during the rest of the year.
			The Treatment Purchase Team to manage the new fund has been established. It includes medical, nursing, economics, public health and administrative expertise. The team has had preliminary discussions with the medical organisations and private hospitals and has initiated contacts with health services in other countries that have experience of operating similar schemes.

ActionNumber	Action	Deliverable	Progress to Date
108	A detailed Action Plan for People Management will be developed	Plan published [Plan published by October 2002]	A working group of HR personnel was established in February – representatives from the health boards, the Dublin Academic Teaching Hospitals, my Department, the HSEA and OHM. Following a meeting of the national partnership forum 3 union representatives were added – INO, SIPTU and MLSA. A subgroup has been established to make progress on issues raised between plenary group meetings. A consultative workshop has been set for May 22nd. Professor Bill Roche will be providing academic support to the creation of the plan. The plan is on schedule and should be complete by the deadline date of October 2002.
109	The Department of Health and Children will be restructured	Review completed [Review completed June 2002]	Work has commenced on a review of structures within the Department of Health and Children. A consultant has been appointed to work with the top management on the changes needed.
112	The Health Boards Executive (HeBE) will be developed as a key instrument in the change agenda	HeBE established and operational [March 2002]	The HeBE was established by order on 15th February 2002. Its work has already commenced with the launch by the Minister for Health and Children, of three reports prepared under the aegis of the HeBE.
114	An independent audit of functions and structures in the health system will be carried out	Audit complete [June 2002]	An invitation to tender for the audit of structures and functions of the health system has been posted in the EU Journal, national newspapers and the Department and Government e-tendering websites. A pre-tender briefing was held on 17 April for prospective tenders. Final date for receipt of completed tenders is May 20.
115	The National Health Information Strategy will be published and implemented	Strategy published[December 2001]	It is hoped to bring the NHIS to Government in the coming weeks. Finalisation of the strategy is later than anticipated. This occurred due the need for the NHIS Project Team to review issues which arose in the context of the preparation of the main Strategy document including, for example the establishment of National Health and Information Authority.

Mr. G. Mitchell

Would the Minister agree that the so-called health policy he put forward is no more than an election gimmick, and that none of the deadlines he set himself for the first quarter of 2002 was met? Would he also agree that all the 107 standing committees, reviews and inquiries are no more than paralysis by analysis? When the time comes to examine his real role in the Department, it will be found that he will have left the same legacy as Mr. Seán Cromien at the Department of Education, namely chaos in management.

Mr. Martin

I, of course, reject the Deputy's assertions. As I mentioned, the primary care task force has been established. The team to manage the treatment purchase fund has been established—

Mr. Neville

Late.

Mr. Martin

—and headed up by Ms Maureen Lynott. The Crisis Pregnancy Agency has been established with Olive Braiden as chairperson.

Mr. G. Mitchell

That was not in the strategy.

Mr. Martin

It was.

The national committee on breastfeeding has been appointed, to be chaired by Miriam Wiley of the ESRI. The Health Boards' Executive was established on 15 February. The following documents have been published, the primary care document; the consultation document, "Your Views About Health," January 2002, and "Trav eller Health – A National Strategy 2002-2005," also in January.

Mr. G. Mitchell

The Minister is talking baloney. These are only words.

Mr. Martin

The Public Health (Tobacco) Bill has been signed into law, and scheduling of the implementation process, including the making of commencement orders and regulations is under consideration.

Mr. G. Mitchell

What about refloating the Titanic?

Mr. Martin

Progress is also being made on the following key issues – finalisation of the national environmental health action plan, review of medicines legislation, licensing of alternative medicines, information and education campaign on the strategy's goals and objectives—

Mr. G. Mitchell

The Minister has not met any targets.

Mr. Martin

—commissioning of over 700 additional acute hospital beds, which exceeds the target we set ourselves in the health strategy—

Mr. G. Mitchell

The Minister did not meet any targets.

Mr. Martin

—preparation of an action plan for people management, restructuring of the Department of Health and Children, an audit of functions and structures in the health system, the establishment of the Mental Health Commission and many others. I could list a range of targets and objectives that have been met. We have made almost 20% progress so far in the health strategy's objectives. The funding that we allocated this year will have a knock-on implication of over €759 million over the next two years, even before any other measures next year or the following one.

Mr. G. Mitchell

I am glad the Minister mentioned funding. Is he aware that the six major teaching hospitals in Dublin in the second quarter of this year have still not received their budgets for this year? Is he aware that they did not receive any income to fund the repair and maintenance of important CAT scanners, for example, either last year or this year, or that when they break, as they will as sure as night follows day, the chaos will be ten times as bad as what happened in accident and emergency? What kind of legacy is he leaving to his successor?

Mr. Martin

I welcome the fact that political parties across the board are prioritising investment in health going into this election, which is an achievement of the process that led to the formulation of the strategy. We have substantially increased funding again this year to the ERHA in respect of the acute hospital sector. I understand that talks are ongoing between the major voluntary hospitals in the ERHA region and the authority, and that there will be tripartite talks between these two parties and the Department to resolve issues and difficulties that have arisen. There should be no mistake about health funding which has increased by 120% over the past four years.

Dáil Éireann debate -
Wednesday, 24 Apr 2002