Vol. 557 No. 6
1 Ms O. Mitchell asked the Minister for Health and Children if in view of spending Estimates for 2003, he will be publishing revised target dates for the delivery of the health strategy; and if he will make a statement on the matter. [23104/02]
In 2001, I launched a comprehensive strategic plan for the health system. The national health strategy has been widely welcomed for the consultation process involved in devising it, its comprehensiveness, its long-term outlook and its in-built flexibility to allow for local ownership and environmental changes over its lifetime. This is the essence of a good strategic plan.
This is a seven to ten year plan and several key actions will take the full ten years to implement, such as the primary care strategy. The action plan and target dates enable systematic monitoring of progress in the achievement of the type of world class health system envisaged. At the reconvened national consultative forum held on 11 November last I outlined, with the help of Department officials and senior health board staff, a detailed inventory of investment and the associated service developments and changes in practice which have emerged in the last year, in line with the new strategic direction. I will be reporting to the Cabinet committee on the health strategy very shortly.
Many of the actions which are front-loaded in the action plan are concerned with detailed policy development or review for specific care areas, as well as showing a strong early start on the investment programme necessary to reconfigure our capacity around primary care and community services while ensuring that there is greater equity in the provision of acute hospital services. A strong showing has already been made in this regard with additional funding for the acute and primary care sectors in 2002, as well as significant investment, in particular, in services for older people, mental health and disability services.
The following provisions have been made in 2003: €53 million for bed capacity; €31 million for the treatment purchase fund; €29 million for cancer services; €4.5 million for the heart-lung programme; €43 million for the waiting list initiative; €25.7 million for acute hospitals pressures and €10 million for the ongoing development of the primary care model and GP co-operatives. There is also additional funding for mental health, disabilities, older people and children's services. It must be remembered that this is on top of the biggest increases in health expenditure in the history of the State.
The strategy acknowledges the need to change, improve and develop certain aspects of the way the system operates. Almost 50 actions in the action plan are concerned with the reform agenda. Achievements of a great many of these reforms do not require funding. They require a re-engineering of existing processes to focus on the new priorities and to focus more on the patient and client as being at the centre of the care process.
Additional informationI expect these targets to be met. Never has the need for maximum efficiency, value for money and accountability been more acute, and these concepts are well-embedded into the philosophy and practical actions of the strategy.
Work is under way to ensure that strategic and service planning is in place at regional and organisational levels. This means that service plans have the strategy's goals and objectives fully embedded as part of the everyday routine of health service delivery. The implementation of the strategy is not a parallel stream of activity, it is the way business will be conducted in the system from now on. The development of processes to fully capture, monitor and evaluate system improvement and change through the planning process is also under way. Other organisational reforms, such as the establishment of the health boards' executive, also provide renewed focus on the efficiencies and improved consistency across the system to be gained from conjoint working.
There remains a long agenda. Key initiatives which will inform and advance the reform agenda include the ongoing work of the consultants charged with the audit of structures and functions of the health system. I have already described the purpose and scope of the audit to the House in some detail. It is now well under way and has just entered its consultative phase. Its primary focus is to establish the organisational improvements needed to strengthen the capacity of the health system to meet the challenges of implementing the programme of development and growth, modernisation and reform set out in the Quality and Fairness Strategy document. A report is expected very early in the new year.
Work has begun on over 70 of the 121 actions in the strategy action plan. While the pace of the introduction of some elements of the strategy which require significant investment may vary, this is not the case for many other elements. While we will, of course, take stock of progress over the medium term, it is not my intention to publish revised dates for the delivery of the health strategy at this time. There is no doubt that implementation of the strategy involves chal lenges for everyone in the health system. Its implementation must be underpinned by strong management of the economy. That is our best guarantee that the health strategy will be delivered on.
I accept the Minister's point that this is a strategic long-term plan, nevertheless, the targets in it were set by him. The Estimates will clearly not fund the targets for next year, and many targets have already been missed for this year, such as that to provide additional beds. At the stroke of a pen this has become next year's target because it was not achieved this year. There is no funding for the expansion of the medical card scheme. I could give the Minister endless examples. Is he not concerned about the morale of the almost 100,000 workers in the health service, quite apart from patient considerations, who have bought into the strategic plan and who now see that the targets are not being met for a second year?
I do not accept that at all. In fact, this is the first plan in which targets were included. The earlier strategy in 1994 did not have any timetable for implementation.
It had commitments.
Target dates are important and place significant pressure on providers, the Department and myself to do everything possible to meet them. At the conference on 11 November we estimated that work has begun on up to 70% of the 121 actions, which is significant progress in 12 months.
In terms of the beds referred to by the Deputy, it was our aim to try to provide 709 beds, which is in excess of the strategy. The strategy itself provided for only 450, which itself was significant in the first year. I am informed by the health boards that they will reach the target of 600 this year and 109 early in the new year. The key point is that no one said at any stage that we would have 600 beds by January or, indeed, by the middle of 2002. We have to provide for the full year costing of the bed capacity in 2003. It is stated in the Estimates that it will now cost €118 million to commission 709 public beds in 2003. That has necessitated an additional €53 million over and above last year's provision in order to meet the full 12 month costs of beds that have been put in place this year. It is the first time in 20 years that we have had any kind of concerted increase in hospital beds in the public sector.
The organisational reform agenda is also important. Some 50 actions in the national health strategy revolve around reforms which do not involve significant costs and we are aiming to implement them as well. The strategy is one of reform and investment.
A sound fiscal strategy is the ultimate guarantor of the delivery of the health strategy. Any alternative, such as the fiscal strategies we experienced in the 1980s would truly consign it to oblivion.
Deputy Mitchell must be very brief.
I do not dispute that a sound fiscal policy is a good idea, but it was also a good idea last year and the year before.
What is the point in funding additional hospital beds when, inevitably, existing beds will close, given the core budgets that have been allocated to hospitals for the coming year?
We must move on to the next question.
Are any of the promises in the strategy in regard to disability going to be started in the current year, given the pathetic increases in this area?
Question No. 2 is called.
I wish to reply to Deputy Mitchell.
Very briefly.
I acknowledge that this year will be tighter. We are in a much more restrictive fiscal environment and that will limit the degree to which we can progress. We can still achieve much in 2003. I do not accept the projections made for 2003 in regard to the acute hospital system. Over the past two years alone, the base funding that is in place for the secondary care side of the hospital system is far greater than anything before. It is important to remember—
Question No. 2.
—that hospital activity has gone up by record levels over the past few years.
