Written Answers. - National Health Strategy.
Bernard Allen
Question:
163
Mr. Allen
asked the
Minister for Health and Children
the items which are and those which are not deliverable within the health strategy in view of the effective cut in expenditure in the health services for 2003.
[26040/02]
In 2001, I launched the national health strategy which is a comprehensive strategic plan for the health system. The strategy is a seven to ten year plan and several key actions will take the full ten years to implement – for example, 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 shortly.
Many of the actions which are front-loaded in the action plan in the strategy 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 in 2002 with additional funding for the acute and primary care sectors as well as significant investment in services for older people, mental health and disability services in particular. It must be remembered that this was on top of the biggest increases in health expenditure in the history of the State.
An additional €694 million has been allocated for 2003 bringing the total health spend for next year to €8.9 billion, including capital. In relation to the health strategy, this provision will enable further advancement in a range of specific areas:
Action 78 relates to the provision of additional acute hospital beds for public patients. An extra €53 million in 2003 has been provided for the completion of the programme of 709 additional beds in acute hospitals. The overall investment in bed capacity over 2002 and 2003 is therefore €118 million, including capital.
Action 55 relates to a programme of investment to provide the necessary capacity in primary care, acute hospital and other services. Additional funding of €514 million is being made available to further improve health infrastructure and allow for progress on projects.
Action 81 relates to the reduction of waiting times for public patients. Some €31 million is available in 2003 for the treatment purchase fund, in addition to substantial base funding of €43 million for the waiting list initiative.
Action 61 relates to the further development of organ transplant services. In 2003, an additional €4.5 million is available for the lung transplant programme at the Mater Hospital, Dublin.
Actions 76 and 77 relate to the development of primary care. An additional €10 million has been provided for the development of primary care including GP co-ops and primary care units in 2003.
In relation to homelessness (Action 21), a total €4.2 million in additional funding was provided –€2.7 million targeted at adult homelessness and €1.5 million targeted at youth homelessness. A further €6 million was provided for the development of child care services, including family support services (Action 27).
An additional €7.6 million will be invested in mental health services in 2003 (Action 25).
An additional €28.4 million is provided for 2003 to improve services for people with disabilities and to further develop the availability of appropriate care in an appropriate setting (Actions 54 and 55).
An additional sum of €29 million is being allocated for cancer services in 2003. This investment will ensure that next year we will continue to address increasing demands in cancer services in such areas as oncology/haematology services, oncology drug treatments and symptomatic breast disease services (Action 12).
Additional funding (€7 million) has been provided for the further implementation of the cardiovascular strategy (Action 5).
Further funding of €12.6 million will be available in 2003 for services for older people (Actions 26 and 55).
Additional funding of €2.4 million has been provided for palliative care (Action 31).
As the Deputy may already be aware, the economic situation, regrettably, does not allow for the extension of medical card eligibility at this time. Nevertheless, this remains an objective of the health strategy.
The strategy also acknowledges the need to change, improve and develop certain aspects of the way the system operates. Almost 50 actions in the action plan for the strategy 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 (i) to focus on the new priorities and (ii) to focus more on the patient and client as being at the centre of the care process. I 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 organisation 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 are also under way. Other organisational reform 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.
A key initiative which will inform and advance the reform agenda includes the ongoing work of the audit of structures and functions of the health system. The audit was commissioned in order 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 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. In addition, it should be noted that the estimates for 2003 show that the Government have provided for 74% of the net total increase in public expenditure in the Estimates to be set aside for the health service. This demonstrates the Government's determination to continue to prioritise health. While we will, of course, take stock of progress over the medium term, it is not my intention to revise dates for the delivery of the health strategy at this time.
There is no doubt that implementation of the strategy involves challenges for everyone in the health system. Its implementation must be underpinned by strong management of our economy. That is our best guarantee that the health strategy will be delivered on.
