I am aware of the report by the Public Health Alliance to which the Deputy refers and the material contained therein in relation to health inequalities.
The Deputy will be aware that both the National Health Strategy, Quality and Fairness: A Health System for You, and various reports of the chief medical officer, in particular the annual report of the chief medical officer 1999 and Better Health For Everyone: A Population Health Approach for Ireland, the annual report of the Chief Medical Officer, 2001, have pointed out the links between poverty and ill health in an Irish context.
The national anti-poverty strategy is the main vehicle through which the Government's response to the problems of poverty and social exclusion is being channelled. The targets to reduce health inequalities set in the Government's review of the NAPS have been integrated into the national health strategy. These targets were developed in the course of an extensive consultation process with poor and excluded groups. Key health targets are to reduce the gap in premature mortality and low birth weight between the highest and lowest socio-economic groups by 10% by 2007, and to reduce differences in life expectancy between Travellers and the rest of the population.
Because of the wide range of factors which affect health status and health inequalities, both the National Health Strategy, Quality and Fairness: A Health System for You and the report of the working group on NAPS and health envisage these targets being met through a range of actions including greater focus on multi-sectoral work and health impact assessment. A health element has been included in Ireland's National Action Plan Against Poverty and Social Exclusion 2003-2005 published in August 2003 — an EU requirement in relation to progressing the Lisbon agenda.
The report of the chief medical officer Better Health for Everyone sets out how a population health approach led by a population health division in the Department of Health and Children would enable the multi-sectoral nature of the determinants of health and health inequalities to be more effectively addressed. This issue is being considered in the context of the reorganisation of the Department.
The national health strategy asserts quite clearly that to achieve better health for everyone and to reduce health inequalities, health must be put at the centre of public policy. In this context health impact assessment, HIA, is being developed so that relevant policies, strategies and legislation undergo a comprehensive process of health proofing so that their impact on the physical, mental and social well-being of the population is positive. The Institute of Public Health is already involved in some initiatives in this area and the Department of Health and Children in partnership with the Institute is developing a programme in this area which will include: policy seminars for senior management; training courses for HIA practitioners (project management, hazard identification, risk management, health gain interventions, HIA appraisal, inter-sectoral action); and review of HIA tools. An introductory policy seminar for senior managers has been held and HIA methodology guidelines and a screening tool for HIA have been published.
The important role of primary care in effectively addressing health inequalities was highlighted in the consultation process for the national anti-poverty strategy. The national health strategy acknowledges the central role of primary care in the future development of the health services. The implementation of the primary care strategy, Primary Care: A New Direction, is introducing a new model of primary care involving a core multidisciplinary primary care team, which will work with a wider network of health and personal social care professionals and will offer 24 hour cover. There has been substantial progress in the development of the ten initial primary care teams — one in each health board area — which were approved in late 2002, and additional personnel were funded. Once-off capital funding of €2 million and a further €1 million in respect of information and communications technology supports for the teams was also provided in 2002. Already, some of the teams are providing new or enhanced primary care services, for example, physiotherapy, social work services, shared care, to their target populations. Various teamworking initiatives are receiving high-level support and investment, as are needs assessment developments and research relating to primary care. The establishment of 24 hour GP co-operatives as part of the strengthening of primary care will help to reduce demand from, and treat appropriately, patients who would otherwise have to attend at an accident and emergency department.
One of the key objectives of the health service reform programme is to put in place organisational structures that will facilitate roll-out of the primary care strategy, building on the work already undertaken by the health boards in that regard. The development of future primary care teams will be informed by a needs assessment process at regional and local level. The primary care strategy sets out a vision for the development of primary care, building on the existing strengths of the system to develop an integrated, high-quality, multidisciplinary and user-friendly primary care service to meet people's health and social care needs.
Community participation is being progressed in the context of the primary care strategy, the Combat Poverty Agency building healthy communities programme, in which my Department participates, and implementation of HeBE's community participation guidelines.
The national health promotion strategy 2000 — 2005 is also central to reducing health inequalities, as are the cardiovascular strategy, the new cancer strategy currently being developed and the mental health policy also in development. Many other actions to reduce health inequalities are also under way.
Intensive community based services which have been put in place to provide support for children who may have emotional and behavioural problems include the springboard initiative and the youth advocacy pilot projects. There are now 22 Government funded springboard family support projects countrywide. Some 700 children and 400 parents benefit from these services.
My Department has made available €1.5 million to the Department of Community, Rural and Gaeltacht Affairs this year to match RAPID money being provided for play facilities following on from the publication of the national play policy for children Ready Steady Play.
The consultation process for the all-Ireland study on Traveller health status and health needs has been concluded. A proposal from the Institute of Public Health in relation to the design, management and funding of the study is currently under consideration in my Department. It is expected that the study will commence later this year. A pilot study on the inclusion of an ethnic identifier in a number of data sources is also being supported. These initiatives are taking place in the wider context of the ongoing implementation of the national strategy for Traveller health.
My Department has commissioned the Institute of Public Health to undertake a programme of work involving the health boards, the Health Board Executive, the Office for Health Management and the Combat Poverty Agency to support health boards to implement actions to achieve the NAPS targets to reduce at health inequalities. The first phase of the work which relates to information gathering and agenda setting is well under way.
The Institute of Public Health is progressing work on data and monitoring requirements for NAPS health targets and is also finalising an extensive literature review to identify effective interventions to address the higher rates of low birth weight found in more disadvantaged groups. The NAPS and health working group, including the social partners, has been reconvened in a consultative capacity to inform implementation and monitoring of the NAPS and health targets and to situate the work in the broader NAPS context.
My Department is working jointly with the office for social inclusion in the Department of Social and Family Affairs to develop guidelines for poverty proofing tailored to the health services.
Performance indicators for a number of groups at risk of social exclusion have been included in the national suite of performance indicators developed jointly by the Department of Health and Children and the health boards and currently in use in the context of the annual service plans. The groups included are Travellers, refugees and asylum seekers, homeless and those with an addiction.
The Public Health Alliance report raises the issue of capacity in the health system. The health strategy sets out a programme of investment and reform that will stretch over the next decade. It provides for the largest bed capacity expansion in the history of the health service. €118 million was provided, capital and revenue, to meet the first phase of a programme to provide a total of 3,000 new acute beds over the period to 2011. The Department has been informed by the Eastern Regional Health Authority and the health boards that, to date, 584 additional beds have been commissioned. Funding has been made available to health boards/authority to commission the balance of the 709 beds this year.
In relation to waiting lists in public acute hospitals, the target set out in the national health strategy states that by the end of 2004 all public patients requiring admission to hospital will be scheduled to commence treatment within a maximum of three months of referral from an out-patient department. Intermediate targets have been set to achieve this aim to ensure that the focus is being turned towards those patients waiting longest for treatment.
As the Deputy will be aware I have transferred responsibility for the recording and publishing of waiting list figures to the national treatment purchase fund. The NTPF has a multi-disciplinary team who have been working with individual hospitals to identify patients on waiting lists. The NTPF has been successful in locating additional capacity and arranging treatments for approximately 13,000 patients by the end of May this year. The NTPF has reported that waiting times have fallen significantly with 37% of patients now waiting between three and six months and 43% waiting between six and 12 months for surgery. Therefore, 80% of patients now wait less than one year for surgical treatment. This represents a major reduction in the length of time patients have to wait. The NTPF has the available capacity to treat patients and will continue to focus on reducing waiting times even further. The fund's target is to treat over 12,000 patients in 2004 and has the capacity to treat a minimum of 1,000 patients per month in Ireland and in the United Kingdom. If referrals can be maintained at this level the NTPF expects that waiting times for surgical operations should be reduced further and be brought in line with the health strategy targets of three to six months. It is now the case that, in most instances, adults waiting more than six months for an operation and children waiting more than three months will be facilitated by the fund.
In 2004 some €31 million was allocated to the health boards and Eastern Regional Health Authority as base funding to fund consultant and other support staff costs associated with reducing elective waiting lists. Funding for the national treatment purchase fund was also increased to €44 million in 2004. Therefore the total amount of dedicated funding available to tackle waiting lists in 2004 is €75 million.
In relation to the recommendation in the Public Health Alliance report advocating for publicly salaried hospital consultants who work exclusively for public hospitals, as the Deputy will be aware consultants currently holding the category 1 contract are contracted to devote substantially the whole of their professional time, including time spent on private practice, to public hospitals. There are approximately 1,200 approved category 1 consultant posts at present. The Deputy may also be aware that the Report of the Commission on Financial Management and Control Systems in the Health Service, the Brennan report, recommended the recruitment of consultants on a public only contract. This recommendation, and other recommendations relevant to the consultant contract arising from the Brennan report, the report on the Audit of Structures and Functions in the Health System, Prospectus report, and the Report of the National Task Force on Medical Staffing, Hanly report, will be progressed in the context of the negotiations on a new consultant contract. I am anxious to get these negotiations underway as soon as possible.
I might add that, as set out in the White Paper on Private Health Insurance, it remains Government policy to move, on a phased basis, to full economic pricing for private beds in public hospitals.
The Public Health Alliance report raises issues about eligibility for health services. The Government is fully committed to the extension of medical card coverage as set out in the health strategy. This will focus on people on low incomes and will give priority to families with children, particularly those with a disability. The timing of the introduction of the extension will be decided having regard to the prevailing budgetary position.
The reduction of health inequalities is a central objective of the national health strategy and of the Government's wider national anti-poverty strategy. My priority now is implementation of actions in the context of the these strategies and other related health strategies for particular groups and of the Government's health reform programme generally.