Dáil Éireann díospóireacht -
Thursday, 7 Dec 2000

Vol. 527 No. 5

Other Questions. - Hospital Services.

Bernard J. Durkan

Ceist:

9 Mr. Durkan asked the Minister for Health and Children if any evaluation has been under taken within his Department to assess the total national need in respect of all aspects of hospital treatment and services; if the precise requirement in this area has been identified in view of the increased population and its age profile; if provision is being made to provide a quality health service in accordance with international standards and consumer needs; and if he will make a statement on the matter. [28952/00]

Mr. Martin

The Government is committed in the Programme for Prosperity and Fairness to a review of bed capacity in both the acute and non-acute settings. The bed review is being conducted by my Department in conjunction with the Department of Finance and in consultation with the social partners. I presented the interim findings of the review to my Government colleagues and identified a range of immediate investment proposals aimed at addressing identified service difficulties in both sectors. I am pleased to say that funding of £25 million has been approved on foot of the review to alleviate service pressures on the acute hospital sector. The second phase of the national bed review is now under way and involves the development of a longer term investment strategy for the acute and non-acute sectors. The review will also involve a detailed assessment of need, including an analysis of future bed requirements by medical and surgical specialty. These proposals take account of the effect of various factors, including anticipated demographic changes. The review will be completed in spring 2001.

Quality of service is one of the key principles underpinning the existing national health strategy and continues to be a cornerstone of health policy. I have a strong personal belief in the value of developing and supporting system wide quality initiatives which have as their principal focus the pursuit of continuous improvement of standards across the health service. I recognise that in health care, quality is not an option but a feature of the service which consumers have come to demand and expect. The overriding objective is to achieve real and measurable improvement for the consumer by putting the interests of the patient to the fore.

Preliminary work on the drafting of a new health service strategy to build on Shaping a Healthier Future has now begun. The new health strategy, due to be published in 2001, will provide a blueprint for the strategic management of the health service over the next five to ten years. It will draw on a wide consultative process involving key stakeholders in and around the health system. As well as a policy agenda it will address the partnership process required to carry the new health strategy forward to implementation. The new strategy will inform the quality agenda in health care which I am already supporting through a number of important initiatives. Examples of these initiatives include the introduction of a hospital accreditation programme, governance and management development, risk management, clinicians in management, clinical audit, patient advocacy and the development of hospital performance indicators.

Mr. Durkan

I thank the Minister for his comprehensive reply. Given developments in relation to hospital services and requirements in general, in particular over the past ten years, does the Minister agree that all the evaluation which has taken place, detailed as it is, is insufficient to either identify or provide for the current needs of the population? That was the case five years ago and is now the case to a more acute extent. Surely at this stage it is essential that public needs be satisfied to some extent in order to bring hospital services in terms of quality, standard and availability up to international standards. Does the Minister agree this is expected?

Mr. Martin

I do agree. We must continue to be vigilant in terms of standards and improve them. The hospital accreditation programme is probably one of the more effective strategies we have developed in terms of quality. We have brought in the national accreditation body in Canada to advise on the development of that initiative which will establish guidelines for hospitals and objective yardsticks against which they should be measured in terms of the delivery of services. This is the quiet, velvet revolution which will take place in our health services over the next number of years. We have allocated the funding to enable that to happen. That is happening in the case of all the major teaching hospitals. I look forward to the results of that engagement. The signs are good in terms of the personnel from the major hospitals who are engaging in the exercise under hospital accreditation.

An area I am anxious to promote is that of patient advocacy. There has been a lack in the health system in allowing for proper articulation of patients' needs and concerns. Some of the groups who emerged in recent times have made a meaningful contribution to that debate. I would like strong patient advocacy structures within the health service and I am working towards that end.

I dealt with bed capacity in previous replies. I have acknowledged we need extra beds and are engaged in a comprehensive exercise that has been facilitated by the Programme for Prosperity and Fairness, a bed review capacity to enable us to identify not only the global issue of how many beds we need but where they should go.

Mr. Durkan

Would it be preferable to reduce the problem to the micro factor by identifying a single hospital in a particular catchment area, dealing with it and then attempting to apply that principle to the overall system? What worries me about this proposal is that a good deal of the problems will be dealt with in the future. Having been a member of a health board for many years, I have heard it all before. Nothing has happened in the meantime and nothing will happen unless the problem is reduced to the smallest common denominator by focusing on one hospital catchment area and then applying the principle used to deal with it to other hospitals throughout the country.

Mr. Martin

In terms of hospital accreditation?

Mr. Durkan

In relation to the spectrum of services the public expect hospitals to deliver.

Mr. Martin

We will do that on a number of fronts. It makes sense in terms of the development of a hospital accreditation policy which is about quality and standards, and that is a central part of the Deputy's question. We have selected the major teaching hospitals as the starting point and they are engaging in that process.

In relation to the medical manpower forum which has recently concluded its deliberations, the idea is to situate the models emerging from that into specific sites or hospitals around the country to ascertain how they would work in practice, and we will do that.

In terms of the junior doctors issue, we are proceeding on the same basis in terms of introducing models on specific sites.