Written Answers. - National Health Strategy.
Finian McGrath
Ceist:
400
Mr. F. McGrath
asked the
Minister for Health and Children
if he is ignoring the most damning aspect of the health services, that is, the grossly unfair, unnecessary and avoidable inequality which provides health care according to financial means rather than medical need; and his views on whether equality is supposed to be at the centre of health policy.
[21923/03]
The Deputy will be aware that equity is one of the four key principles underpinning the national health strategy, Quality and Fairness: A Health System for You. The strategy explicitly identifies equity as being central to policy development, particularly in reducing the difference in health status currently running across the social spectrum in Ireland and in ensuring equitable access to services based on need. The strategy outlines measures to ensure that all public patients can expect a high quality of service within a reasonable period of time. This includes a ten-year programme for the largest ever concentrated increase in public acute hospital capacity. In addition, the national treatment purchase fund is being used for the purpose of purchasing treatments for public patients who have waited longest for treatment. Some €31 million has been provided in 2003 for the NTPF and available capacity has been identified in different specialities in Ireland and Britain to treat those eligible. In excess of 7,200 patients have been treated since the commencement of the scheme in July 2002. Investment in public hospital services has led to a reduction in waiting lists by 35% in the number of adults waiting more than 12 months for in-patient treatment between June 2002 and March 2003 and a reduction of 56% in the number of children waiting more than six months in the same period.
The health strategy recognises that there are barriers in the system to equity and these have been prioritised to ensure that the eligibility framework in the future can support equal access for equal need. As part of the implementation process for the strategy, a review of all existing eligibility legislation is ongoing in my Department. Arising from this review, legislation will be drafted to clarify and simplify eligibility and entitlements to health services in line with the goals and objectives set out in the strategy. In addition, the health strategy includes a whole series of initiatives to clarify and expand the existing arrangements for eligibility for health services, including recommendations arising from the review of the medical card scheme carried out by the health board chief executive officers under the PPF which include: streamlining applications and improving the standardisation of the medical card applications process to ensure better fairness and transparency; providing clearer information to people about how and where to apply for medical cards; and proactively seeking out those who should have medical cards to ensure they have access to the services that are available.
The actions set out in the strategy will ensure that all those eligible understand their entitlement, can easily access services they need and can be sure that, no matter where they live, there is a standard approach to their eligibility for services. As part of ensuring fair access, the strategy identifies the need to assure equitable access to services. This is primarily concerned with improved access to hospital services for public patients as well as recognising other barriers, which affect people's ability to access services.
The targets to reduce health inequalities set out in the Government's review of the national anti-poverty strategy have been integrated into the 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 ten per cent 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, the health strategy envisages these targets being met through a range of actions including greater focus on multi-sectoral work and health impact assessment. The 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 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 important role of primary care in effectively addressing health inequalities was highlighted in the national anti-poverty strategy consultation process and in the report of the national anti-poverty strategy and health working group. The primary care strategy provides for an interdisciplinary team-based approach to primary care provision. Clients may self-refer to any team member, and appropriate procedures will be in place to facilitate referral between team members and, where necessary, joint management by the team also. I have approved the establishment of an implementation project in each of ten locations.
The primary care strategy model includes mechanisms for the involvement of the community. The community and voluntary pillar is represented on the steering group for the implementation of the strategy and is also working with four of the ten initial implementation projects. Sustaining Progress includes a commitment that the learning from community involvement will be used to inform models of participation appropriate to the wider national health strategy. Also, the document community participation guidelines, published last December by the Health Board Executive sets out the spectrum of ways of involving patients and communities.
In May, my Department co-hosted a conference with the Combat Poverty Agency to launch their building healthy communities programme, which has a special focus on community development approaches to reducing health inequalities. My Department is also supporting financially, in the context of the implementation of the primary care strategy, a number of research projects under the aegis of the building healthy communities programme.
The report Ireland's Changing Heart, the second report on the implementation of the cardiovascular health strategy, published recently, highlights the importance of addressing health inequalities in the context of strategy implementation. Consideration is currently being given as to how this can best be addressed. Targets to reduce health inequalities will also be taken on board in the review of the cancer strategy currently under way. Mechanisms for developing an injury prevention strategy are under discussion between my Department and the health board executive.
In the 2003 letters of determination, and in other correspondence, my Department has asked health agencies to prioritise actions to reduce health inequalities. Further, the chief executive officer of each health board was asked to prioritise its funding allocations in favour of the RAPID and CLÁR projects. The Deputy will be aware that there are also a range of policies targeting specific vulnerable groups, for example Traveller Health: A National Health Strategy 2002-05 and the integrated strategy on homelessness, the youth homelessness strategy and the homelessness preventative strategy.
