John Deasy
Ceist:21 Mr. Deasy asked the Minister for Health and Children the efforts he has made to ensure that persons on low incomes have better access to health care; and if he will make a statement on the matter. [10861/04]
Amharc ar fhreagraWednesday, 7 April 2004
Ceisteanna (24)
Freagraí scríofa
The health strategy emphasises fairness and the objective of reducing health inequalities in our society. The Government has taken a series of initiatives which are set to improve access to the public health services and therefore have a particular impact on access for those on low income. Shorter waiting times for public patients are being prioritised, with the expansion of bed numbers and the national treatment purchase fund. In addition, there are clear commitments to targeting vulnerable and disadvantaged groups including: continued investment in services for people with disabilities and older people; initiatives to improve the health of Travellers, homeless people, drug misusers, asylum seekers and refugees, and prisoners; and implementation of the NAPS targets relating to health.
The health strategy includes a commitment that significant improvements will be made in the medical card income guidelines in order to increase the number of persons on low income who are eligible for a medical card and to give priority to families with children, particularly children with a disability. This should be viewed in the broader context of the strategy's emphasis on fairness and its stated objective of reducing health inequalities in our society. Due to the prevailing budgetary situation it is not possible to meet this commitment this year but we remain committed to the introduction of the necessary changes within the lifetime of this Government. Access to health services is more complex than medical card eligibility. The provision of improved services in the publicly funded health services is key to better access for people on low income.
Under the first phase of the acute bed capacity initiative, I have provided €118 million for an additional 709 beds, of which 584 have been commissioned to date in the first phase. Funding has been made available to health boards and authorities to commission the balance of the 709 beds this year, all of which are intended for use by public patients.
Significant progress has been achieved in reducing waiting times for adults and children. The number of adults waiting more than 12 months for in-patient treatment in the nine target surgical specialties has fallen by approximately 42% from 6,273 to 3,658 between September 2002 and September 2003. The number of children waiting more than six months for in-patient treatment in the nine target surgical specialities has decreased by 39%, from 1,201 to 734 in the same period. The national treatment purchase fund continues to target those adults and children waiting longest for treatment. The fund will facilitate, in most instances, adults waiting more than six months for an operation and children waiting more than three months. If patients are prepared to exercise choice by travelling to where there is capacity, they can be treated more quickly in many instances. By the end of March the fund had arranged treatment for approximately 12,107 patients. To give it a significant lead role in targeting waiting times for patients, I have increased the level of funding for the NTPF in 2004 bringing its overall allocation to €44 million.
Access to primary care services is of crucial concern to this Government as is evidenced by the publication of a separate strategy document, Primary Care: A New Direction. Primary care is the first port of call for most who use health services. It can meet 90-95% of all health and personal social service needs. It is a vital public service. The primary care strategy sets out a vision of the service we want to put in place building on our existing strengths, to develop a high-quality, user-friendly primary care service to meet people's needs in the future. However, change will not be effected overnight. The strategy sets out an implementation plan, which recognises the breadth of the change required to support the roll-out of the new primary care model over the next decade.
The primary care strategy acknowledged that the current health board structures are not optimised to support the development and reorganisation necessary to implement the new primary care model on a widespread basis. The new structures being developed under the health service reform programme will ensure that the system is organised and managed to support the development and implementation of the health strategy, including the primary care strategy. The targets to reduce health inequalities set out in the Government's review of the national anti-poverty strategy and which were developed in the course of an extensive consultation process have been integrated into the national health strategy. 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.
While access to health services is one of the factors that affect health status it is not the only one. The policies and activities of a wide range of areas effect health and health inequalities. This is why the first objective of national health strategy, under goal one, better health for everyone, is that "The health of the population is at the centre of public policy." To achieve this objective the Department of Health and Children is working with the Institute of Public Health to implement a programme of health impact assessment.
In the 2004 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 NAPS and health working group has been reconvened in a consultative capacity to monitor progress towards achievement of the targets. The social partners are represented on the working group.
Action 19 of the national health strategy is aimed at developing and expanding initiatives to eliminate barriers for disadvantaged groups to achieve healthier lifestyles. Health boards have established key partnerships with organisations in the community, both voluntary and statutory sectors, to try to eliminate such barriers and achieve healthier lifestyles. Implementation of the health promotion strategy, the Traveller health strategy, homelessness strategies and the national drugs strategy continues. Groupings targeted include low income groups, mother and toddlers groups, young lone parents, clients of mental health services, older people, people with disabilities, early school leavers and asylum seekers.
Action 52 of the national health strategy advocated community participation initiatives to enable people to have their say in health matters that concern them locally. Initiatives include: guidelines on a health service approach to community participation were produced by the Health Boards Executive in association with the Department in 2002; four boards have established regional advisory panels or consumer panels for older consumers and their carers, six boards have established consumer panels dealing with a range of service delivery issues; and the national consultative forum is convened annually to monitor progress in the implementation of the national health strategy and to comment on priorities and emerging trends. The forum is broad-based and includes patient and client groups, service providers, senior management in the health system, the voluntary sector, and organisations with an interest in the health system and relevant Departments.
Since 1997 funding for the health services has increased by 188.2% to over €10 billion in 2004 and hospital activity has increased by 28%. This, together with the actions outlined above, demonstrates my commitment to better access to publicly funded health care which particularly benefits those on low incomes.