Building a better health service
Fine Gael wants to create a health service where people have universal access to affordable, quality healthcare in a timely manner. We can deliver more health services in the community so people get a good range of care close to home. We will increase bed capacity and staff numbers so hospital care can be provided in a timely manner. We can and must promote healthy lifestyles to support people staying well and living longer, healthier lives. Many parts of our health service do work well and we have dedicated healthcare professionals right across our services. Many health outcomes have significantly improved. But it is clear that our current health service needs major reform and is not currently the right size or shape to meet the needs of our growing and ageing population.
Our ambition is for a health service that:
- is compassionate, accountable and patient-centred;
- is focused on prevention and wellbeing as well as illness;
- is efficient and delivers value for money for taxpayers and patients;
- has enough capacity to meet the medical and social care need of our citizens;
- provides care to our people in a timely manner.
- enables citizens to access more care close to home in their communities;
- cares for its older citizens, enabling them to stay in their own homes as long as possible; and
- offers more choice and involvement in decision-making for people with disabilities and their families.
Among the actions that will be brought forward to meet this ambition are:
Implement the Sláintecare Plan
In the aftermath of the 2016 General Election, we established a cross-party committee to agree a 10 year plan to reform our health service – Sláintecare. We are now building on that unanimity, and through a detailed implementation plan we are transforming the all-party vision into reality. Over one hundred actions will be implemented in the next three years, reaching right across the health service to deliver better care for all.
Significant change such as this needs to be driven and championed, an Executive Director has been appointed, the Sláintecare Programme Office is already in place and an Advisory Council, comprising patient representatives, clinicians and international experts is providing advice and leadership.
Good governance of our health services
With a budget of €17 billion the HSE is the largest state agency and one of our most important. It provides essential services in every village, town and city, playing an important role in our lives often when we are at our most vulnerable.
It is vital that we ensure good governance, performance and accountability across all its layers, without which reform will be fleeting. This will be achieved through the establishment of an independent Board for the HSE. We have already appointed a chairperson designate and will pass legislation not only to underpin the new Board but to remove layers of bureaucracy and create regional structures to better align community and hospital care. These new governance structure will set the tone for the culture of the organisation, which must be based on the principles of independence, inclusiveness and compassion.
Major long-term investment in our health services to improve access to care
After years of budget cuts, Fine Gael oversaw increased health budgets from 2013 reflecting improvements in our economy. This substantial investment has resulted in 3,000 additional nurses, 1,500 more hospital doctors, improvements in pay and the provision of extra beds across the country.
Under ‘Project Ireland 2040’, we are providing €10.9 billion for 40 capital projects improving access to quality healthcare services, including major projects like the National Children’s Hospital, the National Forensic Mental Health services, the relocation of the National Maternity Hospital and the provision of additional long term residential accommodation for older people.
We are also delivering local improvements with new emergency departments in Kilkenny and Limerick, and additional plans for new EDs in Drogheda, Galway and Beaumont. There are now 125 Primary Care Centres in operation, with over 80 sites at various stages of development.
This funding will provide for 2,600 acute hospital beds, this includes new dedicated elective only hospitals in Dublin and Cork and 4,5000 social care beds. It will accelerate the roll-out of eHealth infrastructure.
We will build on the progress already made in tackling waiting times for some of the most common hospital operations and procedures including cataracts, hips, knees and tonsils. Investment in the National Treatment Investment Fund led to over 8,000 people receiving offers for treatment in 2017, in the first nine months of this year that figure had almost doubled. In 2019 we are further increasing funding to €75 million, to ensure more people are treated and spend less time waiting.
A similar focus is required to target outpatient waiting lists. In 2019 40,000 outpatient appointments will be arranged through the National Treatment Purchase Fund.
Making further advances in public health
Protecting the health of citizens is a duty of the state. Healthy Ireland is our national action plan to help people live healthier and longer lives. The most recent Healthy Ireland Survey demonstrates good progress on reducing the prevalence of smoking, citing the introduction of plain packaging as good motivation to quit. However, successive surveys have found problems with levels of alcohol consumption. The implementation of the recently enacted Public Health (Alcohol) Act will be instrumental in reducing harm from excessive alcohol consumption. The introduction of a tax on sugar sweetened drinks has positively impacted on the sugar content of many drinks.
For too long the issues of sexual health and reproductive rights were considered taboo, or often ignored. In 2015, we launched the first national approach to sexual health and wellbeing to promote positive attitudes, instilling a healthy attitude to sexuality in young people and ensure access to high quality information, education and services. We will continue to drive forward implementation of the ‘National Sexual Health Strategy 2015 – 2020’, including the roll out of a PrEP programme in 2019.
Following the repeal of the 8th amendment to the Constitution, we are committed to legislating for the provision of doctor-led termination service providing care at home and ending those lonely journeys to access healthcare abroad.
As part of our development of a National LGBTI Inclusion strategy, we will consult with leading LGBTi+ voluntary and community organisations to ensure accessible community-based services and supports across the country, improving training for health and social care professionals and developing a communications plan to raise awareness of mental health resources.
We will develop a best practice model of care for Trans People in line with World Professional Association of Transgender Healthcare (WPATH) standards of care. We have funded new posts in both adult and child and adolescent trans-health services and will continue to do so to address waiting times for specialist endocrinology services. We will deliver a framework for the development of National Gender Clinics and Multi-Disciplinary Teams for children and adults, funded by the Acute Hospitals and Mental Health divisions of the HSE based on the 2017 Service Development Model.
Improve patient safety
Speaking up is one of the critical aspects of patient safety. We have enacted legislation providing the legal framework to support voluntary open disclosure and are committed to introducing legislation providing for mandatory open disclosure and the mandatory reporting of patient safety incidents to HIQA.
A new Patient Safety Council will be tasked with undertaking a detailed review of existing open disclosure policies to ensure fitness for purpose.
Resourcing mental health services
Mental health challenges, in particular depression and anxiety, are amongst the most pervasive issues facing us today. Effective resourcing of our mental health services is vital to providing help when it is needed.
Additional funding has been targeted at mental health services since 2012 providing for an increase in CAMHS teams, the recruitment of more than 1,500 posts, the continued development of counselling services across primary and secondary care including Jigsaw, the development of clinical programmes on self-harm and eating disorders and the extension of seven day a week services.
A significant budget of almost €1 billion for 2019 will provide for further recruitment and the delivery of new services, focusing in particular on early intervention and support services which assist in dealing with mental health challenges before requiring hospital care. New services will also be brought on stream via the use of digital technology that will give service users the choice to connect with clinicians in the shortest possible time frame, complementing existing services in acute and community settings.
Better care close to home
General practitioners caring for patients in their homes and communities is the bedrock of our health service. We are developing a new GP contract providing for multi-annual investment enabling practitioners to better meet the needs of their patients and promote general practice as a viable career choice. This is essential to ensure the increased number of GP training places which we are committed to, are filled.
We have already made changes to entry provisions to the GMS scheme to accommodate more flexible GMS contracts, extended the retirement age to 72 and introduced an enhanced support package for rural practices.
Making the shift towards primary care in order to deliver more care close to home is paramount and a key principle of Sláintecare. There are 125 primary care centres in operation and 83 further are at various stages of development. These are supported by 16 Community Intervention Teams (CIT) which we will continue to develop and expand building on progress to date. CIT referrals are now 17% above the same period in 2017, helping to ease the pressure on hospitals by treating people at home, in a residential setting or in the community.
We will continue to increase the Primary Care Workforce. Over 130 new psychology posts for counselling services for children and 83 Speech & Language Therapy posts have been filled, and we are recruiting 40 additional Occupational Therapists. We will continue to increase funding for Paediatric Home Care Packages.
Advanced nurse practitioners are highly skilled clinical leaders contributing to solutions for some of the challenges in our health service including access to services, reducing delays and supporting early discharge. The first 120 advanced nurse practitioners commenced the new programme in 2017, with 30 further in October 2018.
Making cervical cancer a rare disease
In the aftermath of all the suffering, pain and worry caused by the CervicalCheck crisis it is incumbent upon us to set out a positive way forward, to recommit to our screening programmes and strive to make cervical cancer a rare disease as a lasting legacy to those affected. Our move to HPV testing and the extension of the HPV vaccine to boys will be key in making this a reality.
We know that screening saves lives and will continue to invest in CervicalCheck, BreastCheck and BowelScreen.
All 50 recommendations of the Scally Report will be implemented including the establishment of a National Screening Committee, an Independent Patient Council and the introduction of a statutory duty of candour.
Traveller and Roma Health
We know that by reducing health inequalities, we can deliver real benefits for all of us and for future generations, but health and wellbeing is not always evenly spread across our society. Health inequalities are experienced by members of the traveller community, demonstrated by the disproportionate impact from chronic disease and lower mortality rates. To deal with these challenges, we will ensure integrated primary care services aligned with comprehensive national projects, including
- accessible primary care projects, family support programmes, counselling, dedicated public health nurses;
- targeted mental health promotion and suicide prevention services; and
- ongoing engagement between our health service and representatives of Traveller and Roma communities to ensure that health policies being provided deliver for the needs of communities.
Improve organ donations
Irish people are extraordinarily generous in donating organs to save lives, and outcomes for transplant recipients in Ireland continue to rank amongst the best in Europe, but the need for organ transplants continues to increase. It is important that we do all that we can to enable individuals and families to make this life-saving decision and are committed to introducing an opt-out system for organ donation.
Giving patients access to the medicines they need
Securing access to new and innovative medicines for Irish patients is vital and this must be achieved in a safe and sustainable manner. The challenge of securing affordable access to new medicines is not unique to Ireland. That is why we must seek out initiatives leading to better access to medicines for patients, including membership of the Beneluxa Initiative joining with other European countries to work together in increasing access to new medicines for patients. We have also put in place a Rare Diseases Technology Committee to provide for the expert assessment of orphan drugs and other medicines for rare diseases. We are developing a National Biosimilars Policy to help patients access cheaper medicines in a similar way as we are already delivering via generic substitution.
High quality end-of-life care
We have made significant improvements in specialist palliative care services including new hospice beds and the establishment of a children’s palliative care programme. We have increased the number of specialist palliative care beds country wide by 50% in the last five years will increase the number by a further 50% over the next five years ensuring there will be a hospice serving every region in the country. We will open units in Mayo, Waterford and Wicklow in 2019. Plans are underway to build units in Drogheda and Cavan, and a further inpatient unit is planned for the Midlands.
We will continue to support Community Specialist Palliative Home Care Teams in all HSE areas, fund designated home care packages and resource specialist palliative care provided in 39 acute hospitals. We are increasing resources for the Children’s Palliative Care Programme supported by Consultants with a Special Interest in Children’s Palliative Care and Children’s Outreach Nurses to coordinate care for children with life limiting conditions and their families.