The timeline for the reform agenda

The Smaller Hospitals Framework will be published and administrative Hospital Groups will be established in the first quarter of this year, leading to Hospital Trusts by the end 2015, the Secretary General of the Department of Health, Dr. Ambrose McLoughlin told the HMI West Regional Meeting in Galway. Maureen Browne reports.

The Smaller Hospitals Framework will be published and administrative Hospital Groups will be established in the first quarter of this year, leading to Hospital Trusts by the end 2015, the Secretary General of the Department of Health, Dr. Ambrose McLoughlin told the HMI West Regional Meeting in Galway.

Dr. Ambrose McLoughlin
Dr. Ambrose McLoughlin

He said the programmes to reduce waiting times for scheduled and unscheduled care – a critical element in advance of the transition to UHI – would be continued and the ambulance service reconfigured by the first quarter of next year.

Dr. McLoughlin paid tribute to the work of the HMI, saying it was a vital pillar of professional development for health managers and professional development would be vital in the months and years ahead.

He said Future Health, the Government’s high level plan for reforming the health system had mapped out the key actions, with timelines, for the achievement of the reform agenda.

These actions were focused on the steps required in order to implement Universal Health Insurance.

The reform meant that every citizen would be insured for a standard package of curative health services, there would be no distinction between ‘public’ and ‘private’ patients, there would be universal primary care, with GP care free at point of use for all and universal hospital care with independent, not-for-profit trusts and private hospitals.

Dr. McLoughlin paid tribute to the work of the HMI, saying it was a vital pillar of professional development for health managers and professional development would be vital in the months and years ahead.

There would be a multi-payer model, based on competing insurers. Social care services would be outside UHI system but integrated around the user.

The four pillars of Future Health were health and wellbeing, changing the model of care, financial reform and structural reform.

Health and wellbeing would provide a new concentration on keeping people healthy; it would require a whole-of-Government approach to addressing health issues across the life cycle and a Health and Wellbeing Policy Framework. A Health and Wellbeing Agency would be established early in 2015.

In primary care, GP care without fees would be extended on a phased basis, chronic disease management programmes would be introduced between 2013 and 2015, a programme of investment in Primary Care Centres would be implemented between 2013 and 2015 and the numbers of healthcare professionals working in primary care would be increased from this year.

On Social & Continuing Care, the Plan for VFM Disability Report would be implemented. The single assessment tool for older peoples’ services would be rolled out this year and in the last quarter of this year there would be a review of the Fair Deal Nursing Homes Support Scheme for sustainability and to assess its applicability to other sectors.

Work would be commenced on a national standard assessment tool for people with disabilities in 2013, the HIQA regulatory regime would be extended to residential services for people with disabilities this year and to other social and continuing care settings by 2016, while the roll-out of A Vision for Change, would be continued.

On the financial side, the Health Vote would be returned to the Department from January 1, 2014, with detailed preparatory work and road-testing throughout 2013. A programme-based budgeting would also be developed in 2013, a comprehensive financial management system would be implemented as a priority and there would be time bound plans for Money Following The Patient (MFTP) to create incentives that encouraged treatment at the lowest level of complexity that was safe, timely, efficient and as close to home as possible.

Robust governance and management structures were currently being developed which would clearly define roles, set out the accountabilities and responsibilities for each role, and develop effective management and reporting arrangements.

Dr. McLoughlin said that, in preparation for Universal Health Insurance, a preliminary paper on UHI would be published shortly. Work was already underway on reform of the private health insurance system, including a Risk Equalisation System and the regularisation of the status of the VHI.

From 2016, there would be a UHI funding model to cover primary care and acute hospital care.  This was vital for an effective MFTP system, social care, long-term care etc. would continue to be funded from general taxation.

Turning to structural reform, Dr. McLoughlin said the goal was to dismantle the ‘command and control’ system in health and replace it with a system of devolved autonomy, where increasing control was given to the frontline. There would be governance legislation and phased change towards UHI structures, including a Healthcare Commissioning Agency, ISAs would be reviewed in the second quarter of this year, primary care structures developed and action plans for shared services and external service delivery implemented.

“To implement this reform, we will need to get the building blocks for reform right and ensure overall coherence of reform initiatives. Keep the ‘show on the road’ while pursuing reform, learn the lessons of other health systems and be both ambitious and realistic in implementing change.

“Critical enablers will be Information/ICT, a comprehensive financial management system, a Health Information Bill, Unique Identifier and Universal Registration, the National Clinical Programmes, structural reform and governance, the Public Service Agreement, (which must be used to its outer limits) and Human Resource skills and capacity.”

Dr. McLoughlin said that real progress had already been made. Robust governance and management structures were currently being developed. These would clearly define roles, set out the accountabilities and responsibilities for each role; and develop effective management and reporting arrangements. A Programme Management Office was currently being established in the Department and a Programme Board would be established in the coming weeks

Dr. McLoughlin said the reforms were already benefiting patients. Between December 2011 and December 2012 there had been a 98% decrease in the number of adults waiting more than nine months for inpatient and day case surgery.

There had also been a 95% reduction in the number of children waiting more than 20 weeks for inpatient or day case surgery and a 99% reduction in those waiting more than 13 weeks for a routine endoscopy procedure.  The number of patients waiting on trolleys had been reduced by 23.6 per cent in 2012 compared to 2011.

He said consultation and collaboration with stakeholders would be crucial to success in the future. This has already begun – in the two weeks following the launch of Future Health, the Minister met with 1,500 local clinical and administrative staff and management as well as regional health forum members at 14 events across the four HSE regions. Consultation would continue throughout the reform process.