Department’s new policies and priorities

The new Department of Health policies, priorities and practices which, he said, would play an important part in shaping the development of the services in the coming 12 months, were spelled out to the Conference by Mr. Jim Breslin, Secretary General, Department of Health.

Mr Jim Breslin
Mr Jim Breslin

He said that the Department of Health was now embarking on considerable change and they believed it was their role to give leadership and policy direction.

“The Department should provide leadership and policy direction for the health sector to improve health outcomes, governance and performance oversight to ensure accountable and high quality services. It should collaborate to achieve health priorities and contribute to wider social and economic goals and an organisational environment where, on an on-going basis, high performance is achieved and the knowledge and skills of staff are developed.”

We have to have a rapid and credible response to public concerns.

Mr. Breslin said they wanted a Department of Health that was focused on priority outcomes, evidence informed, responsible and accountable, supportive of staff, committed to learning, development and health and wellbeing and open in sharing and collaborating.

There was particular emphasis on leadership and cross-Department working on policy and strategy and governance and performance and stronger resourcing of existing and new areas including patient safety, policy, the different care settings, finance and evaluation, R&D and the new area of Health Analytics.

“The challenge for each health organisation (including the Department) is to develop a vision of the organisation’s contribution to population health, command legitimacy and support and deliver operationally.

“We have to examine where population health is in our organisational priorities within the health sector, if our contribution is as positive and up to date as it could be, if we are trapped in outmoded routines if our contribution is attuned to current and projected requirements, if we are collaborating internally and externally to the degree that population health required.”

“We have to have a rapid and credible response to public concerns. We have to deliver operationally by addressing outmoded structure and rigidity, improve skills, processes and performance, emphasise delivery of strategic outcomes, e.g.governance and performance policy and strategy and R & D and Analytics.

Under EU rules we could no longer spend money we didn’t have through excessive borrowing.

“We must place public service and health care values at the centre, lead higher performing, and more accountable organisations, deliver credible operational improvements today and radically reform operating models to cope with growing demands.

“The key thematic areas for the Department are to drive the Healthy Ireland agenda, deliver improved patient outcomes, reform operational systems, implement agreed steps towards universal healthcare, introduce innovative funding models and modernise health facilities and ICT infrastructure.

The Secretary General said that performance problems with the health services which we read about in the media did not reflect the everyday experience. There was much going on that was much more powerful and positive but cumulatively these performance problems provided a barrier against the kind of support people must have for the public health service.

“I think in many instances we have patients’ trust but this is corrosive of that trust. We have to move forward while working on these problems”

Mr. Breslin said that the Department took a view that in relation to 2015 they would seek to set out a range of priorities which would be seen as achievable although they would take considerable effort around the health services and the Department to deliver that approach.

He said progress as at September included the under 6 and over 70 GP service, an increase in the number with health insurance, and 25 out of 33 public priorities were on track to be delivered by year end. Reducing trolley waits and waiting times for scheduled care to target levels were not yet assured.

He said that Ireland’s demographic challenge would come at us at a much sharper pace and a much steeper curve than other EU and other countries and with a service already struggling it would pose considerable challenges. Between 2001 and 2013, Ireland’s percentage population growth at 20%, was over twice the EU average, while the projected percentage population growth in the 65 years and older age group at over 24% compared to the EU average of 15%.

“Fiscal space is another challenge which we have begun to talk about in recent years and I don’t think we fully appreciate its implications. This is now part of the EU Treaty and it provides for fiscal restraints and our expenditure has to be managed in the context of EU rules. Its objective is to address the ‘boom and bust’ economic cycles, which have not served us well and to address our budgetary policy.

“Under EU rules we could no longer spend money we didn’t have through excessive borrowing (if our 3% deficit or 60% debt level were not reducing satisfactorily, it triggered an Excessive Deficit Procedure).

“Even if we had the money we still might not be able to spend it. Expenditure was only allowed increase in line with an estimate of the sustainable growth path of the economy. One-off, temporary or buoyant revenue was not available to spend. Compliance was subject to an increased level of EU budgetary surveillance and sanctions of up to 0.2% of GDP.

“Health represented over a quarter of current public expenditure and modest low single figure (but more consistent) increases in health spending were the very best we could hope for.   We were not in a position to vote supplementary funding as it could only come from reductions in funding to other areas or increased taxes and there was very little prospect of the government embarking on that.

“We had now got below the 3% deficit which allowed us more room for manoeuvre but if we were to go back above that we would lose our discretion overnight and decisions would no longer be made in Hawkins House or in Merrion Street. However, if we did things correctly we might get modest predictable budget increases.”

Mr. Breslin said he wished to join in the congratulations to the HMI award winners and the HMI Council for its role in organising the awards. “I am a very strong supporter of HMI and the role it plays,” he said.