Establish Patient Councils

Health Minister, Dr. Leo Varadkar asked managers to establish patients’ and residents’ councils where they did not already exist, when he addressed the Conference.

Dr. Leo Varadkar
Dr. Leo Varadkar

The Minister said patient safety was about values and recognising the experience of users of the health service was the single most important barometer of values.  Quality could only improve by listening to patients.

In the next couple of years they hoped to have detailed patient experience data in hospitals which would include what patients thought about the quality of the health care they received, broken down to department and ward. “I think it would be very useful for us to be able to compare patient experiences from place to place.”

He said he wanted to speak about some key areas in the health service, particularly as it referred to reform and new developments.  Change was very difficult in the health service.  It was like a ship needing upgrading and improving at sea– it had to be carried out while services continued to be provided.

“I think it would be very useful for us to be able to compare patient experiences from place to place.”

There were currently a number of major areas of reform:  Healthy Ireland with requirements for key actions involving tobacco, alcohol, obesity and even sunbeds.  “We should have a Public Health Alcohol Bill in the next few weeks and we will be carrying out a Healthy Ireland survey which will be the first survey of Ireland’s health as a nation since Slan in 2007 and we plan to repeat this every year. I would ask you to put Healthy Ireland, public health and a better health agenda in your work on developing strategies.”

Dr. Varadkar urged his audience to take particular interest in the next few weeks on the uptake of the ‘flu vaccine by staff.

He said medicine was not an exact science and our goals should be to learn from error. If we were open and honest we learned from mistakes and listened to patients and what they needed with integrity and humility.  HIQA had raised lots of challenges if we were to learn from adverse events and see that our health service was of the highest quality. “HIQA has also demonstrated a failure to hold managers to account and this has to change. Doctors and nurses are told they are not fit to practise and struck off, but we do not have such a system for managers or senior executives and I think we need some sort of system.  I do not intend to replicate the systems governing nurses and doctors but certainly I think if possible the next government will have to see that people are held to account if they fail in their responsibilities.”

The Cabinet subcommittee will be discussing funding models etc and we will continue the structural reforms of dismantling the HSE into Hospital Trusts and CHOs and establishing a commissioning body.

The Minister said that each group of hospitals would work together to provide acute care for patients.  “We want to make sure that as much care as possible is delivered locally, while ensuring specialist care is delivered safely in our teaching hospitals.   Through the Community Health Organisations we have a clear picture of how older persons etc., will be linked with primary care.

“One of the Government’s biggest commitments has been to move to Universal Healthcare and the first phase of this has already with introduced with free primary care for the youngest and the oldest.  This is the first step and there will be further steps towards Universal Health over the next five years.

He was pleased that patients with Type 2 Diabetes would now be managed by their GP and something similar was starting for under 5s with asthma.  “I would love to think it would result in fewer referrals but international evidence does not support this.  However, I believe it will mean that GPs will diagnose the disease earlier and this will be better for patients.

“In the next few years I would like to expands the role of the GP in the management of chronic disease, and extend GP care without fees to everyone under the age of 18.  A major costing exercise has been undertaken for a White Paper on UH and I will be seeking approval from Cabinet to publish that within the next few weeks.  The Cabinet subcommittee will be discussing funding models etc and we will continue the structural reforms of dismantling the HSE into Hospital Trusts and CHOs and establishing a commissioning body.

All over the country we have hospitals operating out of what were old workhouses or country homes.

“There will be capacity reforms because we are always going to have dermatology waiting lists if we do not have enough dermatologists and it is clear that we lack capacity at a number of levels in hospitals and in the community.  We need capacity to provide services because a UH system with everyone on a waiting list is not worth having.  We are well below the OECD average where- physiotherapists, speech and language therapists, orthopaedic consultants and a number of other specialists are concerned.  We need to bring our numbers up to OECD levels and press ahead with financial reforms particularly Activity Based Funding which aims to see that hospitals are funded for the volume and quality of work they do.

“I have been told that consultants and other clinical and administrative staff have shown real engagement in implementing Activity Based Funding in the 38 hospitals where it is being introduced.  Clinical and administrative staff have a crucial role to play in implementing Activity Based Finding and we intend to apply it to Outpatients and other areas in future.  It is intended to create specific links between activity and spending and identify those performing best and those who are not.”

Dr. Varadkar said we needed to invest in modern infrastructure.  “As part of the Government’s capital plan which runs over the next six years we have secured €3 billion.  It will provide an increased envelope on an annual basis – €3 billion over six years, from €440 million next year to €660 million by 2021. This will allow us to press ahead with the four major national hospitals – the new National Children’s Hospital on the campus of St James’s and the satellite centres in Blanchardstown and Tallaght, the new National Maternity Hospital to be co-located with St Vincent’s, the new National Rehabilitation Hospital in Dun Laoghaire and the new National Forensic Mental Health Hospital in Portrane.

“The expectations are that work will be underway on all of these next year and they will be completed by 2021.

“t will also allow us to go ahead with further primary care centres.  We anticipate between 50 and 80 more during the lifetime of the plan.  There will also be an investment plan agreed over the next few weeks to renovate or build new nursing homes and some funding for the national radiation oncology programme for Cork, Galway and Beaumont, (although not as much as I want) plus the co-located maternity hospitals.

“All over the country we have hospitals operating out of what were old workhouses or country homes.  We cannot replace them all in six years but I think it should be possible over 30 years to replace all the infrastructure.

“Everything depends on having staff in place to implement reform and the real priority is doctors and nurses and specialist management.  I want us to have a health system which values all its staff and I want people coming into the service and service users to have a high quality fit-for-purpose environment.  We are facing into a global shortage of health workers.  There is an international shortage   However, our staffing numbers are increasing and recruitment is underway.  The number of wholetime equivalents is increasing, some by agency conversion and there is growing evidence that graduating classes of doctors and nurse are more likely now to remain in Ireland.

“The number of consultants employed in the year to August 31 has increased by 72 net  There are more doctors registered in Ireland now than ever in our history.  I would ask you to do as much as you can to fill nursing vacancies. Some places are offering innovative educational facilities and I urge you to do what you can, as we need to be able to open facilities before winter. It is also crucially important to fill consultant posts I would hate to see a consultant post not being filled because of a row over an increment.  The clear priority is to fill posts and not argue if somebody should be on the 4th or 5th point of the scale.  It is also important that NCHDs get paid for overtime hours which appears to be a problem in HSE hospitals.

“All of us have a particular duty as people who work in the health service not to be critics but advocates of the health service.  The health service is an enormous contributor to the economy, employing 100,000 people in the public health service, and 100,000 more in private healthcare, the pharmaceutical industry, medical devices and life sciences, and keeping millions of workers healthy.
“There are lots of good things happening in health and we should all be proud of that.  I want to thank you for your good work and commitment and dedication your jobs.”

HMI President, Mr. Derek Greene, on behalf of the HMI Council, thanked the Minister for attending the Conference. “I also want to thank both you and Minister Kathleen Lynch for the work you do on our behalf in terms of reforming our health service and in terms of advocating and securing much needed additional funding for our service because that is the lifeblood n which the services are run.”