Key recommendations of the Oireachtas Report

EXPAND HEALTH AND WELL BEING

  • Increase Health and Wellbeing Budget – €233m over ten years.
  • Resource and develop a universal child health and wellbeing service – €41m over first five years.

REDUCE AND REMOVE CHARGES

  • Removal of inpatient charges for public hospital care – €25m in Year 1.
  • Reduce prescription charge for medical card holders from €2.50 to €1.50 in year 1 and to 50c in year 3 – €66.7m in year 1, a further 66.7m in year 3 (€133.6m in total).
  • Reduce the Drug Payments Scheme threshold from €144 per month to €120 and €100 at a cost of €75m in year 3 and €184.9m in year 6 (€259.9m in total).
  • Halve the Drugs Payment Scheme threshold for single-headed households in year 1 to €72 per month.
  • Removal of Emergency Department charge in Year 8.

PRIMARY CARE EXPANSION

  • Expansion of community diagnostics and shifting treatment from the acute sector to the community.
  • Counselling in primary care: extend counselling provided by private providers through GP/primary care referral at a cost of the order of €6.6 million over three years.
  • Develop public psychology services in primary care at a cost of the order of €5m over two years to get this service up and running. This would fund 114 assistant psychologists, 20 child psychologists and allow for the development of a CBT online resource.
  • Universal GP care – €455 million over five years.
  • Universal primary care – €265.6 million over first five years of the plan

SOCIAL CARE EXPANSION

  • Universal palliative care – €49.8 million over the first five years of the plan increasing homecare provision – €120 million in the first five years of the plan.
  • Additional services for people with disabilities – €290 million over ten years.

MENTAL HEALTHCARE

  • Child and Adolescent Mental Health Teams – €45.7 million, delivered by year 5.
  • Adult Community Mental Health Teams – €44.5 million, delivered by year 5.
  • Old Age Psychiatry – €18.8 million, delivered by year 5.
  • Child and Adolescent Liaison – €4 million, delivered by year 5.
  • Intellectual Disability Mental Health Services: 120 additional staff – €8.5 million, delivered by year 5. 

DENTISTRY EXPANSION

  • Reinstate pre-economic crisis budget to Dental Treatment Services Scheme – €17 million in year 1. 

EXPANDING PUBLIC HOSPITAL ACTIVITY

  • Expanding public activity in public hospitals – €649 million from years 2 to 6 of the plan.
  • Increase numbers of public hospital consultants – €119 million between years 4 and 10.

LEGISLATION

There are several important areas for legislation associated with the programme of reform. These relate to key values and principles to embed into the Irish health system, new governance structures, funding mechanisms, and organisational realignment and enhancement.

Legislate for a new HSE Board.

Legislate for the National Health Fund and new funding mechanisms for the transitional funding, legacy funding and package expansion components, as required.

Enact the Irish (Sláinte) Health Act which will provide the legislative basis for a universal entitlement to a broad package of health and social care for everyone living in Ireland with maximum waiting times. This involves:

  • Introducing Heads of Bill by 2017 for phased entitlement.
  • Expansion to include all Irish residents by 2023, as described in Section 2 of the report.
  • Introducing legislation by Spring 2018 for the following waiting time policies, to be implemented on a phased basis by 2023.
  • No-one should wait more than 12 weeks for an inpatient procedure, 10 weeks for an outpatient appointment and 10 days for a diagnostic test.
  • Individual waiting lists are published by facility, by specialty
  • Introduce a maximum wait time in EDs, working towards a four hour target.
  • Hospitals that breach guarantees are held accountable through a range of measures including sanctions on senior staff, but not to the detriment of healthcare delivery.

Legislate for accountability – that the Minister for Health is ultimately responsible for delivering health system change and for the delivery of care to the population. Staff at all levels within the health systems are also accountable for their delivery of relevant aspects of the health service to the population through specific, known performance measure and support for the development of needed skills to promote improvement 

Legislate for national standards in clinical governance, national and local accountability structures right down to community and hospital levels, so that clinical governance covers all clinical staff including consultants.

IMPLEMENTATION

Progress on the report’s implementation should begin immediately and be adequately resourced to ensure effective delivery.

The Dáil should be briefed, with a debate on the progress of the report, by the Minister of Health every four months in the first year, to gain momentum, and every six months thereafter.

This will help maintain progress, continue high-level political involvement and further consolidate.

FUNDING

Establish the National Health Fund.

Funding flows into the NHF should include a mixture of general taxation and specific earmarked funds, to be decided by the Government of the day.

Guaranteed expansion of health funding by between €380-465 million per year, for expanded entitlements and capacity to delivery universal healthcare.

Implement transitional and legacy funding arrangements to a total of €3 billion over 6 years, to boost reinvestment into one off system changing measures, training capacity and capital expenditure.

Earmark/ring fence funds to health care priorities, such as expanded primary and social care, palliative care, and mental health.

Ring fence savings that will arise from reduced tax-relief costs as people move from PHI to avail of improved public health provision and allocate these to expansion of entitlement and transitional funding.

Disentangle public and private health care financing in acute hospitals and remove ability of private insurance to fund private care in public hospitals.

Acute Hospital Care, and Public-Private Disentanglement Provide public funding to replace the approximately €649 million income expected from private care in public hospitals, the funding to be phased in as private care is phased out over five years. 

The provision of private care by consultants in public hospitals will be eliminated over five years. This will mean that all patients will be treated on the same public basis in public hospitals, ensuring equity of access for all based on need rather than ability to pay.

An independent impact analysis should be carried out of the separation of private practice from the public hospital system, with a view to identifying any adverse and unintended consequences that may arise for the public system in the separation.

Careful workforce planning to meet current and future staffing needs, and measures to ensure that public hospitals (as well as all service provision units and centres) are/become an attractive place to work for experienced, high quality staff.

Sufficient numbers of consultants and other health professionals to meet population need.

Current unacceptable waiting times for public hospital care in emergency departments, outpatient clinics (OPD) and planned daycase and inpatient treatment must be reduced so that timely access is provided, based on need and not ability to pay.

Enable a system wide response to ED wait times so that integrated, patient-centred care is provided by enhanced primary and social care services.

Investment in hospital infrastructure and staffing in order to enhance capacity. The outcome of the Capacity Review currently underway should inform the detailed planning for the infrastructural investment provided for in the proposed Transitional Fund, as well as for the staffing required.

No-one should wait more than 12 weeks for an inpatient procedure, 10 weeks for an outpatient appointment and ten days for a diagnostic test. Hospitals that breach guarantees are held accountable, through a range of effective measures including, ultimately, sanctions on senior staff, but not to the detriment of healthcare delivery.

Health Workforce

The HSE and the Department of Health must develop their integrated workforce planning capacity so as to guarantee sufficient numbers of well-trained and well motivated staff deployed in a targeted way to deliver care in the most appropriate care setting and that the Irish health system becomes a place where people feel valued and want to work. This will mean re-training of existing staff in many cases to ensure capabilities for integrated care.

Staff recruitment should take place at regional level, or at a more local level if practicable, and in conjunction with local clinical manage. Recruitment of hospital consultants and NCHDs should be to Hospital Groups rather than to individual hospitals, as part of meeting the medical staffing needs of smaller hospitals.

Palliative Care

The current specialist palliative care budget is €76m. Estimates submitted to the Department of Health indicate that with an additional €50m, universal palliative care can be provided. The Committee recommends that this be introduced in the first five years of the plan. This figure includes funding for Laura Lynn Hospice, child respite and palliative care as well as specialist palliative care services for adults with a €10m allocation each year.

MENTAL HEALTH

A Vision for Change set out the staffing requirement to shift the model of mental health care to a community based model of care. There is still significant under staffing of community mental health teams. For example, child and adolescent teams have less than half the staffing required and inadequate services to meet the needs of the population outside of specialist services. Therefore the Committee is recommending increased counselling in primary care and fully staffing child and adolescent mental health teams, as well as child and adolescent liaison and mental health services for people with intellectual disabilities. It is also proposing the current spend be examined to ensure it is providing value for money.