THE NEW NATIONAL HEALTH STRATEGY – QUALITY & FAIRNESS

The government’s National Health Strategy, launched nearly a year ago, is to inform the long-term development of Irish healthcare. Michael Noone, Managing Director Sunbeam House Services summarises the strategy and documents its aims and goals.

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Towards the end of 2001 the new National Health Strategy was launched. In compiling the strategy, the Department of Health received over 1500 written submissions from individuals throughout the country and also received submissions from over 300 organisations. The strategy also had inputs by specialists in the health field from many parts of the world.

The Steering Group which devised the Health Strategy was chaired by Michael Kelly, Secretary General of the Department of Health and Children. The final report benefited from the wide range of experiences of the members and the comprehensiveness of the report, reaching to 208 pages, is testimony to their interest in the health sector and their dedication to this particular task.

Essentially the Health Strategy, the full title of which is Quality and fairness, a health system for you, amounts to a clear blueprint to implement wide-ranging changes in Irish health services within the next ten years. A clear message which is evident throughout the document points to the need for all those involved in the health and personnel social services areas to change the way we go about our business and to ensure that the services we deliver are person-focused and that the quality and the fairness of the services we deliver are to the forefront.

Some definitions

The previous health strategy document was the 1994 strategy entitled Shaping a Healthier Future. Two key concepts emerged in that document, namely ‘health gain’ and ‘social gain’. These concepts are also central to the 2001 strategy which defines health gain as ‘concerned with health status, both in terms of increase in life expectancy and in terms of improvements in the quality of life through the cure or alleviation of an illness or disability or through any other general improvement in the health of the individual or the population at whom the service is erected.’ The Health Strategy defines social gain as concerned with broader aspects of the quality of life, ‘the quality added to the lives of dependent elderly people and their carers as a result of the provision of support services, or the benefit to a child of living in an environment free of physical and psychological abuse.’

Cost of the Health Strategy

Total expenditure to implement the new strategy is expected to reach a total of €12.70m over its entire 7-year lifespan. Approximately €7 billion of this figure will be allocated for capital development and the remainder for non-capital. On 20 November 2001, the outgoing Fianna Fáil/PD government promised that the funding would be made available to implement the strategy in full. They have also promised that there will be no significant change in the methods by which the health services are funded, and they intend to stay with the present general taxation method. However, there will in future be a major emphasis on quality of services and value for money. The Department of Health and Children intends to concentrate on reform of the present health system. In future, funding will be linked to:

  • Clearly defined service plans
  • Significant emphasis on performance/outcomes
  • Audits to ensure that expenditure is used to best effect
  • Support for the development/educational needs of staff who work within the health system.

It is very necessary to monitor closely the level of expenditure on health, since this has doubled since 1997. Much has been achieved as a result. The waiting lists for elective treatment have fallen by 16% for the year June 2000 to June 2001, and considerable progress has been made in reducing waiting lists in some of the important areas, such as cardiac surgery where waiting time decreased by 85% and for ENT services which decreased by 25%.

Given the number of people involved in receipt of services or delivering services, it’s not difficult to understand why health services cost so much. For example:

  • The number of day cases attending hospital between 1997 and 2001 increased from 249,000 to 360,000 – an increase of 111,000 (44%).
  • The total number of people discharged from hospitals in 2001 was 920,000 – an increase of 17% over 1997.
  • Between 1997 and 2001 frontline staff numbers increased by 4100-
  • Nurse training places throughout the country increased by just over 15%, to 1500-
  • Just over €76m has been allocated for cancer treatment since 1997.
  • Since 1997, €260m has been allocated for intellectual disability services. This has meant an increase of 1650 residential places, 2300 day places, a 70% increase in respite places, and a reduction of 40% in the number of people with intellectual disabilities cared for in psychiatric settings.
Why do we need a new Health Strategy?

Shaping a Healthier Future clearly set out priorities for improvements in health services. Its primary focus was on health gain and social gain, and its primary concern was the redesign of existing health services to achieve those ends. The strategy also highlighted the need to address issues which resulted in premature deaths such as cancer, heart diseases and accidents. The new strategy continues from the solid base established by the 1994 document. It’s recognised that much has been achieved but that there remains quite a significant number of deficiencies which must be addressed if our health services are to achieve and sustain a standard of quality which many of our European neighbours currently enjoy.

The Health Strategy 2001 identifies overall goals to guide activity and planning in the health system for the next seven to ten years. The Government, the Department of Health and Children and the health boards, the goals state, will:-

  • Work with everyone in the health system who has a role to play in improving health
  • Engage with the wider community to improve health
  • Evaluate services so that resources are used to best effect
  • Reform the way we plan and deliver services within the system
  • Modernise and expand health and personal social services through focused investment
  • Support the development and contribution of people who work within the health services.

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