The Health Strategy 2001: Moving Forward

1
The Health Strategy 2001 Moving Forward

• Presentation by Michael Kelly, Secretary General,
  Department of Health and Children
• to
• 2nd Annual Conference
• National Council for the Professional Development
  of Nursing Midwifery
• 20th 21st November 2002

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Overall Challenge Unlimited Demand vs Limited
Supply ?Rational Choices
Demand Factors
Supply Factors

• Demography
• Knowledge
• Expectation
• Technology

• Funding
• People/Skills
• Infrastructure
• Social Patterns
• Voluntary Input
• Public/Private

Health System Choices
HEALTH RESULTS
3
A Strategic Approach

• Shared Vision/Long View
• Definite Direction/Clear Leadership
• Stakeholder Involvement/Partnership
• Clear Accountability for Action
• Dynamic Managing Process/Adaptive Mode

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A New Approach
Strategy Vision
Developing Information
Frameworks for Change
National Goals
5

• Primary Care
• A Strategy in Action
• Presentation by
• Ms. Antoinette Doocey

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Whole Health System Approach
7
Acute Hospital System Hospital Activity

• No. treated in 2001
• In-patient basis 560,124 (1.5 on 2000)
• Day case basis 359,144 (11 on 2000)
• Overall 5 increase in activity over 2000
• Activity levels have been increased by
• Reducing ALOS (eg 9.7 days in 1980 6.5 in 2001)
• Increase in use of day procedures
• From 2 of activity in 1980 to 39 in 2001
• To date in 2002 14
• Availing of new technology

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Reform of Acute Hospital System- Additional
Capacity

• Strategy commits to additional 3,000 beds by 2011
• Additional 65m allocated in 2002
• First phase - 709 beds
• 272 beds in place
• 600 by end 02
• Staffing implications

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Reform of Acute Hospital System -Waiting List
Initiative

• 43.8m in 2002
• 24,850 at end of June 2002 (-7 on 2001 figure)
• Reduction in waiting times (June 2001- June 2002)
• Adults gt 12 mths -in target specialties
  decreased 22
• 51 gt 12 mths -cardiac surgery
• 40 gt 12 mths - ENT procedures
• 28 gt 12 mths - ophthalmology procedures
• Children
• 40 gt 6 mths for cardiac surgery

10
Reform of Acute Hospital System-Treatment
Purchase Fund

• 15m in place for 2002
• Acute Hospitals 10m
• Orthodontics 5m
• Over 1,000 patients treated to date
• To treat 1,900 in 2002
• Throughput for 2003 estimated at 7,200
• 400 patients/mth in Ireland
• 200 patients/mth in England

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Funding of Hospitals- Efficiency, Effectiveness,
VFM

• Strategy links additional investment to
  achievement of specific reforms and outcomes
• Casemix budget model
• Strategy commits to progressive adjustment in
  rate
• From 15 to 20 for in-patient cases
• From 5 to 7 for day cases
• Implement in 2003 financial allocation

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Funding - Public Private Partnership

• Work has begun in ERHA and SHB on development of
  PPP programme
• Areas where need for long stay beds is most
  acute
• Community Nursing Units for older people up to
  maximum of 850 new beds when completed
• Reduce pressure on acute hospital beds
• Responsive and appropriate care

13
Human Resources- Supply Issues

• Position of surplus in mid-1990s
• Commission on Nursing 1998
• Workforce Planning

14
Human Resources-Study of the Nursing Midwifery
Resource

• 118 actions Steering Group
• Gaps in information
• Development of Minimum Dataset
• Q F committed to integrated workforce planning

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Human Resources-Integrated Workforce Planning

• Strategy provides for its
• Alignment with service planning
• Skill mix
• Health care assistants
• Integration with training bodies so numbers and
  training places match
• 1,640 places in 2002 - 13 colleges
• 10 year projection-16,400 trained
• Capital Development 242m 2002-2004
• Revenue cost 90m over 4 years
• Health Services Skills Group

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Human Resources-Professional Development

• National Council for Professional Development
• 1,400 Clinical Nurse/Midwife Specialists
• Advance Nurse Practitioners approved in A E and
  Sexual Health
• Continuing education programme
• 800 post graduate places
• Funding of education courses
• Specialist Programmes
• Return to Practice Courses
• Sponsorship for PHN courses under graduate
  part-time degree programmes

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Human Resources- Scenario for the Future

• Fewer nurses/Assistants
• More clinical nurse specialists/ANPs
• Nurse-led services
• Changing role
• Promoting health wellbeing/treating illness
• Research evidence-based care

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Human Resources-Action Plan for People Management

• Plan formulated in consultation with the Health
  Services National Partnership Forum Action 108
• Investment in training and education
• Best practice employment policies procedures
• Manage people effectively
• Improve the quality of working life
• Develop performance management
• Promote improved industrial relations
• Develop the partnership approach further

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Legislative Developments

• National Research Strategy for Nursing
  Midwifery
• National Strategy for Nursing and Midwifery in
  the Community
• Amendments to Nursing Act, 1985
• Draft heads in 2003

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Human Resources-National Task Force on Medical
Staffing (1)

• Key work areas
• To devise a strategy for reducing the average
  working hours of NCHDs in line with European
  Working Time Directive
• To address the consequent medical staffing needs
  of Irish hospitals
• Analyse the practical implications, including
  costs, of moving to Consultant provided hospital
  system
• Consider the requirements for medical education
  and training arising from any changes to the
  current model of delivering services
• Substantial work done
• Two pilot sites ECAHB MWHB
• 200 consultative meetings- 600 individuals met

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Human Resources-National Task Force on Medical
Staffing(2)

• Detailed work in pilot regions leading to
  national recommendations
• Substantial implications for services
• Likely to be more Consultants and fewer NCHDs in
  a Consultant provided service
• Medical training will take place in shorter
  working week
• Significant agenda emerging
• Role of hospitals,
• Working patterns,
• Rostering of medical staff,
• Skill mix,
• Extended working day throughout hospitals
• Closer service integration
• First report due by end 2002/early 2003

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Organisational Reform-Audit of Structures and
Functions

• Primary focus to meet the challenges of
  implementing the Strategy
• Audit critically examining
• The number and configuration of existing health
  organisations
• Their interaction with one another and the DoHC
• The adequacy of governance arrangements
• The scope for rationalisation
• Ideal Model
• To be completed early 2003

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Organisational Reform Integrated Hospital System

• Establishment of National Hospitals Agency
• To prepare a strategic plan for the expansion of
  capacity in the acute hospital system
• To advise on the organisation and development of
  all acute hospital services
• To advise the Minister on the designation of
  national specialist services and the development
  of designated services
• To develop a strategic relationship with the
  private hospital sector
• To manage a new national waiting time data base
• To liaise with regulatory and professional bodies
  on matters affecting acute hospitals

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Developing Information

• Need for evidence-based decision making
• HIQA
• Health Information Systems
• National Standards/Quality
• Technology Assessment
• Health Information Strategy
• Electronic health record

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Conclusion

• High Performing System
• Groundwork Underway
• Opportunity for New Order
• Work in Partnership
• Communication!

The Journey is underway