home » election 2007 manifesto » fixing the health service

Fixing the Health Service

The Challenge

The Irish health service is in crisis. Despite all the money that has been poured into the health service, long queues remain in A&E, patients are deeply concerned about MRSA, conditions in hospitals are frequently unacceptable, patients face long delays for treatment, and access to services is deeply unfair. Recent attempts to paper over the cracks in A&E without tackling the underlying problems have led to some 40,000 operations being cancelled, as surgical beds are requisitioned to reduce the pressure on A&Es. The HSE is not seen as delivering improvements to front-line care.

There is a deep inequality built into what is a two-tier system, such that public and private patients enjoy very different levels of access to medical services. Recent Labour Party research, for example, points to significant disparities in waiting times for appointments to see consultants, between public and private patients. The co-location plan for super-private clinics will further deepen that division, and marks an unprecedented and unacceptable departure into for-profit medicine in Ireland.

The core problems remain of a system with perverse incentives, inadequate capacity, and poor use of existing facilities. Primary care and preventative medicine are under-developed, as are services for the elderly, with the result that services for patients are poorer and considerable strain is placed on the acute hospital sector.

Mental health services, long the forgotten and neglected branch of Irish medicine, continue to be under-funded. There are often alarming gaps in provision of mental health services, including services for children.

Fixing the health service is the first, but not the only step, towards a healthier people. Life expectancy in Ireland is below EU norms, and Ireland faces a number of public health challenges, such as obesity, including obesity in children. The social and economic inequality in our society has a detrimental effect on health which must be addressed.

Ireland can do better

Fixing the health service will be Labour's first priority in government. Our objective is to tackle the existing crisis and, through investment and reform, to lay the foundations for a health service based on excellence, value for money and fairness, to provide a better standard of care for patients, and to enhance the health and wellbeing of the people of Ireland.

What Labour will do

More Beds in Clean Hospitals

The Irish health service needs more beds and it needs to make better use of existing capacity through organisational change. Both must proceed in tandem.

We will:

• Provide 2300 additional acute in-patient hospital beds.
• Scrap the co-location plan to build super-private clinics.
• Ensure the rigorous enforcement of strict cleaning regimes. Systems to ensure that there is clear responsibility and accountability for day-to-day cleanliness standards will be a priority.
• Develop a coherent planning function for ongoing provision of new capacity and improvement of existing facilities.
• Provide for 1500 community care beds, 600 in Dublin.
• Move towards a consultant-provided service, rather than a consultant-led system. Subject to successful conclusion of the negotiations for a new consultant contract, we envisage employing at least 1500 new consultants, with a corresponding reduction in the number of non-consultant hospital doctors.
• The new consultant contract must provide for clinical and administrative accountability and equality of care.
• Improve manpower planning to address shortages in key health professions, including social work.
• There should be a system of governance, funding and management which will foster strong hospital networks, well connected with their communities and well aware of their needs.
• Hospital networks should be based on the 'Golden Hour' principle, i.e. that a patient should have to wait no more than one hour between the onset of a serious illness or accident and the beginning of treatment in a suitable acute hospital setting.
• We will undertake a full review of ambulance services to ensure rapid access to services.
• We will revisit the decision to locate the National Children's Hospital on the Mater Site. We favour a model of a National Children's Hospital with campuses on both the north and south sides of Dublin under unified governance.
• Ensure on-going funding and support for the Cancer Strategy.

The Money Follows the Patient: Towards Universal Health Insurance

The existing two-tier structure in the health services is both unfair and inefficient. It establishes a perverse structure of incentives, particularly for consultants. It leads to resources being allocated bureaucratically to health care providers, rather than ensuring that resources automatically flow to wherever patients are and want to be. Labour believes that a high quality and fair health service requires the introduction of universal health insurance, which would ensure that resources are allocated to meet the needs of patients. In other words, the money follows the patient. We are committed to this objective. Such a system can only be introduced over a period of time and requires significant change to the structure and capacity of the health service in advance of the introduction of full UHI. Accordingly, we propose to develop a UHI system through a series of steps, each of which represents an important reform, in and of itself, improving the quality of service to patients.

We will:

• Change the way doctors are paid, establishing a stronger link between the work consultants do for public patients and what they get paid.
• Change the way hospitals are paid to link budgets more closely to work done for patients, and to provide explicitly for activities such as teaching.
• We will extend free health insurance cover to everyone up to age 16. 18 The Fair Society - Labour Manifesto 2007

The A&E Crisis

Ultimately, tackling the crisis in A&E units requires a broad-based reform programme across the health service. Nonetheless, there are a number of changes that can be made in the short and medium term to address the immediate problems of overcrowding, poor hygiene, long delays, indignity and discomfort for patients, and the associated stress for staff. We have published a detailed plan for improving conditions in A&E which includes the following measures:

• Introduce a separate stream for minor injuries, using the 'see and treat' system applied in the UK, whereby a dedicated team of skilled clinicians works to see patients with minor injuries when they arrive, treats them and sends them home.
• Provision of Medical assessment units to cater for patients referred by GPs or A&E units, where patients can be seen in comfort and dignity, be assessed, undergo tests, be treated, and await admission to an acute bed.
• Patients referred by a GP should not have to wait hours in an A&E to be seen by a less experienced doctor. Protocols should be drawn up so that patients referred by GPs would be seen by a consultant within a specified period. GPs should have improved access to diagnostic facilities. The decision to admit patients must remain with the hospital.
• Greater out-of-hours cover for diagnostics within hospitals to speed up decisions on admitting and discharging patients.
• Tackling delays in discharging patients, including better discharge planning.
• Additional aid for elderly patients to prevent the need for admission to acute hospital beds, including a better home help service, out-ofhours services, and fast-tracking of home adaptation applications.
• Provision of urgent care centres staffed by GPs and nurses, open out of hours, to provide an alternative to A&E units.
• Provision of out-of-hours GP services and out-of-hours pharmacy services.
• Additional consultants in emergency medicine.
• Emergency helpline and GP location service on a 24 hour basis, staffed by trained personnel, to advise patients on how they might be treated at home, where to access their nearest GP out-ofhours service or other appropriate assistance.

Labour believes that a high quality and fair health service requires the introduction of universal health insurance, which would ensure that resources are allocated to meet the needs of patients.

Patient Safety Authority

Several cases have come to light in recent years which highlight the requirement for an independent agency within the health services to inspect, monitor and regulate patient safety.

Accordingly we are proposing the establishment of an independent Patient Safety Authority which would oversee the registration and accreditation of hospitals and inpatient facilities, set and monitor standards of patient safety in all registered health and social care facilities and investigate complaints.

Palliative Care

We welcome the development of hospices in Ireland, but we are concerned at the fact that there is no uniform funding across the country to support these hospices.

What Labour will do:

• Set a target of having a hospice in every former health board area.
• Introduce best practice protocols in hospitals to ensure dignity at the time of a person's death.

Primary Care and Prevention

One of the biggest problems in the Irish health system is the under-development of primary care. A properly developed primary care structure is essential to ensuring that illness is detected early and treated promptly, that patients are treated in a setting they know and trust, that pressure is taken off the acute hospital sector, and for getting the best use of healthcare resources. Research shows that the cost of primary care is discouraging significant numbers of our people from attending a GP.

What Labour will do:

• Labour will promote the development of primary care, and improve access to primary care.
• We will extend medical card eligibility to include 40 per cent of the population with a focus on families with children.
• We will provide GP cards for children under-5, who tend to have heavy demand for GP services.
• Develop incentives for doctors working in deprived communities and remote rural areas.
• Facilitate GPs over 65 who can and wish to continue working.
• Promote the integration of primary health services at community level.
• Continue to promote the development of group practices and primary care centres.
• Promote the integration of community based nursing services with general practice.
• Introduce universal patient registration whether public or private.
• Develop robust data collection systems in general practice.
• Initiate agreed primary care based preventative strategies to combat the current inequalities in mortality rates due to geographic location and socio-economic backgrounds. This will include universal cervical screening; secondary cardiac preventative programme; and a robust Well Man and Well Woman service.
• Provide Breastcheck nationwide.
• Promote regular exercise and healthier lifestyles as detailed in our proposals on sport elsewhere in this manifesto.
• Promote better nutrition as set out in our policy on food poverty. 20 The Fair Society - Labour Manifesto 2007

Mental Health Services

Mental Health has long been the Cinderella of the health services, under-funded and neglected. There a number of unmet needs, including mental health services for children and services for those suffering from dementia. Meanwhile, the problem of suicide requires urgent attention. Labour supports the concept of 'recovery-orientated mental health services'.

What Labour will do:

• In time, we envisage a minimum base line funding for mental health services of 10 per cent of current health spending.
• Put in place multidisciplinary community mental health teams, reducing the need for inpatient care.
• Close psychiatric institutions that are inappropriate for their purpose, once adequate out-patient services are in place. Funds from the sale of such institutions to be ring-fenced for mental health services.
• Introduce long-term personnel management to address staff shortages.
• Appoint adequate numbers of psychologists to all prisons.
• Increase the budget of the National Suicide Prevention Office to €10 million initially and to €20 million over five years.
• Provide a comprehensive package to all primary
• Establish formal structured partnerships between the voluntary and community sector and the statutory sector to strengthen community-based suicide prevention strategies and bereavement support.
• Act to solve the crisis in child and adolescent psychiatric services by increasing specialist out-patient teams by 50 per cent and bringing established teams up to the recommended staffing complement.
• Ensure early intervention, including a Youth Mental Health Initiative aimed at teachers and other adults who have frequent contact with young people.
• Develop specialist child and adolescent intellectual disability services, establish specialist eating disorder services, develop multi-disciplinary teams nationally to deal with addiction and increase the in-patient facilities to meet the needs of the 0-15 year-old age group and the in-patient needs of the 16-17 year-old age group.

Our objective is to tackle the existing crisisand, through investment and reform, to laythe foundations for a health service, based on excellence, value for money and fairness, to provide a better standard of care for patients, and to enhance the health and wellbeing of the people of Ireland. and secondary schools, including mental health programmes and comprehensive counselling services.