Health Policy V7

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HEALTH POLICY DOCUMENT PUTTING PATIENTS AND SERVICES FIRST

CONTENTS

Foreword 2

Summary of Key Measures 3

Overview 4

A Strong Public Health Service 6

Primary and Community Care 11

Hospitals and Residential Care 18

Mental Health 26

People with Disabilities 29

Chronic Diseases 30

Health Protection and Health Promotion 35

Further Measures 42

The Health Service Executive 44

Costings and Budgets 46

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FOREWORD

Instead of putting all of our eggs in the broken basket of Universal Health Insurance we are committed to drawing on what works in the system and fixing what doesn’t. The focus of this document is on patients not big bang, silver bullet policies. We concentrate on long term results in place of the massive upheaval, disruption and dubious results involved with UHI. In stark contrast, the government still does not even know how much its flagship UHI policy will actually cost let alone the impact it will have.

This document puts forward a series of costed measures to put the patient at the centre of our health service. We take an all-Ireland approach to make very sure every cent put into health has the maximum impact on patients. From ramping up investment in primary care to increasing spending on the National Treatment Purchase Fund the common tread in this document is investing in solutions to persistent challenges.

Our policy does not fall into the trap of easy solutions and centres on the delivery of achieving real results. Additional health policy proposals in our general election manifesto will build on this.

In “Putting Patients and Services First” Fianna Fáil will give our health service the real leadership that patients and workers alike, fully deserve.

Billy Kelleher TD, Fianna Fáil, Spokesperson on Health.

Fianna Fáil believes in a publicly funded, publicly delivered health care service, a health service that emphasizes patient care above structures. This means leadership rather than spin, reform rather than revolution and building on the strengths of the service and the hard work of its staff.

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SUMMARY OF KEY MEASURES

• Retain HSE as the basis of a national health service. • A strong public health system, funded from taxation. • Fundamental shift in health towards primary and community care. • Expansion of free GP care based on means. • Enhanced role for nursing and more nurses recruited. • More treatment of chronic illness in community setting. • Expanded role for community pharmacists. • Phased abolition of €2.50 prescription charges. • Reduce threshold for the Drug Payment Scheme to €120 a month. • 500 additional therapists. • 5,000 extra home care packages and more home help hours • Paediatric/Palliative Care Packages for Young Children • 800 extra Fair Deal places in 2016. • Treatments and diagnostics in hospitals to work on a 7 day basis. • National Treatment Purchase Fund to address waiting list crisis • Waiting Times within international benchmark of 6 months. • A national Mental Health Authority. • National Respiratory Disease Strategy to tackle lung diseases. • Increased supports for people with dementia. • An end to Alcohol Sponsorship of Sport. • Set up Office of Alcohol Control to address harmful consumption. • 20% tax on sugar sweetened drinks (SSDs) to tackle obesity. • Dedicated unit within the Department of Health to examine the potential health impact of policies proposed by other departments. • Assign National Procurement Office task of medicine pricing negotiations.

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OVERVIEW

Fianna Fáil’s focus over a five year term in government is to make more progress in what is good in our health care system. We want to build on the positives. We want to concen-trate on improving services and patient outcomes not systemic upheaval.

There needs to be far more integration and interaction between primary and secondary care providers with the patient being the main focus.

Fianna Fáil endorses the publication of the policy framework Healthy Ireland, and its goals. We believe, however, that these goals will not be achieved without consultation and agreement with those working in primary and community care.

The practicalities of implementation must be subject to consultation and those who are tasked with this implementation at the coal-face must be given the opportunity to raise concerns and have those concerns addressed.

The reform agenda implemented between 2000 and 2010 achieved good results. From 2000 to 2010 the number of inpatient/day case treatments in our hospitals increased from 870,000 to 1,318,000 and while this trend did continue to 2013, alarmingly in 2014 the number of day cases in our hospitals fell by 30,000.

Number of inpatient and day cases treated 2000-2010

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Waiting times were reduced substantially through the National Treatment Purchase Fund which treated almost 200,000 people with average waiting times were reduced from two/five years to two/three months.

In opposition, we have been to the forefront in highlighting the underfunding of our health services and the Fair Deal, the attack on discretionary medical cards and the risks of the proposed compulsory health insurance system. Our concerns have been vindicated.

We firmly believe that any extra money that becomes available should be used in developing and maintaining services to meet the public demands.

Fianna Fáil is against the introduction of universal health insurance (UHI). It will cause too much disruption. It will also not treat any extra patients or improve any medical outcomes. We believe that the maintenance of a tax funded system publicly delivered would have a number of benefits over a multi purchaser insurance based system.

Health services are required on a 365 day basis yet a lot of support, diagnostic and treatment facilities are based on the Monday to Friday core week. This cannot continue. It was tackled in 2009 in the laboratory services and it has resulted in blood results being known far quicker and patients being treated and discharged earlier.

Where services have been converted to a seven day approach it can transform hospitals. It does not have to cost more money. The NHS in Scotland is implementing this change and it has already worked very successfully in Canada. Elective admissions should be admitted over a seven day period rather than just Monday to Friday. This will help avoid the normal congestion of elective admissions between Monday and Wednesday. This would also assist with emergency department overcrowding given that admissions would be dispersed over the week. Senior clinicians should be available on a rotating basis over the seven day period to ensure that patient outcomes are improved. It is well known that patient mortality increases at weekends due to lack of senior staff being present.

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A STRONG PUBLIC HEALTH SERVICE

Fianna Fáil stands for a strong public health service. One where the impact of public funding is maximised, where services are as close to people as is consistent with quality care and where new opportunities to provide improved care are being sought.

Irish people are living longer. We have seen improvements in clinical outcomes across a range of diseases over the past decade. For example, death rates from cancer decreased by 11% between 2000 and 2009.

Likewise death rates from cardiovascular disease decreased by 39% over the same period. These improvements can be directly attributed to the development, resourcing and implementation of targeted programmes including the National Cancer Strategy and successive policies for cardiovascular health.

Trends in mortality rates, all causesIreland 1994-2008

Source: Eurostat Statistics Database. Data are age

standardised to the WHO European standard population

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These improvements can also be credited to the dedication and expertise of staff within our health service who, despite successive budget adjustments, have continually demonstrated their ability to deliver in challenging circumstances.

Serious problems persist however. Despite the promises of revolution and reorganisation, people continue to wait too long for hospital investigation and treatment. The annual trolley crisis has been worse than ever.

Those with chronic conditions like asthma and arthritis cannot access services which could prevent their conditions deteriorating. Healthcare staff working in the hospital, primary care and community sectors are under enormous pressure and stress.

Fianna Fáil believes that these problems can only be solved by addressing the underlying factors which are driving them. It is imperative that we move away from the knee-jerk, reactive policies which have consumed the Government’s approach to healthcare in recent years. This ‘sticking plaster’ approach has merely served to prolong crises and guarantee that they become issues again in the future.

As an alternative, Fianna Fáil proposes that primary and community care must be prioritised as the cornerstone of our public health service. We believe that general practitioners and their allied health colleagues in the community are best placed to provide care at the lowest level of complexity and in the most cost-effective manner.

They must be resourced to do this. This means that they must be adequately funded. It also means that modern information technology systems must be put in place which link healthcare professionals together so that they can communicate and work collaboratively and effectively for their patients.

Fianna Fáil’s proposals also involve a sustained focus on the needs of our ageing population. While we welcome the National Positive Ageing Strategy, we believe that more is required.

In particular, while we support the objective of supporting older people to live in their own homes for as long as possible, we believe that there must also be recognition of the need for adequate long-term care for those who require it. We are living longer and the medical needs of our older people become more complex and it is not possible for all older people to live independently in their own homes.

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Failure to recognise this problem has contributed to delays in discharging patients from our acute hospitals and has directly resulted in overcrowding and cancelled elective operations for other patients. It has let our older people down. Fianna Fáil believes in intergenerational solidarity and that all older people should be treated with dignity.

Of course, our public health system is just one component in a range of factors which contribute to the health of our people. In many cases it is not hospitals or individuals who drive our health but rather the environment in which we live and work.

We cannot continue to ignore the challenges from the impact of factors like crime, transport and pollution on our health. These can and should be tackled and Fianna Fáil will commit to placing the public’s health at the centre of policy development across all government departments over the coming five years.

We will make explicit our concern for health and equity across policymaking and make these policies accountable for their impact on health.

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Funding our Health Service

As stated we believe a taxation-funded health system is more progressive as it allows the government more control over the overall health care bill. It also prioritises health care for the most vulnerable and those who cannot afford to pay towards their care.

There will be one purchaser of care and that purchaser will therefore retain maximum control and influence in price and budget negotiations. As a result the sole focus will be on the provision of evidenced-based, cost-effective care, with funding prioritised for the most vulnerable and those who cannot afford to pay towards their care.

By contrast, a system of universal health insurance (UHI) with multiple purchasers of care would involve the government surrendering some control over the overall level of resources devoted to health.

Universal health insurance is being sold as universal health care and we believe they are fundamentally different issues. Universal health insurance will cost people with even those who are now paying nothing being required to open an ‘insurance account’.

The maintenance of a tax-funded system, publicly controlled, would have a number of benefits over a multi-purchaser, insurance-based system. There is simply insufficient evidence from international systems to suggest that a change in the funding mechanism would produce benefits sufficient to justify the disruption that such a change would cause, and indeed there is some evidence to suggest that such a move would lead to higher costs for the Irish public without significant improvements in health outcomes.

Bear in mind that UHI with multiple purchasers of care means the state surrendering some control over the overall level of resources devoted to health. It gives responsibility for the purchasing of health care to private insurers. This could remove services from certain areas in Ireland resulting in patients having to travel further for medical treatments.

However healthcare is rationed in every country and there is no country that has the resources to deliver all of the health care needs of its citizens when they require them. Rationing of services will be made worse by introducing UHI as it means that insurance companies will be in charge based on throughputs so small hospitals are in danger of being closed.

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Insurance-based systems tend to have higher spending on health than those funded primarily from taxation. The Dutch system, on which Fine Gael based its proposals, introduced universal private health insurance with managed competition in 2006. In the Netherlands health care spending per capita increased by 41% increase from 2005-2012.

We believe in a complementary private health care system as this gives people who can afford private health insurance a choice while subsidising the public health care system through their tax contributions.

However, over time we are committed to all patients in public hospitals been treated on the basis of clinical need.

Universal health insurance in place by 2019 is “too ambitious”, - Minister for Health, August 2014.

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PRIMARY AND COMMUNITY CARE

Fianna Fáil believes that primary and community care must form the bedrock of our health system.

Robust and active primary and community care is seen as playing an essential role in enhancing health outcomes and limiting costs.

It is within this setting that we should seek to meet 90-95% of all health and personal social service needs.

A strong primary and community care system will be invaluable for preventing the development of conditions that could ultimately require acute hospital care. It will also provide the right environment to enable earlier discharges from hospital.

Rebalancing the Health Budget towards Primary Care

It is difficult to quantify exactly what proportion of our health spending goes to primary care. Nonetheless primary care expenditure in Ireland is low by international standards where there is an accepted benchmark of around 10 per cent of health expenditure.

Fianna Fáil believes that if we are to make primary care the bedrock of our healthcare system we must gradually rebalance the proportion of our health budget going to primary care to that international benchmark.

This would entail an annual average increase in the primary care budget of €120 million over a five year term.

Fianna Fáil believes that GPs and their colleagues in the community-based allied health professions – public health nurses, physiotherapists and occupational therapists, social workers, pharmacists, care assistants - have been neglected by this administration.

It is essential that we focus on how these professionals can deliver optimal care to patients in their communities, thereby removing pressure from already stretched acute services. It is crucial that we develop a service which aims to forestall illness prior to its onset in the first place.

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We believe that community medical practice, in all its forms, and the preventative and social components of medicine which that entails, must form the nexus of a sustainable, effective Irish healthcare service.

Fianna Fáil believes that it is only through promoting and supporting the work of medical professionals in the community that Ireland can transition from its current ‘sick-care’ model to a true ‘health-care’ system.

Primary Care Plan

Every year as part of the HSE annual plans, there will be a specific programme for the rebalancing of our health service towards primary care.

Targets will be set for the

• required number of GP, nursing and other staff to provide the services. • expansion and assignment of services into primary care that currently take place in hospitals. • patient outcomes. • management of chronic disease care programmes. • developing the necessary IT supports for patient care.

GPs

At the heart of primary care must be the family GP. Fianna Fáil values our family doctors, appreciates the work they do and believes that GP services must be properly resourced. Negotiating a new contract with GPs to facilitate the rebalancing towards primary care will be a priority for us.

There is great anger amongst family doctors at their treatment by government, anger we believe to be justified and legitimate.

Fianna Fáil accept that many GP practices are now running at unsustainable levels of net income after meeting unavoidable practice costs. It has been estimated that around one in 12 practices are under financial risk of closing.

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There are a number of areas across the country, both rural and urban where there is no GP cover. There are other areas where a GP may be due to retire soon and there are fears about their being replaced. Fianna Fáil will act so that GPs are taken on as salaried employees of the HSE where no self-employed contractors are available to operate as GPs. These contracts would require GPs to be available over a seven day working week on a rotating basis.

There has been too much focus on the potential for bricks and mortar, for catch-all primary care centres, to solve the problems faced by GPs across our country.

While Fianna Fáil supports the building and adequate resourcing of these centres where it is appropriate to the needs of the surrounding population, we also believe that the essential role of small practices within rural communities must be recognised and adequately resourced. This is essential as our primary aim is providing timely, quality care to people at the lowest level of complexity and in the most cost-effective manner.

Free GP Care

If we want to make primary care dominant and embed it as the first point of contact in health care we need to make it more accessible. That’s why Fianna Fáil did not oppose the bill to provide GP cards to under 6’s.

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The 2010 Report of the Expert Group on Resource Allocation and Financing in the Health Sector pointed out “any shift of services into primary and community settings means that, for many individuals, hospital-based services that are effectively free at the point of use would be replaced by services in the community which currently involve significant charges for those without medical cards or GP Visit cards. It is not plausible to expect patients to make this change voluntarily”.

The idea behind this reform is to remove the financial barrier to accessing a GP in order to encourage people to seek treatment at an earlier stage, rather than delaying the decision to seek care until the point at which the illness has progressed to the point where it requires hospitalisation – a much more expensive form of care.

Evidence suggests that around a quarter of Irish people who do not have a medical card have put off going to the GP on cost grounds.

However while we support the overall goal we believe that further expansion of free GP care should be on the basis of means and we will incrementally raise the income thresholds for the GP Card, which was introduced when Fianna Fáil was in government in 2005.

However, people with very serious illnesses which is causing them undue financial hardshipshould receive a discretionary medical card. These cards are vital for us and peoplewith disabilities should also be protected.

Nurses

The role of nurses in the development and delivery of primary care is both operational and strategic. The correct implementation of these roles could have a significant impact both in improving health and reducing costs.

The role of the public health nurse could also be expanded so that it could assist in managing chronic illnesses in the community and also extend the limited prescribing role in relation to pain control and antibiotics in certain circumstances. The posts have become too administrative in nature and should be more hands on to assist with patients treatments. They should also have a more active role protecting the more vulnerable groups and more at risk people in the community.

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There is also more room for development of this role – into the vein of Advanced Nurse Practitioner – taking on such extended and expanded roles as nurse prescribing, pain management and care of patients with chronic illnesses such as diabetes.

Pharmacists

In the UK it has been estimated that 51 million GP visits could have been dealt with by pharmacists and that 1 in 12 emergency hospital visits could also be handled at a pharmacy. Countries like Canada and Scotland have expanded pharmacy services thereby freeing up GPs to spend their time with more urgent cases.

Evidence from Scotland indicates that in-depth Medicine Use Reviews conducted by pharmacists with patients suffering from chronic illnesses reduced hospital readmission rates by a third.

Canadian pharmacists’ range of practice has also been widened to include Chronic Disease Management; this involves checking patients with chronic illnesses, renewing and amending prescriptions to ensure tighter control of their symptoms and delivering better treatment outcomes.

We believe that pharmacists have a role to play in the provision of vaccination services. They have already participated in the seasonal influenza vaccination programme and this role could now be extended to vaccination services such as pneumonia, Hepatitis B, cervical cancer and travel vaccines.

We feel that the role that pharmacists can play should be expanded further. There are almost 2,000 pharmacies across the country that can help alleviate the pressure on GP surgeries by providing a greater breadth of healthcare services to their patients and the public, in line with what happens in other countries.

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Pharmacists can also play a role in health checks that could prove effective in identifying those at risk of developing a chronic disease such as diabetes mellitus, cardiovascular disease, osteoporosis and chronic obstructive pulmonary disease. Pharmacists have the most regular contact with patients with chronic diseases due to their accessibility and pharmacists in collaboration with other health professionals could provide clinical and cost benefits through their existing network. Pharmacists also have a role to play in providing anticoagulation services to patients on warfarin.

Community pharmacists have proposed that they could administer a Minor Ailment Scheme in a manner that is cost-neutral to the Exchequer. Currently, GMS patients requiring a non-prescription medicine must present at a GP’s surgery to obtain a prescription for it which, when dispensed, results in a dispensing fee being paid to the pharmacist. This should be changed.

In the UK, it is estimated that 18% of a GP’s workload is spent dealing with minor ailments, costing the NHS €2.5 billion; 80% of this cost is due to the cost of the GP’s time. Ten minor ailments were responsible for 75% of the cost of minor ailment consultations and 85% of the cost of prescriptions for minor ailments.

Pharmacists are qualified to deal with each individual ailment and are already doing this every day with private patients. Suitable ailments for inclusion would be those which are suitable to self-diagnosis and self-treatment or those where a pharmacist can appropriately identify the patient population and diagnose the indications. All patients with GMS eligibility would be entitled to access the Minor Ailment Scheme. When the GMS patient presents in the pharmacy, they will be seen under the Scheme. The patient would not have to make an appointment.

We should also implement the recommendation of the Joint Committee on Health and Children’s Report on the Adverse Side Effects of Pharmaceuticals.

Prescription Charges and Drug Payment Scheme

Fianna Fáil will abolish the €2.50 prescription charge over two years. We will also reduce the threshold for the Drug Payment Scheme to €120 a month from €144.

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Therapies

Waiting times for both assessments and services for essential therapies are unacceptable. This covers a wide range of groups including children with speech and language needs, physical therapists for stroke victims and occupational therapists for people with life challenging conditions.

It is essential that children with speech and language difficulties have access to therapy prior to going to school. There are waiting lists of up to 3 years in some areas and this is unacceptable.

There is a chronic shortage of resources at the moment across the full range of these services and the recruitment of an additional 500 therapy staff should commence in 2016.

Home Care Packages

Fianna Fáil believes that the funding allocated to enable older people remain at home provides not only the best value for money but also the most humane result for older people. We would propose an increase of 1000 home care packages annually.

Paediatric Care Packages

There are 1,400 children in Ireland today with life-limiting conditions. There are 350 child deaths each year owing to life-limiting conditions. Most of these lives are limited to less than one year. The majority of parents want to care for their child at home. It costs up to €150,000 a year to keep a child in an acute hospital setting. Palliative care at home can be provided to children for €16,000, with the rest of the cost being met with the support of organisations like LauraLynn and the Jack and Jill Children’s Foundation. Fianna Fáil will prioritise the introduction of paediatric care packages.

Home Helps

We will increase the total home help hours year on year to better meet demand and to give the recipients an allocation of hours per week to be meaningful for the recipient and the helper in terms of effectiveness.

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HOSPITALS AND RESIDENTIAL CARE

While we firmly believe that the future of health care lies in the primary care setting, it is undeniable that the acute hospital sector is underfunded.

This year’s standstill budget is effectively a cut when demographics are factored in. If we want to permanently tackle emergency department overcrowding and reduce the waiting times for scheduled procedures and out-patient appointments in the short term we need to provide greater resources for our hospitals.

March 2015, 405,501 people waiting for an outpatient appointment. More than 77,000 are waiting over a year

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Consultants

Ireland has around two thirds of the number of consultants recommended over a decade ago in the Report of the National Task Force on Medical Staffing. We also have one of the lowest numbers of consultants on a per capita basis. Furthermore in some specialties, Ireland has one third to half the number of consultants on a per capita basis compared with recommended norms. We propose to recruit at a minimum 200 extra consultants over five years, with a particular emphasis on geriatricians, obstetricians, neurologists and emergency medicine.

Non-Consultant Hospital Doctors

Sustained efforts must be made to guarantee compliance with the European working time directive. While progress has been made it may be necessary to assign new responsibilities to other health practitioners to make further advances. Non-Consultant Hospital Doctors are still spending time doing things that nurses could easily do if there was proper skill mix introduced in hospitals. This would result in more efficiency overall.

Nurses

Fianna Fáil believes there are too many agency and temporary nurses in the public health system and that these positions need to be formalised and made permanent as it will save money in the long run and also improve services to patients.

500 nurses are being recruited this year. We believe that at a minimum a similar number will be required in 2016 too.

Ireland has a shortage of midwives and the patient/midwife ratio needs to be dramatically increased over the next five years to make staffing levels in the country’s maternity hospitals safer. We will increase the number of midwifery training places in the short term in the main teaching hospitals.

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Emergency Departments

The persistent problems in our Emergency Departments must be tackled once and for all. The government has recently published the report of the Emergency Department Task Force and there is much in it that we welcome.

The new report has a recommendation that the number of delayed discharges in hospitals must not exceed 500 by the end of this year. This is simply too high, the equivalent of a hospital the size of St Vincent’s Hospital being unavailable for emergency admission.

Fianna Fáil will also implement the recommendations of the National Emergency Medicine Programme Report launched in June 2012

The 2009 Prospectus Report: Towards Excellence in Critical Care recommended that the number of critical care beds be increased to 579 beds over the period 2010 to 2020. We will work towards implementing this recommendation as not putting these required facilities in place is jeopardising patient safety and quality of care in many hospitals.

Residential Care and the Fair Deal

While Fianna Fáil recognises that the majority of older people want to remain in their home and to be cared for in that setting, there will always be a proportion that will require long-term care. A new and emerging trend in Ireland’s demographic profile is the substantial increase that is taking place in our population over 85 years. In 2012, this group was forecast to increase by 46% by 2021. 22% of these people will require long-term care and hence provisions must be made now for this impending crisis.

In 2012, the National Economic and Social Council recommended the establishment of a problem-solving group to examine and address the challenges associated with the provision of quality long term care in an equitable and sustainable way. This recommendation was not acted upon, however, and it has now been estimated that there will be a shortfall of approximately 8, 000 nursing home beds, the equivalent of approximately 100 new nursing homes, by 2021. This is a problem which needs to be tackled urgently.

Fianna Fáil will commit to the development of a national strategy for the long term care of our older people. This will include an analysis of current and future arrangements for the funding and financing of this care.

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In the short term, Fianna Fáil believes that the 2016 HSE Service Plan should provide for an increase of 800 residential places on top of what was announced on April 2 last.

Fianna Fáil also wants Fair Deal funding to be paid from the time of approval.

We will work towards ensuring that delayed discharges are minimised and that those who are delayed must wait no more than two weeks before being provided more appropriate accommodation.

Waiting Lists, Waiting Times

The alarming increase in waiting times during 2014 and into 2015, requires action. In government in 2002, Fianna Fáil established the National Treatment Purchase Fund (NTPF) to purchase spare capacity from the private sector in order to reduce the number of public patients waiting for treatment in public hospitals. We propose to re-activate this.

Where it is not possible to treat patients within a reasonable period, the HSE will make arrangements under the National Treatment Purchase Fund to refer public patients for

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treatment in private or public hospitals both here, Northern Ireland and abroad, having regard to quality, availability and cost. This should always be subject to the patient’s prior agreement.

Fianna Fáil in government would convene a special task force to produce a plan to ensure that all scheduled day case/in patient care is delivered within the internationally recognised target of six months.

We will also make sure the implementation of HIQA recommendations to reduce the number of unnecessary referrals to hospitals.

Outpatients

While the recruitment of additional consultants could have a significant impact on waiting lists for an outpatient appointment, it is not simply a matter of extra resources. It is not unknown for a hospital with significant numbers waiting more than a year for an appointment to have empty outpatient waiting rooms on a Friday afternoon. All hospitals will be required to have 8am to 8pm consultation times and to enforce them.

Diagnostic Scans

The waiting times for some diagnostic scans continue to be of great concern. Fianna Fáil will ensure that the waiting times are published monthly as with other waiting lists.

Diagnostic scans must also be made available in public hospitals seven days a week.

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District Hospitals

The district hospital network that is still with us is an asset that we should examine to see what services it could provide. We want to exploit existing facilities to provide more services.

They may have a role to play as step down facilities or as a transitional centre for those seeking a placement to the Fair Deal or a home care package.

Another way they could be utilised is in the treatment of relatively minor medical conditions such as a medication review; or treatment of a chest infection, a chest x-ray or to allow patients access to other health professionals like chiropody/physiotherapy – this type of early intervention and treatment can greatly assist in offsetting later admission into an acute hospital where the patient’s condition is invariably more serious.

District or community hospitals could play a dual role in both averting admission to, and enabling discharge from an acute hospital. Assistance from the local GP teams is essential for this. GPs in some areas who work jointly with the local District Hospital already see benefits for patients.

Ambulances and Pre-Hospital Emergency Care

When Fianna Fáil was last in government the National Ambulance Service was established following the merger of services provided by eight former health boards. While there have been many positive developments in our ambulance services over the past 10 years, the 2014 HIQA review of pre-hospital care emergency services gave cause for great concern.

The National Ambulance Service and Dublin Fire Brigade need to tackle inefficiencies and bring forward joint action plans to improve performance.

With regard to the future of Dublin Fire Brigade in the provision of ambulance services, proper consultation must take place between the HSE, Dublin City Council and the paramedics who work on the ground before any attempt is made to remove the fire brigade from ambulance provision.

Fianna Fáil will ensure that a comprehensive workforce plan is developed and acted on

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to provide an upskilled and modern emergency response workforce.

The HIQA report pointed out that neither the National Ambulance Service nor Dublin Fire Brigade has done enough to examine alternative care pathways for patients instead of transferring them to Emergency Departments. We will have this expedited as a matter of urgency.

While Fianna Fáil does not believe that additional resources are the exclusive solution to the shortcomings in the ambulance service, it is clear that there needs to be greater investment. Much of the fleet is ageing and needs or will need to be replaced.

Fianna Fáil believes that notwithstanding the challenges in rural locations, standards and target times should be maintained.

Maternity Services

While it is clear that the vast majority of expectant mothers enjoy a high standard of care across the country, it is also increasingly clear that our national maternity infrastructure is under strain and needs serious review and investment.

We need a proper debate about whether the infrastructure that is currently in place is sufficient to meet the needs of the country over coming years.

This debate needs to include a discussion about what greater role community midwifery can play, the urgent need for greater numbers of consultant obstetricians and what level of investment in the physical infrastructure is actually needed.

Ireland has one of the lowest ratios of obstetricians to patients in the OECD and - there is a need for investment in maternity and neo-natal services across the country.

The provision of accessible, safe and high quality obstetrician-led maternity services to all mothers and babies, regardless of where they live must be a core objective of public health policy.

Rather than downgrade services we want to focus on attracting the necessary number of qualified consultant obstetricians to facilitate an accessible, safe, high quality obstetrician-

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led maternity service to all existing maternity centres nationally and to promote obstetrics as a career option among our medical professionals in order to achieve this and in order to overcome the challenges that our obligations under the working time directive present.

We believe that obstetricians led services must be a priority and have called for them in maternity hospitals throughout the country.

We also believe there must be further investment in infrastructure within existing centres for paediatric and neonatal areas.

We will ensure that current maternity services are protected and enhanced rather than downgraded. People outside Dublin must have high quality health and maternity services.

In Dublin we agree with proposals to relocate the maternity hospitals to more suitable locations.

New Children’s Hospital

Fianna Fáil is fully committed to the completion of the new Children’s Hospital.

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MENTAL HEALTH

A National Mental Health Authority

Mental health issues continue to have a devastating impact on our society. The Ireland we want to build must commit itself to an all-out effort to help people and reduce the number of cases which end up in self-harm and suicide. In doing this we can learn from initiatives that have worked well in our country.

Since we established the Road Safety Authority it has helped halve deaths on our roads. That’s more than 200 people a year whose lives are being saved.

We believe we can do the same in the field of mental health. That’s why we are proposing the establishment of a National Mental Health Authority to be charged with leading an all-out national programme to promote positive attitudes to mental health and to reduce the incidence of self-harm and suicide.

A National Mental Health Authority will provide a focus on mental health through an organisation that has the treatment of mental ill-health and distress and the promotion of positive mental health as its sole focus. We need to give the same sense of urgency to

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mental health and the reduction of self-harm and suicide as was so successfully given to reducing road deaths through the creation of the Road Safety Authority.

It will also provide definite ring-fencing of funding for our mental health services. It has become a cliché, but mental health has been and remains the Cinderella of the health service. Far too often money is pulled from mental health in order to shore up other areas of the health service. The establishment of this authority will mean that a vote of the Dáil will be needed to alter the Budget of the Mental Health Authority, ensuring that there is full accountability. We need to move towards the WHO’s recommended level of spending on mental health of 10% of the total health budget.

The Mental Health Authority will be a separate body from the HSE with its own Director General. It will remain under the authority of the Department of Health and will work in co-operation with the HSE through a range of mutual service-level agreements.

The Authority would also have a specific focus on tackling homelessness among those with mental health difficulties. According to Mental Health Reform, in Tallaght mental health services between October 2012 and September 2013, every nine and a half days someone was discharged into homelessness.

Suicide Prevention

Fianna Fáil will reform and restructure the National Office for Suicide Prevention (NOSP) as a distinct entity within the Mental Health Authority, with a ring-fenced budget, performance targets and an independent employment system with clear inter-departmental input at government and secretary general level.

We will also enhance the size and role of the NOSP to undertake matters such as the development of a new national strategy and the creation of a national 24 hour helpline.

We also propose to increase the number of Resource Officers for Suicide Prevention, enhance their role, and link them directly to the NOSP.

We will implement a system of GP practice whereby the prescription of antidepressant medication has to be reviewed on a monthly basis until the GP is satisfied that medication is the best course of action. We will establish out-of-hours emergency social worker teams across all of Ireland.

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Re-Vision for Change 2016

A Vision for Change will reach the end of its lifespan in 2016. We will implement a full review of what is still left to be achieved and a restatement of a plan to achieve same in the 2016 to 2026 period, also taking into account any deficiencies identified in A Vision for Change by the review group.

The review group will be directed to consider placing particular attention on the need to stress non-medicinal approaches to dealing with mental health issues, including such talk therapies as Cognitive Behavioural Therapy (CBT).

The re-establishment of the implementation review group will issue regular reports on progress in delivering on the 2016-2026 plan.

A Vision for Change envisioned a partnership model between health professionals and services users that would have an equality of respect at the heart of its approach. This has not been followed through on, with a regression from initial progress in that respect. Fianna Fáil will re-establish a Service User representative body.

Housing for people using mental health services

The proposed Mental Health Authority will have a housing officer with a cross departmental brief with Department of Environment, Community and Local Government, and with the local authorities.

Each local authority will be directed to have a statement on housing policy and housing for people using mental health services and to coordinate with local mental health services.

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PEOPLE WITH DISABILITIES

Recognising that 18.5% of our population experiences some level of disability, Fianna Fáil has always demonstrated a strong commitment to providing support and services in order to enable people with a disability to fulfil all opportunities.

Obviously, disability is not just about health services. It is a social justice priority for Fianna Fáil and we firmly believe that the Disability Strategy should be sustained and implemented.

We acknowledge that waiting lists remain too high for a range of disability-specific services, and there is still a substantial level of unmet need with regard to these types of support.

• A total of 1,103 people with disabilities on a waiting list for physiotherapy • A total of 674 people with disabilities waiting for occupational therapy services • A total of 366 people with disabilities waiting for speech and language therapy services. As already indicated we are committed to the provision of more therapists to address the demand for these services.

In relation to the National Disability Strategy Implementation Plan, Fianna Fáil agrees that there has been no priority given to the important role played by existing community services and supports funded through the HSE. We will rectify this.

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CHRONIC DISEASES

76% of all deaths in Ireland are due to just 4 chronic diseases – cancer, cardiovascular disease, chronic lung disease and diabetes.

In 2011, 55% of the acute hospital budget (€1.68 billion) was spent on the care of these patients. 1.8 million bed days were taken up in our acute hospitals in caring for these patients.

Fianna Fáil recognises that people with chronic disease can be managed more effectively, at far less cost, in the community setting. By adequately resourcing general practitioners and their allied health colleagues, as outlined earlier, the majority of these patients can be kept out of the acute hospital system and instead managed in their own homes and communities.

Chronic Lung Disease and Asthma

Ireland’s death rate from respiratory (lung) disease is over twice the EU average and is the highest in Western Europe. Lung disease kills 20% of people in Ireland and is the second highest cause of death for Irish women.

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470,000 people in Ireland have asthma and we have the fourth highest prevalence of asthma in the world. 60% of those with asthma in Ireland have uncontrolled asthma, meaning they are at risk of an asthma attack. More than 1 person dies every week in Ireland from asthma. However 90% of asthma deaths are preventable

1 in every 10 adults has asthma. Adults with asthma miss an average of 12 days at work each year. 1 in every 5 children has asthma. Children with asthma miss an average of 10 days at school each year.

The economic burden of asthma in Ireland is estimated at €500m per year. This could be reduced by two-thirds if approached holistically instead of piecemeal as is currently the case.

Fianna Fáil supports the development of the National Clinical Programmes for asthma and chronic lung disease and recognises the success they have had in the secondary care setting. However, in order to properly address the needs of these patients, to maximise their quality and quantity of life, and keep them out of hospital for longer, Fianna Fáil will commit to the implementation of a National Respiratory Disease Strategy to tackle lung diseases including cystic fibrosis.

Within this strategy, Fianna Fáil will incorporate and implement the recommendations of the National Asthma Programme.

Cardiovascular Disease

Fianna Fáil recognises that while significant improvements have been made over the past twenty years, cardiovascular disease remains the leading cause of death in Ireland. We are committed to the implementation of the Changing Cardiovascular Health Policy 2010 – 2019, which was published during our last term in Government.

Fianna Fáil recognises that there are many risk factors for cardiovascular disease and this is why we have developed strong policies on obesity, smoking and alcohol, as outlined elsewhere in this document. Equally, we believe that the key to reducing the burden of cardiovascular disease is its diagnosis and management in primary care and this one of the many reasons why we are calling for a refocusing of the health service on these services.

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Atrial Fibrillation and Stroke

Up to 5% of our population aged 65 years and over (16,000 people) may have an irregular heartbeat – otherwise known as atrial fibrillation. This condition, often undiagnosed, puts them at a 5-7 times increased risk of stroke. The Health Information and Quality Authority (HIQA) are currently undertaking an assessment of the potential effectiveness of a screening programme in Ireland for people with an irregular heartbeat. If this report finds that screening would be clinically and cost effective, then Fianna Fáil will commit to the implementation of a national screening programme for atrial fibrillation.

Fianna Fáil will commit to the resourcing and implementation of an early discharge programme for survivors of stroke. Research from the Royal College of Surgeons in Ireland and the ESRI, published in September 2014, demonstrated that up to 3,000 (54%) of patients who survive a stroke could benefit from this programme annually, where they are discharged early from hospital so that they can have their rehabilitation in the community. It was estimated that this approach could free up over 24,000 hospital bed days annually and would yield net savings to the acute hospitals of up to €12 million per year.

Cancer

A new national cancer strategy will be brought forward and Fianna Fáil believes that we must include cancer patients or family members on the review group of the strategy to bring their perspective to discussions on treatment

There needs to be a focus on cancers such as sarcomas that don’t get the high profile of other cancers but which are equally as lethal. There also needs to be a realisation that healthy people get cancer too and that everyone needs to make themselves aware of changes in their bodies

People from poor communities are at a higher risk of dying from cancer than their richer counterparts. While overall survival for cancers has increased from 40% (1994-1999) to 59% (2008-2012) for men and from 49% (1994-1999) to 60.5% (2008-2012) for women, people from deprived areas are the most likely group to die from cancer. A cancer map from Maynooth University shows that death rates in some of the poorest parts of Dublin are twice as high as rates in more affluent areas.

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Fianna Fáil recognises the link between health inequalities and cancer and we will provide that this be reflected in the new National Cancer Strategy through targeted initiatives to reach people from poor communities. Since individuals can reduce their risk of cancer by almost 50% by changing their lifestyle, we will introduce a Healthy Lifestyle Programme based in deprived areas, modelled on ‘Fit for Work and Life’, a pilot programme being run in inner city Dublin by the Irish Cancer Society. In the 2006 Cancer Strategy, there is a recommendation that ‘the HSE should put in place arrangements to monitor inequalities in cancer risks, cancer occurrence, cancer services and cancer outcomes’, which we would advance and it would form a critical part of our work on reducing the number of people with cancer.

Early diagnosis is a critical component to surviving cancer. Fianna Fáil recognises that e-referral should be extended to all cancers and would introduce this on a phased basis alongside a GP education programme on the signs and symptoms of cancer. We would also extend the National GP Referral Guidelines and Forms to include more cancers, in addition to breast, lung, prostate and melanoma guidelines which have already been developed.

Many cancer services can be provided in primary care settings and Fianna Fáil would undertake to shift the burden of care from acute to community settings and upskill GPs and practice nurses so that some services can be carried out in the community. The impact of cancer treatment can often leave patients with a chronic condition that needs to be managed. This can be psychological or physical and Fianna Fáil would undertake a needs assessment of patients and begin the introduction of a ‘Cancer Survivorship’ programme through primary care settings where patients could see a health care professional for the management of lymphoedema, receive psycho-oncological support, visit a physiotherapist and access many other ‘survivorship’ services. ‘The HSE should develop programmes that support primary care professionals in the provision of cancer services’ is a recommendation in the 2006 Strategy but this has not been effectively implemented.

Travelling to and from the hospital is difficult for cancer patients and their families. Fianna Fáil would extend the Travel2Care Scheme which is a travel assistance grant funded by NCCP so that an adequate transport solution can be offered to patients who need to travel to a hospital for cancer-related treatment. Resources for Travel2Care have been cut recently and Fianna Fáil would reinstate funding to its original level.

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Dementia

Fianna Fáil welcomed the publication of the National Dementia Strategy in 2014 and we are committed to its implementation and funding.

We will ensure that every person with dementia that requires home care has access to dementia specific care in their home.

We must also act so that everyone with dementia has access to a timely diagnosis and appropriate post-diagnosis support including, but not limited to, a dementia adviser as a minimum standard of follow-up support.

The Department of Health is to conduct a mid-term review of progress in 2016. Fianna Fáil supports the call for the findings from this mid-term review to be utilised to develop a revised dementia plan.

Such a revised plan must address the gaps in the current strategy. Specifically, the needs of people with younger onset dementia must be addressed and there must be a commitment to remove age discrimination barriers in the health system. The strategy purports to be for ‘everyone’ with dementia but in its detail highlights services which will not apply to those under the age of 65.

Similarly there has been little focus on residential care. A recent report from Trinity College Dublin/St. James’s Hospital found that only 11% of long term residential care homes have dedicated dementia units.

Also it is important that we give priority to new social and community approach to dementia and the development of Dementia Friendly Communities.

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HEALTH PROTECTION AND HEALTH PROMOTION

Tobacco – Make Smoking History

With the publication of ‘Towards a Tobacco Free Society’ in 2000, the establishment of the Office of Tobacco Control and implementation of the workplace smoking ban in 2004, Fianna Fáil has demonstrated a sustained commitment to reducing the effects of tobacco consumption on the health of our population.

The latest official HSE figures reveal the measures instigated by us, and built on over the past number of years, have resulted in dramatic improvement. Fewer than 1 in 5 adults now smoke in Ireland. This is a landmark achievement and it is the first time the smoking rate has fallen below the 20 per cent level. The next goal is to break through the 10 per cent barrier. We endorse the aim of 5 per cent by 2025.

We have seen the benefits that legislative changes can have in relation to tobacco control. What is clear, however, is that the improvements have not been experienced uniformly across our population. The DE socio-economic group (semi-skilled, unskilled, or unemployed people) accounts for almost 39% of the smoking population. Smoking levels amongst Traveler women and men was 52.5% in 2010. Specific, targeted efforts must therefore be made in disadvantaged communities.

Cessation services need to be targeted in order to reach those from poorer communities. Investment in such services is one of the most cost-effective healthcare treatments, according to the US Surgeon General. Good cessation services can double the chances of quitting.

One example of this is the ‘We Can Quit’ initiative of the Irish Cancer Society in partnership with the Northside Partnership, the Blanchardstown Area Partnership, the HSE and the National Women’s Council of Ireland. The service offers women a supportive environment in which to overcome the barriers to quitting smoking. The free 12-week programme is group based so that women can join forces with other women as they quit together.

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Pharmacists play an important role and are uniquely placed in the heart of the communities they serve to intervene with their clients to help them stop smoking. Most of their clients seek health advice and are receptive to it. In their professional role, pharmacists can promote smoking cessation by giving advice on quitting and health related benefits.Fianna Fáil will continue to implement measures to reduce smoking prevalence in Ireland over the coming 5 years.

Alcohol

Fianna Fáil believes that in improving the health of our population we must avoid the risk of becoming a ‘nanny-state’ where freedom of choice is removed. We must also recognise, however, that there is an issue with harmful drinking in Ireland. Over 8,000 people were treated for problem alcohol use in Ireland in 2012 alone.

Alcohol is associated with 2,000 beds being occupied every night in Irish acute hospitals, one-quarter of injuries presenting to emergency departments and over half of attendances to specialised addiction treatment centres. A study by the HSE in 2011 estimated that alcohol-related costs amounted to €3.7 billion per annum.

Fianna Fáil supports the Royal College of Physicians in calling for the development of an integrated model of care for the treatment of alcohol related health problems. We also recognise and endorse their recommendation in relation to the need to broaden the focus of alcohol services to include drinkers who may not be alcohol dependent, but who consume alcohol in a harmful/hazardous manner.

Fianna Fáil broadly supports the heads of the Public Health (Alcohol) Bill and the introduction of minimum unit pricing. However, we do not believe that this Bill has gone far enough.

Firstly, the Government have pointedly failed to tackle the issue of drinks industry sponsorship in sport. Contrary to Government rhetoric, the evidence is clear that alcohol sponsorship of sport influences drinking behaviour and, in particular, encourages children and young people to drink at an earlier age and in greater quantities than they otherwise would. Their failure to tackle this issue highlights the insincerity with which the present Government have approached the promotion of a ‘healthy Ireland’.

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In doing so, they have ignored the repeated advice of the Special Rapporteur on Child Protection, Dr Geoffrey Shannon who has repeatedly called for the introduction of a ban on alcohol sponsorship in sport. In marked contrast to this abject failure, Fianna Fáil will commit to phasing out this type of sponsorship over the next 5 years.

We believe that the measures contained in the Public Health (Alcohol) Bill will, in isolation, fail to adequately address the problems associated with harmful drinking as outlined above. Fianna Fáil are therefore committing to the establishment of an Office of Alcohol Control which will aim to holistically address the diverse drivers and consequences of harmful alcohol consumption in Ireland.

As noted by the World Health Organisation’s global strategy to reduce the harmful use of alcohol in 2010, there are ten recommended target areas for national action in relation to alcohol. Fianna Fáil will support the new Office of Alcohol Control in addressing these areas, as outlined below.

• Improving leadership, awareness and commitment • Health service response• Community Programmes • Drink Driving Policies and countermeasures • Addressing inappropriate availability of alcohol • Addressing inappropriate marketing of alcohol• Pricing policies• Reducing the negative consequences of drinking and alcohol intoxication• Reducing the public health impact of illicit alcohol and informally produced alcohol• Monitoring and surveillance

Obesity

One in four children and two out of three Irish adults are now overweight or obese. The cost of obesity to the State has been estimated at approximately €1.13 billion per annum in direct and indirect costs and this is set to increase unless it is addressed promptly.

Fianna Fáil supports the development and implementation of a National Plan for Physical Activity.

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Fianna Fáil will commit to the introduction of a 20% tax on sugar sweetened drinks (SSDs) in the next budget. It has been estimated, using UK models that a 20% tax on SSDs would lead to a reduction in the prevalence of obesity of 1.3%. The Irish Heart Foundation has estimated that the revenue generated by a 20% tax would be approximately €57.5m.

Fianna Fáil will expand the Broadcasting Authority of Ireland (BAI) code to prohibit TV advertising of foods high in fat, salt and sugar (HFSS) up to 9pm.

Fianna Fáil will seek the promotion of active travel (such as cycle lanes, safe walking options) in rural and urban areas through planning regulations and guidelines.

We recognise that children from lower socio-economic households are more likely to be overweight and obese than their more advantaged peers and we therefore commit to targeting resources at lower socioeconomic schools and communities.

We will seek a commitment from schools to allow free play and physical activity in school playgrounds/recreation areas.

Finally, we will promote the adoption of a ‘weight aware’ ethos in all clinical services.

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Public Health Doctors

The role of public health doctors will be central to the achievement of many of the aspirations outlined in this policy document. These doctors are concerned with the health of our population as a whole, and their work attempts to cut across the boundaries of our health system, in partnership with colleagues in both primary and community care and the acute hospitals.

Fianna Fáil recognises that despite qualifications, training and expertise which is equivalent to that of hospital consultants, public health doctors have never been given parity of esteem with regard to status and remuneration. This is a situation which is unique to them amongst doctors in Ireland and a situation which is not reflected internationally where public health doctors are on an equivalent footing with their other medical colleagues.

Fianna Fáil accepts the findings of the MacCraith Report which suggested that this situation threatens the future viability of the specialty of public health in Ireland. We are committed to addressing this issue and to putting these doctors on an equal footing with their other medical colleagues.

Health Screening

Fianna Fáil has a proud record regarding the development of the National Cancer Screening Service and the introduction of innovative health screening programmes, including BreastCheck and CervicalCheck. We commit to the continued support for these programmes and to the stepwise introduction of further national programmes once they are deemed clinically and cost-effective.

Health Protection

The outbreak of Ebola in West Africa in 2014 highlighted the importance of having well prepared surveillance and response systems in place such that the potential impact of infectious diseases can be minimised as they arise. Fianna Fáil commits to resourcing the Health Protection Surveillance Centre (HPSC) and Departments of Public Health around the country so that Ireland meets its obligations under the International Health Regulations and to ensure that the impact of future infectious or other threats can be dealt with as required.

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Healthy Workplaces

Approximately one third of adult life is spent at work, and thus the impact of the workplace on employee’s health and wellbeing needs to be considered. Fianna Fáil have been to the forefront in protecting workers in the past, through the introduction of the workplace smoking ban in 2004 and the cycle to work scheme in 2009.

Fianna Fáil now recognises that there is a need to develop the concept of occupational health amongst our workforce, building on the traditional notion of this as something which is designed solely to prevent injury in the workplace. While this is important, we believe that the concept needs to be expanded to incorporate other aspects of employee’s health and wellbeing, and to be concerned with far more than just the absence of physical disease.

We believe that increased focus on the importance of a healthy workplace can be an important step toward addressing Ireland’s increasing problems with lack of physical activity and obesity, poor mental health and chronic disease. We also believe that these measures can significantly contribute to reduced absenteeism and increased productivity and the evidence suggests that they can therefore be significantly cost-saving.

If our health service employees are to provide excellent care to patients then they themselves must also be cared for. Ireland’s health service should act as a model for other organisations in how it treats its employees and looks after their health and wellbeing. This is simply not the case at present. Absenteeism rates are almost twice that of private companies and it is costing our health service over €200 million per year. The promises by this Government to ‘crack-down’ on this problem are short-sighted and miss the point.

Fianna Fáil believes that this problem must instead by tackled by addressing the health and wellbeing needs of our health service staff. It is only through having a committed, engaged, healthy and happy workforce that our public health system can hope to move forwards. With this in mind, Fianna Fáil commits to engage with the Division of Health and Wellbeing within the HSE to develop a comprehensive employee focused, needs focused, wellness programme which improves the health and morale of our workforce while simultaneously reducing costs.

In 2012 Fianna Fáil introduced the Assaults on Emergency Workers Bill. The Bill provided that any serious assault on or threats to kill emergency workers on duty would result in a minimum term of imprisonment of not less than five years.

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People who seek to assault or threaten on duty emergency personnel are attacking not just these personnel but all of Society. Their crimes should be punished severely so that the message goes out that those who assault emergency workers will go to jail. We restate our commitment to this bill.

Health in all Policies

When launching Health Ireland, the present Government committed to a ‘health in all policies’ approach to our public’s health. It promised that each Government sector would “help to improve health and wellbeing, multiplying all efforts and delivering better results”. This has simply not happened. There has been no evidence of cross-departmental thinking or strategy when it comes to our nation’s health.

Fianna Fáil understands that the health inequalities which exist within our population are driven by a range of social, cultural, economic and environmental factors. Unfortunately, these factors are never given adequate attention when it comes to policy-making across Government departments. We believe that there is therefore a need to develop a dedicated unit within the Department of Health whose sole focus will be to examine the potential health impacts of policies which are proposed by other Government departments. This will ensure that these policies are ‘health-proofed’, provide maximum benefits to those most at risk and, crucially, will avoid the unintended consequences of legislation which would otherwise have been developed with no regard for our public’s health.

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FURTHER MEASURES

Patient Focus

Fianna Fáil understands that traditional models of medical and social care have changed. Increasingly, people want to be actively involved in decisions about their care, to be part of their own medical team. We commit to placing the patient at the centre of future policy initiatives and ensuring that the patient voice is heard.

Information Technology and Electronic Health (eHealth)

Multiple surveys have demonstrated that patients want to be empowered in relation to their health; they are open to new technologies and monitoring systems which keep them and their families healthy.

Similarly, health professionals want improvements in efficiency and patient outcomes, and information technology has been demonstrated to improve both.

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Fianna Fáil welcomed the publication of the National eHealth Strategy in 2013. While the Health Identifiers Act was one element of this Strategy much remains to be done. Fianna Fáil supports the advancement of this Strategy but cautions that this process must be driven by patients and healthcare professionals, with solutions developed which address the practical needs of these stakeholders rather than those of administrative or management functions.

Genetics

The National Centre for Medical Genetics has recently been downgraded to a department in Crumlin Children’s Hospital. The National Centre was under-resourced and long waiting lists were a feature of a unit unable to meet demand given stretched resources. Fianna Fáil would reinstate a National Centre that could oversee the introduction of a hub and spoke model for a central genetics programme for adults. We would also appoint a Lead for genetics in the Department of Health, a post that does not currently exist, despite the UK having 18 staff working on genetics in the UK.

Fianna Fáil is also committed to the implementation of the National Rare Disease Plan.

Drug Costs

The cost of drugs to the HSE continues to remain high notwithstanding significant savings over the past decade or so. Fianna Fáil fully supported and offered to expedite the passage of the Health (Pricing and Supply Medical Goods) Bill during this Dáil.

It is our belief that the National Procurement Office should be given the task of managing purchasing medicines on behalf of the HSE. This must involve direct meetings between the National Procurement Office and the relevant pharmaceutical companies.

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THE HEALTH SERVICE EXECUTIVE

Fianna Fáil will not be abolishing the Health Service Executive as we believe there needs to be equal implementation of health policy across the country.

The HSE is just ten years old and its tens of thousands of workers provide care in every community and in a huge range of facilities. It is progressively ending the fragmentation of policy and delivery in essential services.

We accept that it has had many challenges. However, any new organisation which amalgamates 20 smaller agencies and health-boards and brings 100,000 employees and stakeholders across the country together under one umbrella is bound to have issues.

We established the HSE because we wanted to bring clarity regarding roles and accountability — political responsibility for the Minister and management responsibility for the management. We aimed to put distance between our political system and the day-to-day management of our health system.

In its early years, the HSE supported and enabled the development of new, integrated services on a national and regional basis which, in many instances significantly improved patient outcomes, as evidenced by the improvements in cancer and cardiovascular disease.

While Fianna Fáil wants to see a greater emphasis on the service rather than the executive, a national health service broadly funded from general taxation is intrinsic to our health policy. We will return power to those working on the frontline of those services and we will return control of the budget to the HSE by amending the Health Service Executive (Financial Matters) Act 2014.

Performance Management

While resources are clearly a factor in the difficulties in our health service, we must also guarantee that they are managed efficiently and effectively. If this is not happening underperforming managers will need to be removed to posts more commensurate with their capabilities.

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Every hospital CEO will be accountable for the delivery of key targets. They will include waiting times, delayed discharge numbers, financial expenditure

Fianna Fáil believes that the areas that are not functioning in the health service should be tackled so that it can deliver more. We have all got too used to a “system failure” being used as an excuse for when something goes wrong. This culture needs to fundamentally change. The people who design and who are responsible for the system at all levels should be made more responsible. Sanctions have to be imposed on management to prevent mistakes from reoccurring.

While managers should be held accountable, there also needs to be greater voice given to those at the front-line of care provision in the formulation of strategy, rather than this being entirely carried out by those who are further removed from patients. The culture of managerialism in the health system needs to be ended

Audit and Service Implementation

Fianna Fáil will establish an independent oversight group to guarantee best practice in the management of resources and to ensure that frontline services are maximised to the benefit of patients.

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BUDGETS AND COSTINGS

In this section we provide indicative costings for our key health priorities in the first year. These would be in addition to the financial out turn for 2015 and funding for demographic adjustment. The extra primary care funding will be contingent on a clear action plan for the rebalancing of our health system away from the acute sector. It will only be allocated on that basis. Other increases such as a 10 per cent increase for the National Ambulance Service would not be repeated every year.

Clearly these figures would be subject to significant change in the event of a new public service pay agreement.

The increase in the cost of the under 6’s scheme agreed last week by the Minister for Health has implications too. We have tabled a parliamentary question to establish if there is a new estimate for the cost of providing GP cover to all the population but at this time the Department of Health cannot provide it. That obviously will be a further cost in the future.

Prior to the general election Fianna Fáil will provide detailed fiscal plans for a five year period of government. We did the heavy lifting in terms of restoring the public finances and we will not be jeopardising that work.

As we indicated in our 2015 Budget submission, we believe that there is still scope for savings in both the drugs budget and in expenditure on agency staff in the region of €70 million.

In formulating health budgets in the future, Fianna Fáil will ensure that long-term costs and benefits are also taken into account, as many health-related initiatives involve a short-term cost but a long-term saving. Currently, there is too much emphasis on fitting into a particular budget in any given year, almost as an accounting exercise. We believe that more health economists should be recruited to both the Department of Health and the HSE for the purposes of long term planning.

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Expenditure €mPrimary Care 120National Treatment Purchase Fund 50Consultants 12Ambulance Service 15Therapists 3.3Home Care packages 12.5Extra Nurses / Midwives 15Home Helps 20Paediatric Home Care Packages 10Office of Alcohol Control 2Mental Health 30Disability 10Fair Deal 27Phased Abolition of Prescription Charges 60Drug Payment Scheme Threshold Reduction 24Capital 40Total 450.8 Revenue & Savings €mTax on Sugar Sweetened Drinks 58Drugs Budget 50Agency Staff 20Total 128 Net Total 322.8

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