Future Health: A Strategic Framework for Reform of the Health Service Presentation by Dr. Ambrose McLoughlin Secretary General, Department of Health HMI West Forum for Managers Meeting The Eyre Suite, Clayton Hotel, Ballybrit, Galway 25 January, 2013.

Future Health Future Health is the Irish Government’s high level plan for reforming the health system Approved by Government on 13 November and published by the Minister for Health on 15 November 2012 It maps out the key actions, with timelines, for the achievement of our reform agenda The actions are focused on the steps we need in order to bring us to UHI

What we want to achieve: A Single-Tier Health Service supported by Universal Health Insurance Every citizen insured for a standard package of curative health services No distinction between ‘public’ and ‘private’ patients Universal primary care with GP care free at point of use for all Universal hospital care with independent, not-for- profit trusts and private hospitals Multi-payer model, based on competing insurers Social care services outside UHI system but integrated around user

Health & Wellbeing New concentration on keeping people healthy Need for a whole-of-Government approach to addressing health issues across the lifecycle Health and Wellbeing Policy Framework Establish Health and Wellbeing Agency in Q1 2015

Primary Care Extend GP care without fees on a phased basis Introduce chronic disease management programmes between 2013 and 2015 Implement programme of investment in Primary Care Centres between 2013 and 2015 Increase the numbers of healthcare professionals working in Primary Care from 2013

Acute Hospitals Publish Smaller Hospitals Framework Establish administrative Hospital Groups in Q1 2013, leading to Hospital Trusts by end 2015 Continue programmes to reduce waiting times for scheduled and unscheduled care – a critical element in advance of the transition to UHI Reconfigure Ambulance Service by Q1 2014

Social & Continuing Care Implementation Plan for VFM Disability Report Roll out single assessment tool for older peoples’ services 2013 Review of Fair Deal (Nursing Homes Support Scheme) for sustainability and to assess its applicability to other sectors by Q Commence work on a national standard assessment tool for people with disabilities in 2013 Extend HIQA regulatory regime to residential services for people with disabilities in 2013 and to other social and continuing care settings by 2016 Continue roll-out of A Vision for Change

Financial Reform Health Vote to return to Department from 1 January 2014, with detailed preparatory work and road-testing throughout 2013 Develop programme-based budgeting in 2013 Implement a comprehensive financial management system as a priority Time bound plans for MFTP to create incentives that encourage treatment at the lowest level of complexity that is safe, timely, efficient and as close to home as possible.

Moving to UHI White Paper on Universal Health Insurance; preliminary paper will be published shortly Work already underway on reform of Private Health Insurance system, including Risk Equalisation System from 1/1/2013 and regularise status of VHI UHI funding model from 2016 to cover primary care, acute hospital care. This is vital for an effective MFTP system Social care, long-term care etc continues to be funded from general taxation

Structural Reform Goal is to dismantle the ‘command and control’ system in health and replace it with a system of devolved autonomy, where increasing control is given to the frontline Governance legislation and phased change towards UHI structures, including Healthcare Commissioning Agency Establish Hospital Groups: Recommendations shortly and implement in Q Review ISAs in Q2 2013; develop Primary Care structures Implement Action Plans for shared services and external service delivery

Implementing Reform We will need to – Get the building blocks for reform right – Ensure overall coherence of reform initiatives – Keep the ‘show on the road’ while pursuing reform – Learn the lessons of other health systems – Be both ambitious and realistic in implementing change

Critical Enablers Information/ICT Comprehensive financial management system Health Information Bill, Unique Identifier and Universal Registration National Clinical Programmes Structural reform and governance: who is responsible for what Public Service Agreement (Use the agreement to its outer limits) Human Resource Skills and Capacity

We have already made real progress…..

Progress on Governance & Management Arrangements Robust governance and management structure currently being developed – This will clearly define roles; set out the accountabilities and responsibilities for each role; and develop effective management and reporting arrangements. – Programme Management Office currently being established in the Department – Programme Board to be established in the coming weeks

Progress on Consultation & Collaboration Consultation and collaboration with stakeholders will be crucial to success This has already begun – in the two weeks following the launch of Future Health, the Minister met with 1,500 local clinical and administrative staff and management as well as regional health forum members at 14 events across the 4 HSE regions Consultation will continue throughout the reform process

Other areas of progress (1) Policy papers on UHI; Money Follows the Patient; Hospital Groups; and the Smaller Hospitals Framework to be published in coming weeks HSE Governance Bill has completed its passage through the Seanad and will now be considered by the Dáil New administrative structures in the HSE – process to appoint new Directorate Management and Leadership team has commenced Health and Wellbeing Framework to be submitted to Government shortly

Other areas of progress (2) Implementation Plan on Disability VFM Review to be completed by end January Permanent scheme of Risk Equalisation in place in the private insurance market Drug price agreement in place with IPHA worth in excess of €400m over 3 years Agreement also in place with APMI which provides for reductions in the price of generics Croke Park – revised action plan for health sector recently published and discussions underway

The reforms are already benefitting patients Hospital Access Targets (comparing Dec 2012 with Dec 2011): – 98% decrease in the number of adults waiting more than 9 months for inpatient and day case surgery – 95% reduction in the number of children waiting more than 20 weeks for inpatient or day case surgery – 99% reduction in those waiting more than 13 weeks for a routine endoscopy procedure – 23.6% reduction in the number of patients waiting on trolleys (2012 vs 2011)

20 Conclusion Most comprehensive reform of our health service ever undertaken. Good progress to date. The reforms are working. We need to build on reforms already underway and drive further change in the interest of patients.