National Healthcare Conference 2011

24 March 2011

Presentation by Mr Michael Scanlan, Secretary General,Department of Health & Children

Outline

Opening remarks

Where are we

Where do we want to go

How do we get there

Concluding comments

A better debate

Do we want to be self-critical or just critical Searching for learning or heads on a plate “Vested interests” or “Stakeholders” Emotive or “science based” No one has all the answers We all have a responsibility

Performance Framework

To keep people healthy

To povide the care people need

To deliver high quality services

To get the best value for health system resources

To keep people healthy (1)

In the last ten years life expectancy at birth gone from one year below to one year above the EU average

Life expectancy at age 65 is at or above the OECD average

Healthy life expectancy at age 65 exceeds the EU average

Ireland had the highest annual average decline in amenable mortality of all OECD countries between 1997 and 2007: our rate is now at the OECD average

To keep people healthy (2)

Self-perceived health status in Ireland highest of EU27 One of the lowest mortality rates from stroke Infant mortality rate 3.2 per 1,000 live births in 2009

compared to 2008 EU average of 4.6 All cancer mortality rate same as the OECD average – 212

per 100,000: in 2000 it was 195 compared to an OECD average of 179

Breastcheck, cervical check and forthcoming colorectal cancer screening

To povide the care people need (1)

Waiting times are more important than the number of people on a waiting lists

We do not have acceptable information on waiting times for ED, elective admissions or OPD

Waiting times for ED patients who need admission are not acceptable

OPD waiting times for public patients – a “hidden second waiting list”?

According to EU SILC (2007) 6.3% of population report unmet need, the 5th highest of 20 countries covered

To povide the care people need (2)

Number of people waiting for surgical procedure fell from 7.4 per 1,000 pop in 2002 to 4.3 in 2008

At the end of Dec 2010 there were 50,582 people reported as waiting for an elective procedure on the National Treatment Register, of whom 10,000 were outside the target time for treatment – 3 months for children and 6 months for adults

Over 95% of urgent and non-urgent referrals for symptomatic breast services are seen within 2 and 12 weeks respectively

About 98% of urgent colonoscopies seen within 28 days

To deliver high quality services (1)

HIQA established Protected disclosures Updated legislation on professional regulation Madden Commission Drop of 40% in MRSA bloodstream infection cases

between 2006 and 2009 Nursing homes registration Mental Health Commission/Tribunals

To deliver high quality services (2)

Cancer control programme - trade off between quality and geographical access

Competency assurance, adverse event reporting & open disclosure

Licensing

Clinical effectiveness guidelines

Best value from resources (1)

An increase of 139% in the number of day cases in public hospitals since 2000

The Irish are with the exception of the Mexicans by far the lowest users of medical care within OECD countries

GPs per 1,000 population 0.5 compared to 0.9 OECD average

Global health employment in Ireland (30.8 per 1,000 inhabitants) remains just below the average of OECD countries but….

Best value from resources (2)

…. in absolute terms, hospital employment (17.5 per 1,000) puts Ireland in the highest rank.

Nurses per 1,000 population 15.5 compared to 9.6 OECD average

OECD commented that the cost of medical manpower is expensive in Ireland compared to other OECD countries.

OECD figures (2007) showed hospital nurses remuneration in Ireland is substantially above the OECD average (5th highest) but ...... measured as ratio to average wage it was the 5th lowest

Where do we want to go? (1)

There is no destination – change is a constant

Reach/exceed the EU/OECD average despite(a) aging population and (b) increased burden of chronic diseases/risks associated with lifestyle factors

Faster and fairer access

Better balance between primary care and hospital care

Where do we want to go? (2)

More consistent quality

Appropriate balance between local access and quality care

Economy/efficiency/effectiveness but also affordability/choices

Provide the best care possible for the available resources

Enablers (1)

It is all about behaviour Clarity of purpose and performance Clear policy goals Standards/pathways/protocols/processes Chronic disease management, clinical effectiveness

guielines, integrated care Information ICT Governance/accountability

Enablers (2)

Capacity A whole system approach Changes in professional/work practices User involvement/empowerment Funding/financing mechanisms Structures Aligning the incentives Centralise standards but decentralise delivery

Finally

We are not alone

It is the hard slog of implementation that really matters

Nothing wrong with a “hard nosed business” approach

Transparency is the cure, if it doesn’t kill you first

Can’t “boil the ocean” but can do everything better

We all have a role and a responsibility