Health:

 

As Fine Gael Seanad Spokesperson on Health, I fully support the Provisions in the Programme for Government in relation to healthcare. I am working to ensure that these reforms are carried out.

 

The people of Ireland deserve a world class health service and I am committed to seeing realised.

 

 

Health and Mental Health -

 

I fully support the committment to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income. By reforming our model of delivering healthcare, so that more care is delivered in the community, and by reforming how we pay for healthcare through Universal Health Insurance, we can reduce the cost of achieving the best health outcomes for our citizens, and end the unfair, unequal and inefficient two-tier health system.

 

 

Health Service Reform -

 

This Government will introduce Universal Health Insurance with equal access to care for all. Under this system there will be no discrimination between patients on the grounds of income or insurance status. The two-tier system of unequal access to hospital care must end.

 

As a statutory system of health insurance, guaranteed by the State, the Universal Health Insurance system will not be subject to European or national competition law. This Government will act speedily to reduce costs in the delivery of both public and private health care and in the administration of the health care system.

 

The Government is determined to introducing a system of risk equalisation for the current insurance market.

 

A Special Delivery Unit will be established in the Department of Health to assist the Minister in reducing waiting lists and introducing a major upgrade in the IT capabilities of the health system.

 

A Patient Safety Authority, incorporating HIQA, will be established.

 

The Health Service Executive will cease to exist over time. Its functions will return to the
Minister for Health and the Department of Health and Children; or be taken over by the Universal Health Insurance system.

 

 

Primary Care -

 

The government is committed to introducing Universal Primary Care which will remove fees for GP care and will be introduced within this Government’s term of office.

 

During the term of this Government, GP training places will be increased. GPs will be encouraged to defer retirement and will be recruited from abroad, and the number of practice nurses will be increased so that GPs can delegate care when appropriate to nurses.

 

Access to primary care without fees will be extended in the first year to claimants of free drugs under the Long-Term Illness scheme at a cost of €17 million.

 

Access to primary care without fees will be extended in the second year to claimants of free drugs under the High-Tech Drugs scheme at a cost of €15 million.

 

Access to subsidised care will be extended to all in the next phase.

 

Access to care without fees will be extended to all in the final phase.

 

Under Universal Primary Care, GPs will be paid primarily by capitation for the care of their patients and will work in primary care teams with other primary care professionals.

 

A new GP contract will provides incentives to GPs to care more intensively for patients with chronic illnesses. This will significantly reduce pressures and demands on the hospital system.

 

Registration with a primary care team will be compulsory once the Universal Primary Care system is fully implemented.

 

Exchequer funding for primary care will go to a Primary Care Fund on a transitional basis, which will pay providers of primary care. The goal under UHI will be to create an integrated system of primary and hospital care.

 

Ring-fenced funding will be provided to recruit additional psychologists and counsellors to community mental health teams, working closely with primary care teams to ensure early intervention, reduce the stigma associated with mental illness and detect and treat people who are at risk of suicide.

 

 

Universal Hospital Care -

 

A system of Universal Health Insurance (UHI) will be introduced by 2016, with the legislative and organisational groundwork for the system complete within this Government’s term of office.

 

UHI will provide guaranteed access to care for all in public and private hospitals on the same basis as the privately-insured have now.

 

Insurance with a public or private insurer will be compulsory with insurance payments related to ability to pay. The State will pay insurance premia for people on low incomes and subsidise premia for people on middle incomes.

 

Everyone will have a choice between competing insurers. The VHI will be kept in public ownership to retain a public option in the UHI system.

 

Exchequer funding for hospital care will go into a Hospital Insurance Fund which will subsidise or pay insurance premia for those who qualify for subsidy.

 

The Hospital Insurance Fund will oversee a strong and reformed system of community rating and risk equalisation; provide direct payments to hospitals for services that are not covered by insurance such as Emergency Departments and ambulances; and provide matching payment to hospitals for treatments delivered.

 

The Hospital Insurance Fund will also control those health care costs for which central control is most effective.

 

Under UHI insurers will be obliged to offer the same package of services to all.

 

This guaranteed UHI package will be determined by the Minister for Health in consultation with the Hospital Insurance Fund and medical experts and will be regularly reviewed in a process to be established in legislation, the Universal Health Insurance Act.

 

Insurers will not be allowed to sell insurance giving faster access to procedures covered by the UHI package.

 

Hospitals and clinics which participate in supplying care under UHI will not be allowed to sell faster access to procedures covered by the UHI package.

 

A White Paper on Financing UHI will be published early in the Government’s first term and will review  cost-effective pricing and funding mechanisms for care and care to be covered under UHI.

The legislative basis for UHI will be established by the Universal Health Insurance Act.

 

 

Hospitals -

 

Under UHI public hospitals will no longer be managed by the HSE. They will be independent, not-for-profit trusts with managers accountable to their boards.

 

Boards will include representatives of local communities and staff.

 

Smaller hospitals may combine in a local hospital network with a shared management and board.
Hospitals will be paid according to the care they deliver and will be incentivised to deliver more care in a “money follows the patient” system.

 

Insurers will negotiate directly with hospitals to help control costs and encourage innovation in the delivery of care.

 

Insurers will not take over the running of hospitals which will be independent providers of care separate from insurers as purchasers of care.

 

The Minister for Health will be responsible for hospitals policy and determining that hospitals which play an important role in an area should not be allowed to close under UHI.

 

The Hospital Insurance Fund will assist hospitals in more remote locations that may not have a large throughput of patients to continue to provide important local services.

 

To ensure that hospitals compete on an equal footing, public hospitals will be compensated for costs that they bear that private hospitals do not such as Emergency Departments and training health care professionals.

 

The Patient Safety Authority will introduce a national licensing system for hospitals, and will oversee the transition of hospitals from the HSE to independent local control.

 

The existing policy of co-location of private hospitals on public hospital lands will cease.
Tax incentives for private hospital developments will cease.

 

 

Pathway to Universal Hospital Care Insurance -

 

In the first term of this Government, the foundations will be laid for the introduction of
Universal Hospital Care Insurance:

 

The legislative basis for UHI will be enacted.

 

Public hospitals will be given autonomy from the HSE.

 

The HSE’s function of purchasing care for uninsured patients will be given to a Hospital Care Purchase Agency which will combine with the National Treatment Purchase Fund to purchase care for the uninsured over this transition period.

 

This separation of purchaser-provider functions will enable the development of a money follows the patient system of purchase of care for people without insurance before the implementation of the UHI system.

 

 

Care of Older People and Community Care -

 

Investment in the supply of more and better care for older people in the community and in residential settings will be a priority of this Government.

 

Additional funding will be provided each year for the care of older people.

 

This funding will go to more residential places, more home care packages and the delivery of more home help and other professional community care services.

 

The Fair Deal system of financing nursing home care will be reviewed with a view to developing a secure and equitable system of financing for community and long-term care which supports older people to stay in their own homes.

 

 

Integrated Care -

 

The integration of care in all settings is key to efficient health care delivery, in which the right care is delivered in the right place.

 

Integration of care will be the responsibility of an Integrated Care Agency under the aegis of the Minister for Health.

 

This agency will oversee the flow of centrally tax-funded resources between the different arms of the system so that there are incentives for care to occur in the best setting.

 

 

Cost Control -

 

Reference pricing and greater use of generics will be introduced to reduce the State’s large drugs bill and the cost to individuals of their medications.

 

Under the new GP contract the rate of remuneration of GPs will be reduced.

Under a new consultant’s contract hospital consultants’ remuneration will be reduced.

Action will be taken to reduce the cost of procurement for medical equipment and construction of facilities.

 

 

Health Administration -

 

The Minister for Health and the Department of Health will be responsible for policy and spending.

The HSE will cease to exist as its functions are given to other bodies during this process of reform.

 

The HSE hospital purchasing arm will merge with the NTPF to become a new purchaser of public patient care during this period of transition.

HSE hospitals will become autonomous providers of care.

 

 

Capital developments in Health -

 

Health capital spending will be a priority.

Within the Health capital budget, the immediate priority areas will be primary care centres, step-down and long-term care facilities, and community care facilities such as day centres for older people.

The completion and commissioning of the cystic fibrosis unit will be expedited.

The National Children’s Hospital will be built.

 

 

Mental Health -

 

Our policy on mental health incorporates the recommendations of A Vision for Change.

I believe strongly in reducing the stigma of mental illness, ensuring early and appropriate intervention and vastly improving access to modern mental health services in the community.

A comprehensive range of mental health services will be included as part of the standard insurance package offered under Universal Health Insurance.

Given the central role of primary care in our reforms, we must ensure that patients can access mental health services such as psychologists and counsellors in the primary care setting. GP education must be strengthened and training in mental health so that they can better diagnose, treat and refer as necessary.

Unsuitable psychiatric institutions must be closed moving patients to more appropriate community-based facilities and will develop specific strategies for elderly patients and those with intellectual disabilities who remain under the care of mental health services.

 

 

Other health priorities -

 

We need to develop a national Alzheimer’s and other dementias strategy by 2013 to increase awareness, ensure early diagnosis and intervention, and development of enhanced community based services. This strategy will be implemented over five years.

I am committed to working for the introduction of a cervical cancer vaccination catch-up programme for all girls in secondary school. Breastcheck should be extended to 65-69 year old women.

We need develop a National Carers Strategy to support carers and to address issues of concern.