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October 22, 2014

Briefing notes on health

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Lloyd Mudiwa reports on the briefing materials prepared for the new Minister for Health Dr James Reilly by the Department of Health.

Apart from prompting the Minister to have an early meeting with, among others, the HSE Chairman and the EU Health Commission in Brussels (which have since taken place), Department of Health Secretary General Michael Scanlan, in the 364-page briefing notes to Minister Dr James Reilly, gave the politician the best possible and up-to-date grounding on the Irish health service prepared on a thematic basis.

Apart from the workings of the Department itself, which this year has been allocated an administrative budget of €38.190 million, Scanlan covered themes such as primary care, secondary care, cancer services, public health, patient safety, governance and private health insurance, as well as contentious issues such as abortion and assisted human reproduction.

Secondary care
There could be extra bed closures this year, given the overriding requirement for hospitals to stay within budget, and closures could lead to longer waiting times, the Department warned Dr Reilly. These bed closures could, in turn, result in longer waiting lists for planned operations.

According to the notes, released under the Freedom of Information Act, there are currently 13,400 public beds in the hospital system, of which 11,600 are inpatient beds and 1,800 are day beds, while there were 886 inpatient and nine-day beds closed at the end of February.

The briefing notes said it was doubtful if many of the closed beds would be reopened in the foreseeable future, given the financial costs of staffing and supporting them. It also said there were big variations between hospitals in the extent to which elective patients were admitted on the day of surgery and also in the average length of stay in hospitals.

Primary care
In relation to primary care, the briefing notes indicated that the EU/IMF programme provides for the introduction of legislative changes to remove restrictions to trade and competition in sheltered sectors by the end of the third quarter of 2011, including eliminating restrictions on the number of GPs qualifying and wishing to treat public patients, and restrictions on advertising.

Hawkins House officials, in the notes, stated that the HSE has identified 527 primary care teams (PCTs) and 134 health and social-care networks to be developed by the end of this year. The HSE Board has approved the conduct of negotiations with interested parties in respect of 210 locations for primary care centres (PCCs), with negotiations being conducted in respect of 107 centres, which will accommodate 137 PCTs.

Some 12 centres procured by lease agreement were complete and in operation, with a further five expected to open in the first quarter of this year, the notes revealed. “The HSE expects at least 115 PCCs to be operational by 2013, supporting 160 teams. The HSE is continuing to develop a number of PCCs funded through its capital programme, with 18 completed to date,” a portion of the reports stated.

In relation to clinical leadership within PCTs, the Department said there would be further development of a sustainable model for managing and governing PCTs. Some planning would also be required to ensure that the development of PCTs and the reconfiguration of hospital services initially in the north east and mid west are aligned to deliver a co-ordinated approach to patient care.

Meanwhile, the number of medical and GP-visit cards has increased by 28 per cent in the three years between the end of 2007 and the end of last year, resulting in a significant rise in the costs of the GMS from approximately €1.6 billion to about €2 billion a year.

Reiterating that medical-card income thresholds have not been increased since October 2005, although the percentage of the population covered by medical and GP-visit cards rose from almost 30 per cent in that year to nearly 39 per cent in 2010, the Department said the key challenge was to develop business intelligence around the operation of the schemes in terms of key cost-drivers, payment streams, applications data and estimates of potentially qualifying candidates, given the amount of beneficiaries (1.7 million) and the associated cost.

Dr James Reilly, Minister for Health

Related to this process, the HSE planned to finalise centralisation of the processing of medical and GP-visit card applications and reviews at the Primary Care Reimbursement Service in Dublin by the end of June.

The notes stated that the operation of the Long-Term Illness Scheme, which cost €134 million in 2010, was under general review by the Department and a detailed submission would be made to the Minister “at an early date”.

Cancer services
The Department acknowledged the “substantial progress” made in centralising cancer treatments by the HSE-National Cancer Control Programme (HSE-NCCP). However, the NCCP/National Cancer Screening Services (NCSS) have been requested to review the potential for efficiencies and cost-savings in areas identified in 2009 by HIQA in relation to BreastCheck, which has been screening in all counties since 2009. The first round of screening is currently ongoing in the south and west, scheduled for completion this year.

The NCCP was now in the process of ensuring that the remaining eight cancer centres have adequate case volumes, expertise and concentration of multi-disciplinary specialist skills for individual tumour types, according to the Department.

It was also reorganising other site-specific cancers, including lung, prostate and rectal cancers, and had put in place rapid-assessment clinics for lung and prostate cancers, the notes showed.

In addition to continuing preparatory work already under way since early 2010 for the introduction of a national colo-rectal cancer screening programme to commence in 2012, the Department said the NCCP would seek to enhance theatre and ICU services to support cancer surgical throughput in cancer centres.

Regarding the National Plan for Radiation Oncology (NPRO), the notes informed Dr Reilly that the new radiation oncology units at Beaumont and St James’s hospitals, which were scheduled to open in December, will open in the near future. The units will have the effect of increasing capacity by 50 per cent in the eastern region — a development that will complete the St Luke’s Radiation Oncology Network.

The NCCP’s chief priorities in 2011 are the provision of new radiotherapy facilities, Phase 2 of the NPRO, which aims to deliver further increased capacity by 2014 through public-private partnership funding.

However, the Acute Hospitals/Cancer/Private Health Insurance Division in the Department, in a business plan for 2011, stated that the Department faced a very challenging year regarding cancer policy, amongst other issues, in relation to securing Government agreement to funding arrangements for Phase 2 of the NPRO.

Stressing the significant financial implications for this programme, the Division said Phase 2 of the NPRO was a major capital development that, subject to Government approval, would need to proceed as soon as possible so as to meet radiotherapy requirements. It added that a memorandum, a draft of which was already at an advanced stage, would shortly be submitted to Government seeking approval to go to tender for the project.

European Union
These and other issues will have to be managed with an eye towards Ireland’s Presidency of the European Union from January to June 2013, the notes also suggested. Dr Reilly was informed that the Department was devising a preliminary list of health priorities for further consideration and discussion.

Scanlan advised: “The Minister may wish to take the opportunity at the forthcoming EPSCO [Employment, Social Policy, Health and Consumer Affairs] meetings to meet with Ireland’s ‘trio partners’ Lithuania and Greece, and other EU Ministers for Health. The Department of Foreign Affairs’s advice to Departments is that in preparation for the Presidency, Ministers should also take the opportunity when visiting Brussels to meet with commissioners and key MEPs leading relevant committees.”

Follow-on items from preceding presidencies/legislative obligations will also determine priorities, as will discussion with the EU Commission, Scanlan said. “It is likely that Ireland will be dealing with legacy issues that include: pharmaceuticals (including a draft Directive on Information to Patients); clinical trials; and the review of the Transparency Directive, which relates to the transparency of measures regulating the pricing of medicinal products for human use and their inclusion in the scope of national health insurance systems.”

Negotiations for issues commencing under the current Danish Presidency, such as rare diseases and ageing, were expected to continue under Ireland’s  Presidency, Scanlan told Dr Reilly in the briefing notes.