Launch of 2020 Vision for Health Campaign

Address by Prof Trevor Duffy, IMO President

Colleagues…. ladies & gentlemen.

By the time we in the IMO convene for our next Annual General Meeting, the people of this country will have gone to the polls to elect a Government that will be expected to run up to and past 2020.

Whatever shape that Government may take, it will have enormous influence on this country and it will be responsible for taking decisions that will profoundly affect us all in key areas of our lives.

From our perspective in the IMO, we are particularly conscious that the next Government will make crucial decisions about the future shape of the health services….and because these services are struggling from the damaging impact of years of austerity and poor policy planning……. the decisions of the next Government will be absolutely crucial in determining whether the coming decade marks a period of recovery for our health services or a period of further decline and jeopardy for those services.

For that reason we made the decision that at this AGM we would begin a concerted campaign - running from now until the next election - to make sure that the future of our health services and the vision, the policies, and the credibility of the various political parties and independent candidates towards those services are center-stage come the next election.

We will also be working hard to ensure that each of the political parties and the independents that aspire to being in Government understand our position in the IMO on these crucial issues. We will be setting out our own vision for the health services…a manifesto that will set out what we believe is necessary to underpin health policy in the coming years so that the damage inflicted over the past decade can be reversed over the coming one.

Our starting point is to acknowledge the very difficult position the health services are in today.

We are now in the 6th year of an austerity programme which has put unbelievable pressure on a health services which was already frail and less than fit-for-purpose.

Every section of society has suffered these past years but given the fragile nature of the health services to start with, I believe the damage has been particularly acute in this area.

The figures alone are shocking:

· The HSE budget was cut by €4 billion between 2008 and 2014. That’s a full 27% - almost a third – of the budget stripped back over successive budgets.

· Staffing levels were cut by the equivalent of almost 13,000 full time staff since 2007 – 11% of the staff number.

· 1,631 acute hospital beds were closed since 2007 -13% of the numbers we started with then.

· The number of long-stay beds was cut by 2,185 between 2008 and 2013 – that’s 9% less than the number we started with.

· GPs are treating an extra 500,000 – let me say it again…500,000…medical and GP visit card holders at the same time as their funding has been cut by €160 million.

· And the number of home help hours has been cut by 2.3 million between 2008 and 2014….that is the equivalent of 95,833 24 hour days.

· The population of people over 70 years of age has increased by 20% since 2006.

· And beyond those figures everyone in this room knows of the crisis in morale in the health services that is so corrosive and damaging…..the young, bright, highly-trained doctors who are choosing to emigrate rather than commit to a future in a struggling service.

Our manifesto for health is built on 6 key policy areas.

Universal Healthcare

We start – as we always have – with our commitment to a system of Universal Healthcare.

But let me be very clear about this…this Government does not support a system of Universal Healthcare. It uses the term Universal health insurance in a way which implies a commitment to universal health care while doing nothing of the sort. And we will continue to call them out on this issue as long as they try to confuse and conflate these very different things.

Universal Healthcare is a policy commitment to a system of healthcare that secures access to adequate, quality healthcare for everyone when they need it and at an affordable cost to them.

Universal Health Insurance – by contrast – is effectively a new tax that the Government would impose on everyone in order to fund the current two tier health system. It is not a way of leveling the playing field for everyone with regard to health….it is a way of levying a new tax to offset the costs of providing health in the same way that water charges are a new tax to offset the cost of providing water.

In the lead up to the next election we will be promoting our vision of Universal Healthcare and we will be calling on all political groupings to support a system where:

· All residents have timely access to appropriate and affordable, promotive, preventive, curative and rehabilitative healthcare.

· Universal GP services are the cornerstone to the development of any universal healthcare system. GP services which are free at the point of access must be introduced on the basis of income and the introduction of structured chronic disease programmes

· Access to healthcare services is based on medical need and not on ability pay or any other criteria including place of residence or age.

Financial, Capacity and Manpower Planning

Our second key policy pillar is a commitment to long term objective planning.

Health services are complex and require detailed long-term planning to run efficiently and to best serve the needs of patients.

Health service planning must be based on a realistic assessment of the likely number of patients who will require care accompanied by the financial, infrastructural and manpower resources necessary to ensure a quality healthcare system rather than rationing the services to meet the budget.

So the IMO is calling on political parties to outline a five-year plan to address financial, capacity and manpower issues in the Irish healthcare system including:

· A comprehensive assessment and costing of the level of services and capacity required across the health system including acute hospital care, GP care and ancillary professional services in Primary Care, long-term and community care services. Such assessment to consider the demographic shifts expected over the long term.

· A commitment to ring fence the funding required to meet the service, with capacity and manpower requirements identified. The current system of funding crisis initiatives is not sustainable or viable. Ring fenced funding will commit to ending the system whereby hospitals routinely engage in rolling theatre closures, ward closures and cancelling of elective surgery to meet budget targets

In the broader economy we now have institutions like the Fiscal Advisory Council which provide independent, objective and learned views on the economy and the consequences of proposed budgetary policy. We believe the health services could benefit from a similarly resourced and expert independent body to advise on the impact of proposed policy changes.

Patient Safety and Quality of Care

The third of our six policy pillars is a commitment to Patient Safety and Quality of Care.

IMO members have been increasingly concerned about the effects of successive budget cuts and reduced staffing levels on patient safety and quality of care. Medical error and substandard care has stark consequences on patients, doctors and the State.

Therefore, the IMO is calling on all political parties to:

· Ensure all clinical services operate with sufficient minimum financial and manpower resources necessary to provide safe, quality, evidence-based care.

· Ensure all healthcare facilities are adequately resourced to meet and exceed HIQA standards of care. Dictating standards without supporting resources to implement them is doomed to failure.

· Invest in Information and Communication Technology, particularly electronic health records, to improve patient safety and eliminate duplication across services.

· Encourage and support innovative patient safety initiatives and reform the medical negligence system.

· Any system of performance measurement is weighted towards quality outcome targets in preference to fiscal targets.

Putting Mental Health on a Par with Physical Health

Out fourth policy pillar commits us to eliminating the disparity between mental and physical health.

Mental health disorders affect one in four adults in Ireland and are the leading cause of disability worldwide.

Yet less than 50% of people with mental health issues receive professional help and even less receive appropriate care.

Stigma and discrimination continue to pose a major barrier to help seeking.

While antiquated institutional care facilities have been closed community mental health services are underdeveloped. In Ireland just 6.2% of the HSE budget is spent on mental health services and both financial and manpower resources are unevenly distributed across mental health services with no relationship between population size or socio-economic need.

Therefore the IMO is calling on all political parties to put mental health on a parity with physical health through:

· Investment in evidence-based programmes to reduce stigma and raise awareness about mental health issues and suicide prevention.

· Access to publicly funded counseling and psychotherapy services on GP referral.

· Investment and development of community and specialist mental health teams.

· Transparent allocation of resources based on population need.

Health in All-Policies

Significant levels of health inequalities exist in Ireland - poorer socio-economic groups have relatively high mortality rates, higher levels of ill health and fewer resources to adopt healthier lifestyles compared to better-off sections of society.

A wide range of factors - such as poverty, inequality, social exclusion, employment, income, education, housing conditions, transport, access to healthcare, lifestyle, stress – all impact on an individual’s health and well-being.

Improving the health of all our citizens (particularly the poorest and most deprived) will reap long-term benefits for our country by ensuring a healthier and more productive workforce with less need for expensive health interventions and social supports.

The IMO is calling on all parties to adopt a Health-in-All-Policies approach and commit to the Goals of Healthy Ireland – A Framework for Improved Health and Wellbeing 2013-2025 specifically to:

· Develop a detailed implementation plan the key proposals in this document with appropriate multi-annual ring-fenced funding to support actions and initiatives

· Ensure that all policy decisions across all Government Departments are subject to a health impact assessment

A Healthcare System that Protects the Doctor-Patient Relationship

Finally, we will be campaigning for a commitment from all political groupings to supporting the Doctor-Patient relationship as a relationship that is based on trust.

Patients trust in their doctor’s professionalism and that he/she will act in their best interest without interference from commercial or political interests.

Therefore, the IMO will call on political parties to ensure that our healthcare system protects the doctor-patient relationship by

· Respecting clinical autonomy and ensuring the doctor-patient relationship is free of interference from commercial or political interests

· Continuing to foster a culture of trust in the medical profession

· Ensuring policy decisions affecting the delivery of healthcare in Ireland are evidence –based and made in partnership with the medical profession

Colleagues, over the coming months the IMO will campaign to put these policies at the centre of the debate on health at the next election. We will argue with policymakers and political parties as to why we believe they are the required cornerstones of a new approach to this area and we will call out the parties on these issues as we get closer to the election itself.

As I come to the end of my term as President of this organisation, I am more conscious than ever that this country needs a vibrant and effective IMO to promote the views of doctors working across the health services and to defend the needs of healthcare professionals and their patients.

The IMO has risen to this challenge countless times in the past. It must rise to it again now so that we can begin to reverse the damage caused by austerity and lay the foundations for a new period of progressive and visionary policy making in health.

Thank you.