Reform in the health service is not optional and additional money is not the sole solution to its difficulties, the Minister for Health Simon Harris has told doctors.
Addressing the annual conference of the Irish Medical Organisation (IMO) in Killarney on Saturday, Mr Harris said that the Government's plans to spend an additional €11 billion in hospitals and in the community to boost capacity over the coming decade could not be the only answer to the problems of the health service.
“We must make real changes to healthcare delivery in order to have a sustainable healthcare system in the future. Put simply, we have no option but to reform.”
The Minister’s comments came as the new head of the IMO warned that the medical profession was “under attack” and that doctors were “sick of so-called reform”.
Dr Peadar Gilligan said reform should be change with a view to improvement.
“What we have in the health service is often change without evidence of improvement. I am sick of doing more with less, I am sick of being told what I should do by people who have never done it. I, like many doctors, am sick of those who could help to improve the health system not doing their part and sometimes doing the opposite. It is not just change we need but demonstrable improvement and that improvement will require resourcing.”
Dr Gilligan said the role of doctors was being systematically undervalued and this was leading to an unprecedented shortage of doctors in key positions across the country.
The Minister said he heard loudly and clearly the calls by doctors on the Government to reverse austerity-era cuts imposed under financial emergency legislation, known as Fempi.
The IMO argued during its conference that these cuts have, for example, brought general practice to its knees and contributed to a flight of hospital doctors from the country.
Mr Harris said he hoped new talks with the IMO, to commence in the coming weeks, would herald a move into “a post-Fempi era”.
Medical card reform
“I believe we can work together to ensure general practice is a sustainable and rewarding career choice, while also better meeting the needs of patients.”
The Minister also gave an assurance to doctors that in the event of the forthcoming referendum on abortion being passed, the Department of Health would "consult with representative bodies of all relevant medical practitioners on the details of the legislative proposals" on the provision of terminations which would follow such a vote.
Mr Harris said the contract for the operation of the medical card scheme needed to be modernised - a long-standing Government objective - and he shared the frustration of doctors that such a reform had proved difficult to achieve.
He said the contract needed to be reformed to meet the needs of patients, general practitioners and the State, while providing for better health promotion, structured care and disease prevention.
The Minister said he wanted to be clear that the potential was there “for general practice to secure significant additional investment in the coming years”.
He said GPs needed more staff supports from other healthcare professionals like practice nurses. He said the Government and GPs should work together to seek progress to support the recruitment of additional practice nurses.
Sláintecare
The Minister said the proposed Sláintecare healthcare reforms, drawn up by an Oireachtas committee last year, placed primary and community care at the heart of health care delivery.
He said he understood how this could be construed as pitting hospital medicine against primary care, and why an organisation representing doctors in both areas would be very concerned by that.
“The reality is that those who say we just need more primary care are only telling half the story. Those who say we just need more beds are only telling the other half. When we put them together we begin to see the full picture - adequate hospital beds to meet our demographic needs now and for the future, coupled with primary and community care that is resourced and developed to its full potential.”
Dr Gilligan, who is a consultant in emergency medicine at Beaumont Hospital in Dublin said overcrowding in emergency departments "costs live and must stop".
He said Ireland was an outlier in terms of overcrowding in emergency departments internationally. He called for the introduction of a six hour standard between the time a patient arrives in an emergency department and the time they are admitted or discharged. The current average waiting time in emergency departments in Dublin is 14 hours.
Dr Gilligan said the country needed about 7,000 additional hospital beds and not the 2,500 proposed by the Government, and that the beds are required to deal adequately with an increasing and aging population.
He said the target of providing 2,590 additional beds was based on a series of very positive assumptions including improving health generally and major investment and reform across the health services.
“To plan on the basis of all our plans working out optimally is at best fool hardy and I think we need to plan for the worst but hope for the best, not just bank on the best. In short, we do not just need 2,590 acute hospital beds we need 7,000 beds and the associated staffing levels and we need to get started on producing this capacity in our system now.”
