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Committee on the Future of Healthcare Sláintecare Report May 2017

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Committee on the Future of Healthcare Sláintecare Report May 2017 An Coiste um Chúram Sláinte sa Todhchaí Tuarascáil maidir le Cúram Sláinte Bealtaine 2017 Committee on the Future of Healthcare Sláintecare Report May 2017 Committee on the Future of Healthcare – Sláintecare Report Contents 1 Chair’s foreword 4 Committee On The Future Of Healthcare 6 Acknowledgements 7 Key recommendations 8 Executive Summary 12 Overview of the Report 14 Section One: Population Health Profile 28 1.1 The Health of the Irish Population 29 1.2 Demographics 30 1.3 Social Determinants of Health 31 1.4 The Impact of the Social Determinants of Health 34 1.5 Responding to the Social Determinants of Health 35 Committee on the Future of Healthcare – Contents of Healthcare Committee on the Future 1.6 Implications for the Health Service 37 Section Two: Entitlements and Access to Healthcare 38 2.1 People with Medical Cards 39 2.2 People without Medical Cards 40 2.3 The Maternity and Infant Care Scheme 40 2.4 Access to Primary and Social Care Services 40 2.5 Gp Visit Cards (GPVC) 42 2.6 Long Term Illness Scheme 43 2.7 Special Care Services 45 2.8 Complexities of Accessing Care in Ireland 49 2.9 International Evidence and Experience 53 2.10 Evaluating Options 55 2.11 Preferred Design 56 2.12 Committee Recommendations 57 2.13 Rationale For Phasing Entitlement Expansion 61 Committee on the Future of Healthcare – Sláintecare Report Section Three: Integrated Care 69 2 3.1 Vision for Integrated Care 70 3.2 International Evidence on Integrated Care 71 3.3 Defining and Delivering Integrated Care 73 3.4 Health System Reform in Ireland 75 3.5 Health Service Delivery 76 3.6 Addressing Critical Service Delivery Challenges 78 3.7 Modelling Integrated Care 82 3.8 Leadership and Governance 83 3.9 Healthcare Funding Mechanisms 91 3.10 Healthcare Workforce 94 3.11 Medicines and Medical Technologies 98 3.12 Information and Research 104 3.13 Recommendations 107 3.14 Recommendations addressing the Critical Challenges of Service Delivery 108 Committee on the Future of Healthcare – Contents of Healthcare Committee on the Future 3.15 Recommendations Relating to Systemically Modelling Integrated Care 110 3.16 Phasing and Implementation of Integrated Care 113 Section Four: Funding 115 4.1 Current Funding 116 4.2 International Comparability 118 4.3 Evaluating Options 120 4.4 Preferred Design 126 4.5 Phasing 133 4.6 Committee Recommendations 133 Committee on the Future of Healthcare – Sláintecare Report Section Five: Implementation 134 3 5.1 Enablers for Implementation 135 5.2 Political Will and Leadership 136 5.3 Programme Implementation Office and Board 137 5.4 Legislation 138 5.5 Resources 139 5.6 Communication 139 5.7 Effective Monitoring and Evaluation System 140 5.8 Culture Change and Organisational Enhancement 141 5.9 Clear Timetable for Implementation of Key Recommendations 141 5.10 Timeline for Committee Proposals 142 Appendix 1 – Analysis of Submissions Received 144 Appendix 2 – List of Submissions Received 170 Appendix 3 – 10 Year Budgeted Costings to Expand 174 Footnotes and Methodology to Budgeted Costings 176 Appendix 4 – Waiting List Management 185 – Contents of Healthcare Committee on the Future Appendix 5 – Terms of Reference of the Committee 187 Committee on the Future of Healthcare – Sláintecare Report Chair’s Foreword 4 The formation of the Oireachtas Committee on the Future of Healthcare provided a unique and historic opportunity for TDs from across the political spectrum to come together to develop consensus on a long- term policy direction for Ireland’s healthcare system. Our task has been to consider how best to ensure that, in future, everyone has access to an affordable, universal, single-tier healthcare system, in which patients are treated promptly on the basis of need, rather than ability to pay. The Dáil’s unanimous decision to establish an all-party Committee for this purpose was highly commended by international health systems expert Dr Josep Figueras, who emphasised the positive role that political consensus can play in reform, saying that: “One of the things we have learnt elsewhere is the need to have some stability in the reform process. The idea of putting a multi-party committee together to create consensus is a very wise decision…” Since June 2016, the Committee has worked tirelessly in its consideration of the national and international evidence, through public hearings, facilitated workshops and in-depth consideration of the evidence. The many stakeholder submissions we received provided us with a unique insight into the experiences of Committee on the Future of Healthcare – Chair’s Foreword – Chair’s of Healthcare Committee on the Future those who use our system, those who work in it and of the many organisations and bodies that are involved in it. The Committee wishes to thank most sincerely all those who took the time to respond to our call for submissions, which are available to view online here The Committee also thanks all those who made themselves available to provide evidence to the Committee at its public hearings, sometimes at short notice, and to engage with the Committee on the often complex and complicated issues facing our health system. During its work programme, the Committee worked closely with an expert team from the Trinity Centre for Health Policy and Management, who provided significant and invaluable support in health policy and health economics. Their expertise, knowledge and sheer commitment have been crucially important as we examined and debated a wide range of issues. It is also important to mention the role played by the Oireachtas Library and Information Service, which provided several valuable papers for the Committee on key topics. Committee on the Future of Healthcare – Sláintecare Report As Chair, I want to take this opportunity to acknowledge the hard work and dedication of my fellow Committee Members. All Members have worked respectfully and collegially over many months to deliver 5 this report. Inevitably, Members hold different political views. However, we have reached a consensus on how to achieve the shared goal of a universal single-tier health system. This report represents a new vision for the future of healthcare in Ireland. The Committee considers it imperative that its recommendations are implemented without delay. Therefore, on behalf of the Committee, I wish to formally request that this report be debated in the Dáil at the earliest possible opportunity. Róisín Shortall, T.D. Chair Committee on the Future of Healthcare – Chair’s Foreword – Chair’s of Healthcare Committee on the Future Committee on the Future of Healthcare – Sláintecare Report Committee On The Future Of Healthcare 6 Members of the Committee Mick Barry T.D. John Brassil T.D. James Browne T.D. Pat Buckley T.D. (SP) (FF) (FF) (SF) Committee on the Future of Healthcare – Members of Healthcare Committee on the Future Joan Collins T.D. Bernard Durkan T.D. Dr Michael Harty T.D. Billy Kelleher T.D. (I4C) (FG) (RITG) (FF) Alan Kelly T.D. Josepha Madigan T.D. Hildegarde Naughton T.D. Kate O’Connell T.D. (LAB) (FG) (FG) (FG) Louise O’Reilly T.D. Róisín Shortall T.D. (SF) (SD/GPTG) (Chair) Committee on the Future of Healthcare – Sláintecare Report Acknowledgements 7 The Committee wishes to acknowledge the invaluable contribution of everyone who assisted us in our work over the last 12 months. In preparing this report, the Committee worked closely with a team of health policy specialists from the Trinity Centre for Health Policy and Management, led by Dr Steve Thomas. We wish to sincerely thank Dr Thomas, Dr Sarah Barry, Dr Sara Burke, Dr Bridget Johnson and Ms Rikke Siersbaek for their specialist advice and for their commitment to the project. We also wish to recognise the contribution of Dr Eddie Molloy, Management Consultant, for his assistance and generosity in giving time to brief the Committee. During its deliberations, the Committee placed great importance on considering national and international evidence. We would like to thank Dr Charles Normand, Dr Catherine Darker, Prof. Ian Graham (Trinity College, Dublin), Dr Anne Nolan and Dr Maev-Ann Wren (ESRI), Dr Stephen Kinsella (University of Limerick) for briefing the Committee, and for responding to requests for information. The Committee also wishes to thank Dr Josep Figueras (Director of the European Observatory on Health Systems and Policies) and Professor Allyson Pollock (Newcastle University) for providing the Committee with an international perspective on health systems and universal health. Committee on the Future of Healthcare – Acknowledgements of Healthcare Committee on the Future The Committee wishes to acknowledge Mr Jim Breslin and officials from the Department of Health including Mr Tony Flynn and Mr Derek McCormack; and Mr Tony O’ Brien and officials from the HSE including Mr Ray Mitchell for their co-operation and assistance during the Committee’s work. The Committee also wishes to acknowledge the work of the Oireachtas Library and Research Service in preparing briefing papers, and the Secretariat team for its ongoing support. The Committee would like to especially thank the Royal College of Physicians of Ireland (RCPI) for briefing the Committee on its work, and especially to Ms Siobhan Creaton, for assisting the Committee with facilities for a number of Committee meetings. Finally, the Committee wishes to thank each of the witnesses and stakeholder groups who gave evidence to the Committee, and generously gave of their time to provide the Committee with submissions as part of the public consultation process. Committee on the Future
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