Future Health



Future Health
Future Health: A Strategic Framework for
Reform of the Health Service 2012-2015
Presentation by Dr. Ambrose McLoughlin
Secretary General, Department of Health
HMI West Forum for Managers Meeting
The Eyre Suite, Clayton Hotel, Ballybrit, Galway
25 January, 2013.
Future Health
• Future Health is the Irish Government’s high level plan
for reforming the health system
• Approved by Government on 13 November and
published by the Minister for Health on 15 November
• It maps out the key actions, with timelines, for the
achievement of our reform agenda
• The actions are focused on the steps we need in order
to bring us to UHI
What we want to achieve:
A Single-Tier Health Service supported by
Universal Health Insurance
• Every citizen insured for a standard package of curative
health services
• No distinction between ‘public’ and ‘private’ patients
• Universal primary care with GP care free at point of
use for all
• Universal hospital care with independent, not-forprofit trusts and private hospitals
• Multi-payer model, based on competing insurers
• Social care services outside UHI system but integrated
around user
Health & Wellbeing
• New concentration on keeping people healthy
• Need for a whole-of-Government approach to
addressing health issues across the lifecycle
• Health and Wellbeing Policy Framework
• Establish Health and Wellbeing Agency in Q1 2015
Primary Care
• Extend GP care without fees on a phased basis
• Introduce chronic disease management
programmes between 2013 and 2015
• Implement programme of investment in Primary
Care Centres between 2013 and 2015
• Increase the numbers of healthcare professionals
working in Primary Care from 2013
Acute Hospitals
• Publish Smaller Hospitals Framework
• Establish administrative Hospital Groups in Q1 2013,
leading to Hospital Trusts by end 2015
• Continue programmes to reduce waiting times for
scheduled and unscheduled care – a critical element
in advance of the transition to UHI
• Reconfigure Ambulance Service by Q1 2014
Social & Continuing Care
• Implementation Plan for VFM Disability Report
• Roll out single assessment tool for older peoples’ services 2013
• Review of Fair Deal (Nursing Homes Support Scheme) for
sustainability and to assess its applicability to other sectors by
Q4 2013
• Commence work on a national standard assessment tool for
people with disabilities in 2013
• Extend HIQA regulatory regime to residential services for
people with disabilities in 2013 and to other social and
continuing care settings by 2016
• Continue roll-out of A Vision for Change
Financial Reform
• Health Vote to return to Department from 1 January 2014,
with detailed preparatory work and road-testing
throughout 2013
• Develop programme-based budgeting in 2013
• Implement a comprehensive financial management system
as a priority
• Time bound plans for MFTP to create incentives that
encourage treatment at the lowest level of complexity that
is safe, timely, efficient and as close to home as possible.
Moving to UHI
• White Paper on Universal Health Insurance;
preliminary paper will be published shortly
• Work already underway on reform of Private Health
Insurance system, including Risk Equalisation System
from 1/1/2013 and regularise status of VHI
• UHI funding model from 2016 to cover primary care,
acute hospital care. This is vital for an effective
MFTP system
• Social care, long-term care etc continues to be
funded from general taxation
Structural Reform
• Goal is to dismantle the ‘command and control’ system
in health and replace it with a system of devolved
autonomy, where increasing control is given to the
• Governance legislation and phased change towards UHI
structures, including Healthcare Commissioning Agency
• Establish Hospital Groups: Recommendations shortly
and implement in Q1 2013
• Review ISAs in Q2 2013; develop Primary Care structures
• Implement Action Plans for shared services and external
service delivery
Implementing Reform
• We will need to
– Get the building blocks for reform right
– Ensure overall coherence of reform initiatives
– Keep the ‘show on the road’ while pursuing
– Learn the lessons of other health systems
– Be both ambitious and realistic in implementing
Critical Enablers
• Information/ICT
• Comprehensive financial management system
• Health Information Bill, Unique Identifier and Universal
• National Clinical Programmes
• Structural reform and governance: who is responsible
for what
• Public Service Agreement (Use the agreement to its
outer limits)
• Human Resource Skills and Capacity
• We have already made
real progress…..
Progress on Governance &
Management Arrangements
• Robust governance and management structure
currently being developed
– This will clearly define roles; set out the
accountabilities and responsibilities for each role;
and develop effective management and reporting
– Programme Management Office currently being
established in the Department
– Programme Board to be established in the coming
Progress on Consultation &
• Consultation and collaboration with stakeholders will
be crucial to success
• This has already begun – in the two weeks following
the launch of Future Health, the Minister met with
1,500 local clinical and administrative staff and
management as well as regional health forum
members at 14 events across the 4 HSE regions
• Consultation will continue throughout the reform
Other areas of progress (1)
• Policy papers on UHI; Money Follows the Patient;
Hospital Groups; and the Smaller Hospitals
Framework to be published in coming weeks
• HSE Governance Bill has completed its passage
through the Seanad and will now be considered by
the Dáil
• New administrative structures in the HSE – process
to appoint new Directorate Management and
Leadership team has commenced
• Health and Wellbeing Framework to be submitted to
Government shortly
Other areas of progress (2)
• Implementation Plan on Disability VFM Review to be
completed by end January
• Permanent scheme of Risk Equalisation in place in
the private insurance market
• Drug price agreement in place with IPHA worth in
excess of €400m over 3 years
• Agreement also in place with APMI which provides
for reductions in the price of generics
• Croke Park – revised action plan for health sector
recently published and discussions underway
The reforms are already
benefitting patients
• Hospital Access Targets (comparing Dec 2012
with Dec 2011):
– 98% decrease in the number of adults waiting more
than 9 months for inpatient and day case surgery
– 95% reduction in the number of children waiting more
than 20 weeks for inpatient or day case surgery
– 99% reduction in those waiting more than 13 weeks for
a routine endoscopy procedure
– 23.6% reduction in the number of patients waiting on
trolleys (2012 vs 2011)
• Most comprehensive reform of our health service
ever undertaken.
• Good progress to date. The reforms are working.
• We need to build on reforms already underway
and drive further change in the interest of

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