Public Health in Ireland: Implications of Health Sector Reform Ruth Barrington
Public Health • A perspective and a methodology • To protect health • To ensure equity of access and quality of care • To achieve health potential
What problem is reform addressing? • Poor outcomes? • Lack of capacity? • A black hole?
What Problem is Reform Addressing? • Waste and inefficiency? • Failure of structures?
Change in Prospectus’s Mandate • ‘as the project developed it became apparent ….that there was a need for a sense of direction around a new health system architecture in order to provide a framework for the future …This involved more fundamental consideration of the wider health system and the development of a shape for whole system reform.’ pg 28
What Problem is Reform Addressing? • Take politics out of health?
What Problem is Reform Addressing? • Introduce discipline of the market? • How significant is the next photo? • Taoiseach laying the foundation stone in March for new private hospital in Galway made possible by tax incentives?
What is Reform Attempting to do? • Reduce fragmentation and duplication • Improve policy development and oversight • Manage health services as ‘a single national entity’ • Improve information and quality • Modernise support services
Assumptions of Reform programme • Structures have failed. Number of agencies is the problem • Main challenges are hospital care and value for money • Improved care, not health, is the goal • Services can be managed as ‘a single national entity’ • Health stands alone • The Oireachtas can provide the political accountability that is required
How did Public Health Fare? • Poor outcomes and fair access not drivers of reform • Public health not mentioned • Focus on care and value for money • Highly centralised approach • Health as stand alone system • Number of agencies with publi health mandate to be amalgamated.
Where is Implementation at? • Interim HSE established • Three criteria to be achieved • Better outcomes for patients/staff • Better outcomes for staff • Value for money • National Steering Committee
An Alternative Reform Agenda? • Vision of a healtier Ireland • Health policy informed by public health perspective • Benchmark against best international practice • Agree on core public health issue – poor health of those on low incomes
An Alternative Reform Agenda? • Monitor extent to which access to care is equitable and of high quality • Defend the public health system • Demedicalise public health • Build a coalition for public health
Reconciling the Reform and Public Health Agenda ? • Articulate public health perspective urgently • Esure HSE has a statutory mandate to promote and protect health, improve health and ensure equity of access • Anticipate strong opposition • Have hope – we live in a democracy!