Much happened in the health service last year, but 2006 is set to be more eventful, writes Muiris Houston, Medical Correspondent
Last year was yet another rollercoaster year for the health service. What lies ahead on the political and clinical fronts for 2006, and more importantly, what needs to be done to ensure the service provided to patients improves?
Minister for Health Mary Harney outlined her priorities for this year when she launched the Health Estimates. Primary care services moved centre stage. Some €16 million will be available to appoint an additional 300 front-line health professionals so that primary care teams can be built up in the community. Social workers, physiotherapists, occupational therapists, and others will work with GPs, practice nurses and public health nurses to increase the range of community health services.
The concept, which was central to the 2001 National Primary Care Strategy, is an acknowledgement that a significant part of the solution to the pressure on hospital services is to beef-up facilities in primary care.
While the Minister said she wants 600,000 people to benefit from this initiative by the end of 2006, this aspiration is unlikely to be fulfilled. The Health Service Executive (HSE) will do well to have identified the areas for expansion and to have some of the professionals in post by the autumn. It may even need to recruit abroad due to a shortage of therapists in the Republic.
The move to expand primary care will also feature heavily in talks on a new contract for GPs. This is an opportunity to encourage GPs to undertake more work in the areas of chronic disease and health promotion. A new contract must deal specifically with the needs of patients in deprived areas.
These were identified in the recently- published Crowley Report, which found a high level of psychological and social problems presenting to practices in these areas. It identified the need for multidisciplinary team development in areas where health inequalities were greatest.
HSE chief executive Prof Brendan Drumm is clearly in favour of developing primary care. He needs to urgently address the issue of poor access to diagnostic services, such as X-ray and ultrasound, by GPs.
This contributes to major delays and worry for patients, as well as encouraging inappropriate attendance at A&E departments. If, in 2006, the HSE could refocus existing diagnostic facilities towards primary care and ensure that new developments put GP access first, it would be a major step forward.
Prof Drumm has signalled that new patient care groups will be developed for specific diseases and individual specialities. They are to be both the drivers of policy as well as monitors of policy implementation. The 10- to 15-member groups are to have patient representation, which in the light of last month's national survey of hospital patients, is essential.
The survey found that nearly one half of patients were not advised of side effects of medication prescribed to them, while one fifth complained of poor communication and lack of information during their hospital stay. Patients deserve a better quality service in 2006.
Medication side effects are an important health issue. While we may not see a high profile "drug scare" similar to the Vioxx episode in the coming year, the discovery that newer generation non-steroidal anti-inflammatory drugs caused serious cardiac side effects and deaths was a reminder of how much we depend on the vigilance of drug regulatory agencies. Inevitably, unforeseen drug safety issues will arise in 2006.
Our National Drugs Bill is the subject of current negotiations between the Department of Health and the pharmaceutical industry. Drug costs consume almost 10 per cent of healthcare spending, with recent steep rises in the cost of drugs for the medical card scheme. The Government strategy will be to try to save money by encouraging the greater use of generic medicines (licensed drugs that are no longer under patent). It will need the agreement of GP's and pharmacists for this to happen. And it needs the industry to agree much lower prices for drugs that come off patent. The pharmaceutical companies will want a scheme that guarantees a good return for new drugs that become available to recoup expensive research and development costs.
An agreement on future drug costs should emerge during the second-half of the year, but it may mean patients paying more for branded medications, with the State only covering the cost of a cheaper generic substitute.
A new contract for hospital consultants is a priority for Mary Harney. Talks between the medical representative organisations and the HSE employers division got off to an acrimonious start and hopes of a early agreement are fading fast. The absence of a HSE position paper means the next meeting between the sides will not take place until the end of this month. And with the Minister seeking major changes, including greater emphasis on teaching and clinical governance, work practice flexibility and the appointment of full-time public hospital consultants, progress will be slow. Until agreement is reached, it will be difficult to implement other changes in the hospital system, such as greater team work and a seven-day consultant-provided service.
Preventative health initiatives have not been given a high priority since Ms Harney took over the health brief. So the provision of €3 million in the health Estimates to implement the recommendations of the National Task Force on Obesity is welcome. Some 18 per cent of adults are obese, while one in five children is either overweight or obese. Because so many illnesses are related to obesity, this is a key area for action in 2006. The Department of Health must also commit extra funding to Heartwatch, the scheme whereby GPs target preventative action at those with existing heart disease. Indeed, this is an example of a successful model which could be extended to the management of other chronic diseases.
Psychological health is often the Cinderella of the health service. The setting up of the Mental Health Commission was a major step forward in changing attitudes and there will be keen interest in the report of the expert group on mental health, due to be published this month. The finding by researchers at the Central Mental Hospital that the rate of severe mental illness among prisoners on remand in jails is 40 times higher than the general community is an extreme example of this imbalance.
However, the decision to appoint additional consultant psychiatrists to allow mental health tribunals begin their work is most welcome. The tribunals will review the cases of people detained involuntarily in psychiatric hospitals. As such, they are a key element in a new system of checks and balances contained in the 2001 Mental Health Act.
The Government simply must deliver a Medical Practitioners Act in 2006. Substantive legislation has been promised since Micheál Martin took office as Minister for Health and it can be reasonably argued that the continuing delay is jeopardising patients' health. We are regulating doctors under 28-year-old, out-of-date legislation. With medical practice undergoing rapid change, there is a clear need for a system of ongoing professional assessment.
One of the great unknowns for public health is whether 2006 will be the year when avian flu visits our shores. Much hyped, the threat of a new strain of H5N1 influenza is real. However, experts disagree as to when the flu will make the leap to human transmission.
Although 70 people in the Far East have died from avian flu since 2003, the strain is still hard for humans to catch. As there is no vaccine against avian flu, the Department of Health has ordered stocks of the anti-viral drug Tamiflu so that treatment will be available for the estimated 25 per cent of the population experts estimate will be infected, should bird flu arrive in the Republic.
Whether the next flu pandemic will be due to avian flu or regular flu, the Government must continue it's preparations to be ready to meet the threat.
One thing is certain; we look set for yet another interesting but turbulent year on the health front.