Adelaide Hospital News
Chairman's Address to the Annual General Meeting, 28th May
"The ball is with the policy makers now...as the Society has produced a costed alternative to the present morass in our health services."
Dr David Moore, Chairman of the Adelaide Hospital Society to the AGM
Address by Dr David Moore
Chairman of the Adelaide Hospital Society
to the Annual General Meeting on 28th May 2008
Welcome to the 13th Annual General Meeting of the Adelaide Hospital Society. It is heartening to see so many of our loyal Governors and Members here this evening, and I am grateful to you for making the effort to be here.
While this is the 13th AGM for the Society, I would like to remind you all that it is also approaching the 10th anniversary of the opening of the new Hospital here at Tallaght, then the largest civil project in the state and the union of 3 distinct and unique hospital traditions.
These have been 10 busy and tumultuous years, and the hospital's public profile has not always been that which we would have wished for it. You will see from the Directors report that the financial difficulties persist for the hospital, and in some ways 2007 has been an exceptionally difficult year.
To begin positively however, let us turn to the real and lasting contributions to healthcare in Ireland which this Society has made and sponsored over the past year.
The Directors report outlines the joint publication along with the Jesuit Centre for Faith and Justice of a policy paper entitled "The Irish health Service: Vision, Values and Reality" a thoughtful and well documented evaluation of how inequitable our current health system has been and remains, and providing some provocative insights into how they might be addressed. The Adelaide Hospital Society continues to work with the centre for Faith and Justice to develop an evidence based approach to health reform and to provide a resource for those decision makers who are as concerned as we are about the direction taken by the current Government as they seek to create a better future for the patients of today and into the future.
Even more relevant to the current health debate, last month Prof Tom O Dowd's Health Policy Committee launched the second report of the research initiative in which we have sponsored and supported Prof Charles Normand and his colleagues at Trinity College Dept of Health Policy and Management. "Social Health Insurance: Further Options for Ireland"
This crucial piece of work, which might perhaps have been commissioned by a Department of Health with a fully developed understanding of its role and responsibility in the area of Health Policy, has been a timely and widely acclaimed contribution to the ongoing debate on the issue of access to and funding for health services. Far too much airtime and column inches have been expended considering the relative merits of new for profit health care providers, and all too little considering the actual present and future needs of the population of Ireland.
Through this work the premise of a comprehensive Social Health Insurance scheme for this country has now been placed on the agenda, providing for, amongst other things,
Free primary care consultations
Improved access to hospital specialist services.
Why are such proposals not seized with gratitude and instantly made Government policy? There is most certainly an ideological explanation: universal healthcare is very much more Berlin than Boston. But it is certain that the fear of committing more resources to a problem that has till now appeared to be capable of absorbing as much resource as was available has determined the official response. This is all the more disappointing given the extraordinary detail in which Dr Stephen Thomas's work spells out the actual costs:
A rise in health spending as a proportion of GDP of 1.4% (from 7.5 to 8.9%) which in current terms amounts to about 2.1 billion euro.
This is a large increase in spending by any stretch of the imagination, but could eliminate the two tier system, allowing access to care on the basis of need and would eliminate the need for building multiple co-located hospitals at a cost in tax revenue to the Exchequer which may amount to 700million euro.
Realistically, investment in health care by the State may be difficult to obtain in the medium term: even firm commitments to large scale projects such as the Paediatric Hospital at the Mater and the new North East project appear to have major question marks over their funding.
Our research indicates a need for capacity investment over the 12 years to 2020 of between 3.2 and 6.4 billion euro in any event (its an interesting aside to note that from 2006 to 2015 Ireland is committed to investing 34bn euro in transport under the Transport 21 initiative. Is health investment really such a low priority beside rapid mass transit?
The Adelaide Hospital Society has now contributed three major scholarly works to the Healthcare debate on the fundamental and key issue of funding and ensuring equity of access for all citizens: having been in part responsible for introducing the concept of Universal Health Insurance to the public, we have now provided those whose responsibility it is to create policy with a detailed, and largely costed blueprint for the real and long overdue reform for a health system which threatens to implode and which manifestly cannot be fixed by the piecemeal tinkering that Government has so far been prepared to undertake. A nation which cherishes all its citizens equally, in sickness and in health, cannot possibly neglect to consider, and ultimately to act on proposals which go no further than to ensure that each individual has funded provision for their health needs now and throughout their lifetime, funding being provided by the individual, his or her employer, and by the State in varying proportions according to the means of the individual. If one were starting with a clean slate, no other approach could be contemplated: the challenge to Government is to steer a course from a morass largely of its own creation to a not-quite Utopian system such as we have proposed.
We have challenged health policy makers with a thoroughly argued, coherent and above all evidence based approach to systematic health funding reform. High profile campaigners for health service reform such as Prof John Crown have adopted the proposed model and strong interest has been expressed by health spokespersons from Opposition parties: The ball is very much with the policy makers now.
Three years on from the breathless announcement of co-located private hospitals to supply a bed shortage, confirmed in Government's own Health Strategy report of 2001 to be no fewer than 3000 beds, not a single new brick has been laid, and we will have to see whether private investors are prepared to proceed with these developments in changed economic circumstances. Meanwhile, the HSE policy has changed: new beds are no longer required, and there is almost a stampede towards primary care as the panacea for health problems. Were this adequately researched, considered and resourced, and were there a fundamental community infrastructure to take the brunt of this wholesale policy reversal, this might deliver much needed relief to besieged A&E departments. However, there are seriously conflicting messages from HSE and Government on this issue so that the Primary Care Strategy has a deeply undercooked feel to it. No adequate response has been forthcoming to the blunt truth that Ireland is woefully short of primary care doctors (between half and one third of those in the best performing European health models) while simultaneously having significantly fewer acute hospital beds per million population and almost the lowest number of hospital specialists. This triple whammy is not only ignored but is being increasingly aggressively rejected by policy makers.
All of us recognise that investment in health services represents a catch up in light of decades of underfunding, but it produces the kind of benefits to society that the accountants and economists have difficulty in enumerating. Our political leaders have become obsessed with the notion that health is a millstone which can sink the entire economy. The current solution is to privatise where at all possible and to seek lower cost alternatives which risk introducing fragmentation of service delivery with wasteful duplication in certain profitable areas such as elective surgical procedures, while leaving other orphan areas, like chronic disease management and care of the elderly to a shrunken, demoralised public health service. It is no coincidence that need in these latter areas is greatest amongst those who are poor and vulnerable. "Closer to Boston than Berlin" indeed.
It is in this context, and in light of the tremendously stringent financial constraints on the Hospital, that I would like to turn to perhaps the most exciting, momentous and challenging opportunity on the horizon for AMNCH. As all of you by now know, this Hospital, along with St James's Hospital and Trinity College has signed a Memorandum of Understanding to create a single Academic Medical Centre, an ambitious project almost beyond our most expansionary dreams, which, if successful, will create the largest and most prestigious clinical, teaching and research establishment on this island.
Your Society was a sponsor almost 3 years ago of the original proposal to merge as equal partners. That this was not possible at the time is perhaps understandable, but there is a renewed determination to make things work this time round: the inevitability of an imposed reorganisation of acute hospital services, with the Cancer Strategy as paradigm means we must seek to develop in partnership. However, there are huge potential benefits to AMNCH, with enhanced opportunities for teaching, and enhanced access to major research funding through avenues such as SFI and PRTLI or the Wellcome Foundation. We must have the confidence and strength of purpose, not just to see but to seize the opportunities on offer.
Will this initiative involve irreversible change? It is quite clear that it will. The new TAMC will be run by a much reduced Board representing the 3 partners, and we will have a reduced influence. However, the loss of specialties by the hospital in the 10 years of our existence and the future challenges mean we must be part of a larger university teaching institution to survive.
We in the Adelaide Hospital Society, along with the Board of this hospital are fully committed to making a success of the TAMC, and as I think you would all expect, this Society's Board representatives have been energetic in ensuring that the governance structure of this new venture will be one that reflects the pluralist and inclusive principles which form the Charter of this hospital, and which was so hard won many years ago.
Your annual Report, which I commend to your attention, contains extensive reports of some of the other areas in which the Society has been active during the past year.
We have continued to champion the cause of excellence in nursing, a commitment reflected not only in our continuing interview program for student nurses, our unique bursary system amounting to over €53,000 for student nurses for whom Dublin based education can be a huge family financial burden, and through our sponsorship of major nursing awards which help to promote excellence as well as providing a link between the nurses of today and their illustrious predecessors.
I cannot leave the subject of Adelaide Hospital Society involvement in nursing without mentioning the forthcoming 150th anniversary of the Adelaide School of Nursing with an exciting programme to commemorate 150 yrs of dedication and remarkable achievement, most of it in times of at least as great adversity as those we now face. Details are available from the Society Office, and all those who would like to participate or know more should contact Roisin Whiting.
Another important event is scheduled to take place in the coming year which demands to be recognised: Fergus O'Ferrall has informed the Board of his decision to retire in the autumn and, I assume, given his youth, to pursue other interests.
Fergus was identified as potential officer material as far back as 1988 by Ross Hinds and David Mc Connell and press ganged into the Society. 5 years later he was appointed Director and much of the rest is history. Fergus is inextricably linked with all the adventures we have been through in the last decade and a half, and his clear vision, steadfast, and at times steely, determination have many times been the telling qualities that have brought not only the Society but the Hospital through its darkest hours.
He has over the years established the Adelaide Hospital Society as a leading contributor to Health Policy debate in Ireland and his skill and expertise have been widely acknowledged.
All this has been achieved with a remarkable modesty and self effacement which are at times quite disarming reminding me of Woody Allen's one liner "I don't want to achieve immortality through my work; I want to achieve immortality through not dying!"
He has specifically asked me not to engage in a reading of his extensive CV, but it is right to mention that most of the major health policy initiatives to which I have referred this evening are Fergus's progeny and he has been a leading print and broadcast contributor to all the major health debates of recent years while remaining the single most effective watchdog on the Board of the Hospital.
We will miss Fergus enormously and will need great good fortune in our search to find a suitable successor to take his place.
A word of thanks as well to Roisin Whiting, whose administration skills are simply astonishing, and who has kept the Society office and all its many and varied activities on an even keel for yet another year, and to Heather Wright for her hard work in the office
Finally, I want to commend to you the Annual Report of the Adelaide Hospital Society. It has indeed been a turbulent year; the omens are for more stormy weather ahead. The Society is, I think, in good health and remains determined to meet future challenges with courage and optimism.