~ Wednesday, 1 June 2011
When I was asked to be the new Minister for Health, Social Services, and Public Safety, I was delighted. For, even though this is one of the most demanding and challenging jobs in Government, it gives us all - that is you and me - a real opportunity to make a difference. To make a difference to people's lives, whether it be giving our children the best start in life, promoting a healthy lifestyle, or supporting those, who through illness or disability are unable to look after themselves, as they would wish.
That is what you do, and I want to thank you. It takes a special person, with special skills to do what you do, a person with strong values, of wanting to care, and of wanting to be compassionate to others.
You will know, that if we are to deliver the services that people need, we face some significant challenges. Had there not been a global economic crisis and subsequent recession, we would still not have had enough money to do all we want to do, even though this year we will spend £4.3 billion on health and social care.
The financial situation - important and challenging though it is - is not my over-riding concern. It is the quality of care for patients that is my compass.
We must make sure that every penny is spent effectively. No money can be wasted. If we fail, we will not be able to do the things that the people we serve require. Choices must be made, and priorities set.
Being more efficient however, does not have to be about working harder and harder with less. "Salami slicing" will not do. Instead we must stop doing what does not work, become more assertive in challenging out of date practices, and acknowledge that some of today's services and their current design are no longer fit for purpose.
This is tough stuff - but we need change if we are to have a better service that is safe, accessible, and effective. A service that puts you, and your colleagues, in a position where you can give the care that you know is most appropriate.
To achieve this I need your help. I need you along with colleagues in Medicine, the Allied Health Professions and Social Services, to work with me and the local community to bring about the necessary improvements.
The theme of your conference, is "Leading for Change",and I want to take the opportunity this morning to outline my key objectives for this post.
"driving up the quality of services and outcomes" As I havealready indicated, driving up the quality of services and outcomes for patients will be my underlying priority, and will guide all that I do.
"productivity" I also want to see productivity increase right across our range of services. We must take the initial steps to start closing the gap with other parts of theUnited Kingdom. England for example will always have some economy of scale advantages, but the extent of the disparities that exist are impossible to justify. In many respects, greater productivity is not about what you and your colleagues are doing, but more so, the framework and practices of those of us who design and oversee the system – indeed some of the apparent difference in productivity can be accounted for by the differences in how services are delivered across the UK and the fact that our acute sector resources are spread over proportionally more sites than in other parts of the UK.
"greater involvement of frontline professionals" I will promote greater involvement of frontline professionals in decision making and service development. This includes many of you here today. You know better than anyone else what is working particularly well in your ward or clinic, what needs fine-tuned, andwhere broader improvements can be made across the service. It is my intention to engage fully and collaborate with those on the frontline, harnessing their expertise. I will seek to make evidence-based judgements on their advice and in circumstances where that requires difficult political decisions, I will not be found wanting.
"powerful local commissioning" I see a crucial role for more powerful local commissioning in driving change. I will facilitate greater decision-making powers being devolved to local level, maximising the involvement not onlyof local health professionals, but of local communities in general.
"removing roadbloacks to charity and voluntary sector" I want to promote innovation including removing roadblocks to charity and voluntary sector organisations offering services and assistingus to find solutions to complex issues. Anyone wouldtravel a long way to find a more dedicated workforce than the nurses and other staff of ourNHS - you and your colleagues provide wonderful care to the people of Northern Ireland. However we don't have a monopoly on good quality care. Elements of the third sector have a strong track record too in specific areas such as mental health, dementia, brain injury and learning disability.
AndI will not shy away from usingprivate providers too, where that makes sense. Our small population means the private sector will only ever play a relatively minor role compared with GB but it is still a crucial one in terms of nursing home provision for instance. I won't be setting out to use independent providers for the sake of it, but where there is a clear case that they can deliver a high quality safe service for less cost to the tax-payer, it wouldbe irresponsible of me notto make use of them.
"champion preventative and early intervention measures" I will champion preventative and early intervention measures. I had the opportunity yesterday to address a PHA conference on early years intervention and outlined that is was an area of work I am keen to develop. It would greatly benefit from more effective cross-Departmental working and I am setting out to build strong positive relationships with Ministers in key Departments, and agree shared policy goals. Getting the building blocks right and acting early gives better outcomes and will provide substantial savings in the longer term.
"avoid unnecessary hospital admissions" We must do more to avoid unnecessary hospital admissions. Hospital care is by far the most expensiveso we will pursue a multi-faceted approach to limit needless admissions. This willinclude good intermediate care, rehabilitation, community packages and seeking to bolster multidisciplinary community teams for chronic conditions such as heart failure, diabetes and chest disease.
We still have an over-reliance on hospital care, yet we know from the rest of the UK and Europe that we can deliver more care, often complex care, in the community, or on a day case basis. I want to see a shift in care currently carried out in hospitals, into the community with patients being treated in the right place, at the right time, and by the right people.
"patient experience" And returning to the patient, who after all is the most importantin everything that we do: I want to explore means of enhancing the patient experience. Not simply their treatment oreven aftercare, but every aspect of how the service interacts with the people we care for.We have to be responsive to the world we live in. For non-urgent care, the patient wants to be treated at a time and place that is convenient for them. I want toinvestigate how we can make the service more responsive to the everyday lives of our patients and where possible based around what suits them. If someone requiresa check-up and the day or week it takes place is not absolutely critical, can we not allow more of them to choose when this should be.It might also help to reduce the number of unattended appointment slots.
The eight areas that I have outlined above will be prominent in my work over the coming months.
A word of caution - we can’t achieve what the public deserves by continuing to invest in everything we currently do, or keeping on doing things as we always have done. We will have to cut back, or disinvest, in those areas where the care is no longer effective, sustainable, or affordable. That is why I will want to look seriously at the distribution of services across our network of hospital facilities. And why we must continue to increase the level of generic prescribing, and contain the costs of drugs.
Returning to the public health challenge, we are all living longer, and our health has also improved, but too many of us, still die too young or experience illness or disability which could have been prevented.
All of us have a responsibility for our own health, and by eating the right foods, drinking in moderation, not smoking, and taking regular exercise, many of us can reduce our reliance on the health service.
I will bring forward a range of measures to tackle alcohol abuse, raise awareness of the long term risks, and consider ways in which we can expand our addictions provision. I also want to implement a new tobacco control strategy, and bring forward proposals to tackle the increasing problems presented by obesity, including the role of sporting facilities in schools and communities.
I also believe we need to more active as a society in our promotion of positive mental health and wellbeing. We have to reduce the number of suicides and attempted suicide amongst our young people. I also want to explore more ways in which the public sector can offer training and placement opportunities to people recovering from mental illness.
It is my intention to allocate an increasing percentage of the overall health budget to public health. If we are to be a modern and successful society we must continue to secure improvements in health and wellbeing, and I am committed to working across Government to not only improve health but to tackle inequalities in health. Developing a successor to the ten year ‘Investing for Health’ strategy will be key to this.
Now I'm aware, that you are also going to hear from Professor David Olds later. Professor Olds is one of the world's leading authorities on how we can break the cycle of deprivation, by giving every child the best start in life. We know that disadvantage starts before birth and accumulates throughout life. Early intervention measures have been shown to improve mental and physical health, educational attainment and employment opportunities, and prevent criminal behaviour, drug and alcohol misuse and teenage pregnancy.
We know from the Marmot study in England and from Professor Old's work on the Family Nurse Partnership, that investment in children's early years forms an essential building block for the child’s achievements in later life. I believe that we must embed early intervention at the heart of departmental strategies, and address the cycle of wasted potential across multiple generations of young people. We believe there is a strong economic case for investing in this area of work, and significant savings to be made in the years to come, through better attainment at school, reduced criminal behaviour, decreased reliance on the child care system, and increased opportunities for employment.
I am encouraged by the early indications from the pilot of the Family Nurse Partnership programme in the Western Trust and would be keen to extend this to other parts of the province.
If we are to continue to modernise and develop the service, leadership will be required. This is not just about the Minister of Health, or the Chief Nursing Officer, it is about all of us. As Nurse and Midwife leaders you have the opportunity to influence the quality and delivery of care in your own specific areas. Through your actions and those of the healthcare team you determine the outcomes for patients and their families. But if we are to be successful, we must acknowledge that the world of healthcare is changing rapidly, patient and user expectations are increasing, and advances in knowledge and technology are altering professional roles and how services are delivered.
The next five years will bring an ever greater pace of change and difficult dilemmas on where to focus our health and social care resources. The temptation is to "keep our heads down" and avoid making the decisions that are required of us, but that will not be good enough.
In closing... Rather than wait passively for the tough choices to emerge, let us look ahead now, let us act now, and grab hold of the future. Working together, we can do this. Thank You.