Health issues to come under the microscope this year

This year will see new health legislation and new drugs that could have a significant impact on people's wellbeing, writes David…

This year will see new health legislation and new drugs that could have a significant impact on people's wellbeing, writes David Labanyi.

With a record Budget allocation and the impetus of a looming election, 2007 is going to be a busy year for the health services. However, there is a wide range of views on what will be the most significant development.

Next week the Cabinet is due to discuss the long-promised Medical Practitioners Bill (2006). The legislation follows concern at the Dr Neary scandal at Our Lady of Lourdes Hospital, Drogheda, and is intended to replace the existing law dating from the 1970s.

The president of the Medical Council, Dr John Hillery, says the proposed legislation will allow "doctors falling behind to be identified and helped to improve in a proactive rather than reactive way. The current 30-year-old legislation is about waiting for doctors to do wrong and then dealing with them in a punitive way."

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The proposed legislation is likely to result in an increase in the lay representation on the Medical Council, a move Dr Hillery says is in keeping with the council's emphasis on representing the public interest.

However, while Mr Donal Duffy, assistant secretary general of the Irish Hospital Consultants Association (IHCA) agrees on the importance of the new Bill, certain provisions concern him.

"If enacted as is, Ireland will be the only western democracy without a self-regulated profession," Mr Duffy claims.

This is because members of the new council will be appointed by the Minister for Health and because medical professionals can make up a maximum of 13 out of the 25 member council, he says. "The public seem to think the medical council's sole role is fitness to practise. But I have yet to see a model where lay people are better able to determine education," he says.

The Irish Patients' Association (IPA) chairman, Mr Stephen McMahon, says the waiting lists of under-18s seeking psychiatric services must end this year.

He believes the sector should add psychiatric services to the National Treatment Purchase Fund (NTPF), although a spokesman for the fund says this option is not under consideration.

Mr McMahon also says that improvements in the health services have resulted in a decrease in deaths and that better practices on medication and dispensing errors would see more progress.

"We looked at the mortality rate from 1999 to 2005 - based on CSO figures - and found there are now cumulatively 19,600 fewer deaths per annum. No one has spoken about this but we are making progress."

Alongside the Medical Practitioners Bill, Mr McMahon says the Health Information and Quality Authority (HIQA) will bring huge changes "because with that we have a single agency responsible for the safety side of things and quality assurance".

HIQA is operating on an interim basis with the legislation to formally establish the agency due by Easter.

The Health Research Board (HRB) has commissioned two pieces of research for this year which have the potential to make a significant long-term impact for the health services.

The first will examine the implications of Ireland's growing population for the health services. Dr Ruth Barrington, chief executive of the HRB, says the research will seek to separate the rate of ageing from population growth.

"There is certainly some suggestion that it is the total number of people that will put pressure on the system rather than the number of older people."

In a separate but linked project, the HRB has also commissioned researchers to examine how health service resources are allocated.

"We are the only tax-funded health system, centrally funded tax-based health system that does not have a method of comparing how resources are allocated by region or county," says Dr Barrington.

"We want to examine if there a model for allocating resources within the health services that will give you a more equitable division of resources."

Dr Barrington says the two reports are linked and projections on the population study will be used in the analysis of resource allocation. Initial findings from both reports are due by the end of the year.

For Dr Eamonn Shanahan, ICGP chairman, 2007 brings with it the promise of new diabetes treatments which claim reduced long-term complications.

Heart attacks are the most significant complication for diabetes patients and Dr Shanahan says if the new medications meet expectations, then the new products, which are licensed for use, "have the potential to make a significant change".

Sources in the pharmaceutical sector expect the vaccine that protects women against the virus that causes most cases of cervical cancer, Gardasil, to make an impact this year. A second product for this type of condition is expected later this year.

The European Commission approved Gardasil late last year and the drug is aimed at females aged 9 to 26 years. Around 70 women die from cervical cancer in Ireland each year. Currently the vaccine is available only to private patients and costs around €300 per treatment.

Pharmaceutical research is increasingly focusing on more targeted research for smaller disease cohorts and industry sources also expect new drug releases aimed at diseases that affect older people.

From the Irish Medical Organisation's (IMO) point of view this year may be remembered for all the wrong reasons if it brings the co-location of private hospitals on public hospital sites.

IMO president Dr Christine O'Malley says: "If this co-location policy goes ahead, I think we will realise quite quickly after the hospitals open that they will not bring the anticipated benefits. The reason for that is that private hospitals in Ireland focus on low clinical risk."

She says while private hospitals provide excellent expertise for certain procedures, "if there is a problem post-operatively, the patient doesn't go back to the private hospital, they come to the public hospital system".

She says there remains an unresolved issue around medical training, a role and cost exclusively borne by the public health service and that the private sector then employs staff with no attendant training costs.

"If co-location goes ahead, this is one of the many issues that will have to be addressed."

After what is described as a "very depressing 2006" which brought the Leas Cross scandal, Age Action Ireland hopes HIQA will bring changes to the care and regulation of services for the elderly this year.

"The HIQA Bill is coming before the Dáil and we would hope it will be up and running by the end of 2007. This will be the first time we have had a proper independent inspection service for nursing homes. That is going to be a huge development in services for all the people in 2007," says spokesman Eamon Timmins.

To ensure the new Bill is effective, Mr Timmins says its provisions should be extended to include protections for whistleblowers and also checks on homecare providers.

"There are provisions for a lot of new homecare packages in the Budget and these are being provided by the private sector. But have their staff been vetted? What training do they have?"

Mr Timmins also says the nursing home payments proposal must be amended this year because in its current format it is "neither fair nor equitable".

Interestingly, of all the issues discussed by those contacted, the possible withdrawal of Bupa from the health insurance market hardly registered. An interesting year ahead.