28 September 2000 Edition

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All-Ireland healthcare just makes sense

Sinn Féin Six-County Health Minister Bairbre de Brun broke new ground last week at the first ever major all-Ireland Health conference. Below is the text of her speech, to the joint Irish Medical Organisation and British Medical Association conference on Friday last.

The high correlation between poverty, ill health and premature death

is one which should concern us all. Health is an issue that is

significant not only for individuals but for whole communities as


``In Ireland today, we are looking at the future with a renewed sense of hope and optimism. And we have many grounds for that optimism. We have young and vibrant people, and the seeds of economic growth that hold out the potential of future prosperity for all of our people.

We have new political institutions and we have a clean and wholesome environment and a beautiful countryside. We should be the envy of our neighbours. Unfortunately the picture in relation to the health and well-being of our people is not so rosy.

In Ireland, we have one of the highest death rates from coronary heart disease, cancer and cerebro-vascular disease in Western Europe. A major challenge for us all is the achievement of a real and lasting improvement in the health and well-being of our people.

The great disparities in health between rich and poor are an affront to equality and justice. The evidence is clear: the better off you are, the longer you can expect to live.

Co-operation and the adoption of common policies in areas of mutual interest is an important part of the Good Friday Agreement and nowhere is the potential benefit of this more striking than in the area of health.

I welcome the conference objective to establish a platform from which the IMO and BMA can jointly contribute to Health issues, with which the North South Ministerial Council and the British-Irish Council will be concerned. It is an important link in a new, and growing partnership for health which we are forging.

In health, as in many other areas, our problems are common, and the potential benefit of tackling these together rather than pursuing them in isolation is obvious.

We all grapple with questions of how to promote good health and encourage healthy lifestyles. We all seek the holy grail of making services more responsive and patient-centred. We all recognise the importance of tackling inequalities in health and improving the health of our communities.

In the field of hospital services, it is evident that the delivery of services is increasingly under strain and it is a tribute to the staff that they have continued to provide high standards of service, under the pressures of growing workloads.

It is easy to conclude that the solution lies on the creation of so-called `super-hospitals' serving large numbers of patients. However, it is important not to leave the patient out of the equation. I accept that we must build modern and effective services, and this may mean the concentration of some specialities, in large centres. But we must also recognise that many services and specialities do not require centralisation to deliver effective care.

In my experience, patients have no objection to travelling to receive highly specialist care in fields such as cancer. What they find difficult to accept is why emergency services or more routine care cannot be provided within their locality. The challenge facing our services, North and South, is to achieve a new and effective balance of acute hospital care which will ensure modern, high quality health care and satisfy public expectations.

I have no doubt that there is scope, through North/South co-operation, to strengthen our acute services in the future. The potential benefits to patients from developing complementary services, north and south, are enormous.

This is particularly true when we look at the distribution of populations in the border areas, characterised by small numbers of people living in widely dispersed small communities, often at some distance from the nearest hospital. Our collaboration can reduce this isolation and ensure that our acute services work to minimise response times and deliver acute care effectively to local communities.

Recently there has been significant progress in the development of cross-border acute services such as the development of dermatology services in Monaghan, Dundalk, Newry and Armagh.

Primary care sits at the very heart of our health and social services. It is the provider of most services, and the gatekeeper to others. Our family doctors are highly valued by local communities, particularly because of the continuity of care that they provide as a result of their long-term relationships with their patients. This is a precious service that I want to maintain and develop.

It is no secret that there is considerable scope for improving the health status of the people living on the island of Ireland. There are inequalities in health that we must tackle if we are to make the very necessary improvements to the overall health status of the population.

Good health is a matter of fundamental public concern

``The high correlation between poverty, ill health and premature death is one which should concern us all. Health is an issue that is significant not only for individuals but for whole communities as well. We must consider health in its widest sense, which means being aware of and taking account of issues such as poverty, unemployment and social exclusion.

I will be bringing forward a new and comprehensive public health strategy for public consultation this Autumn. This strategy will address the unacceptable inequalities in health that are evident across society in the North. In particular, it will ensure that programmes are targeted at those suffering the worst health or who are most at risk.

The Medical Profession throughout Ireland has had strong links for many years. Indeed it is recorded that in 1890 the Irish Medical Association agreed to work in harmony with the British Medical Association to avoid overlapping and wasted effort. Co-operation makes as much sense today as it did 100 years ago. As we enter the new millennium, we must reflect on the contribution made to Health by professionals North and South and identify opportunities to improve the health of everyone. We are setting a new agenda for the end to an `ill-health service' and in tackling the very roots of ill-health itself, which are rooted in social justice.''

An Phoblacht
44 Parnell Sq.
Dublin 1

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