President, Vice-Presidents, office-holders, members of staff of the IMO, members, colleagues, distinguished guests.
First of all, I want to thank you for inviting me to be here at your Annual General Meeting. While I am a former member of the IMO, I have to admit that this is the first AGM I have attended. I hope it will be the first of many.
This afternoon, I want to divide my remarks into two parts:
• Some general thoughts on medicine and the health service
• And some specific words on doctors and the crucial and enduring role you play in our health service and society.
Our health service, as you know, has been through a very difficult period. We had three years of spending cuts under the last Government and a three year spending freeze under this one. That occurred against a backdrop of rising demand from a growing and ageing population and the development of expensive new treatments and interventions.
While we have secured the first Budget increase in seven years, we are still operating with about 12,000 fewer staff and a budget that is still more than €1 billion lower than it was at peak.
That is, of course, reflected in things like excessive waiting times and ED overcrowding. Needless to say, this makes it a real challenge to deliver the kind of health service we aspire to and that’s true from the frontline and back office, to Dr Steevens and Hawkins House. It’s a challenge that I welcome and I’m determined to meet it head-on.
Because of the enormous sacrifices that the Irish people have made and the decisions by government, all of which were tough on people, the country is now back on track. The economy is recovering and we can see it all around us:
• 90,000 more people back at work.
• Unemployment at a six year low.
• More cars and trucks on the road.
• Those reductions in USC and income tax in our pay slips in January.
The challenge now is to protect that recovery from those who would wreck it. We must sustain the recovery, make it real for more people, and ensure that all parts of the country benefit. That means more money in people’s pockets through further reductions in USC and income tax so long as the economy keeps growing, more investment in infrastructure including hospitals and primary care centres, and repairing our public services like health and education and children’s services.
If the first phase of the recovery was about repairing our economy, the second should be about restoring our society. That is our ambition and our vision.
I can, of course, understand why people sometimes feel overwhelmed by the scale of the challenge facing our health service. While there is much still to address, we should allow some space to recognise some of the real improvements that have occurred in recent years. Having returned to Health after a period away, I was pleasantly surprised by some of the positive developments. It’s worth highlighting them briefly.
Compared with four years ago and in spite of the financial crisis, we have more consultants and more NCHDs employed in our Public Health Service than ever before, along with more GPs with GMS contracts. If it has been possible to do that during a period of retrenchment, surely it is possible to do better again during a period of growth?
The number of consultants in many specialties remain much lower than international norms and we now need a new workforce plan to address that over the next decade, allowing people to prepare for jobs becoming available. If we achieve what we all want to achieve in primary care, we will need a steady increase in GPs over the next decade, as well as other practice and primary care staff like practice nurses and therapists.
Compared to four years ago, we have a much better ambulance service. Rather than a mere transport service, paramedics now deliver care on the scene and in transit. We have a new National Control Centre in Tallaght with only one region left to transfer to it, and we now have an air ambulance.
We need to build on this by filling in capacity gaps where they remain and developing more bypass protocols to ensure patients are taken to the right place, whether it’s a minor injury unit or specialist trauma centre. The best care, as we know, isn’t always provided at the nearest Emergency Department.
We have the National Clinical Programmes making real improvements to pathways of care in areas like stroke, heart attack and COPD to name just three.
We have a major expansion in prevention and screening including the extension of Breastcheck to women aged 65-69, Bowelscreen, and screening for Cystic Fibrosis and deafness at birth, and diabetic retinopathy in later life.
We have improving cancer survival rates and rising life expectancy, more nurse prescribing, falling medicine prices, falling MRSA infection rates and a new primary care centre opening almost every month.
In public health and wellbeing, we have increased vaccine take-up rates, we are meeting our targets for childhood developmental checks, tobacco is no longer on display in our stores and sunbed use is regulated.
We have HIQA setting, raising and monitoring standards in hospitals, nursing homes and now care homes.
All of us have been shocked at the content of some of HIQA’s reports, particularly when it comes to hygiene in hospitals, quality of care in some hospitals, and the treatment of elderly residents and those with intellectual disabilities in some care homes. But truth be told, these problems cannot be new, they must have been going on for decades. The difference now is that they are made public and we can deal with them and deal with them we shall.
We should also recall that health is not just an expense, not a drain on the Exchequer but rather a huge provider of jobs and revenue for the economy. The HSE is the country’s biggest single employer. Over 100,000 people work in the Public Health Service and as many again in private healthcare, the pharmaceutical industry and medical devices. Let’s keep on making that point.
I am not, for a second, trying to make out that everything is rosy in the garden. It’s not. I know that. But I am trying to point out that a lot of good things are happening in health that we should be proud of and a lot people are making them happen, many of them doctors, who deserve to be recognised. Let’s do that a bit more often.
Doctors, I believe, have a responsibility to advocate on behalf of patients and must continue to do so. There should be and will be no gagging clauses as long as I am Minister, and whistleblowers will be listened to. But I want a real partnership between all our groups, so that we can work together to address concerns and identify problems before they escalate, and stop things getting to the point of no return. Doctors are right to be advocates for patients and press for reforms, but at the same time none of us want to undermine public confidence in our health service.
It can be a very fine line, as sometimes fighting for one can lead to the other. When the line is crossed, we all end up weakened, trust is eroded, and confidence seeps from the system. In a real partnership everyone can advocate for improvements, but without undermining the very nature of the service we provide.
I think the same applies to resources. Our health service is under-resourced without doubt. The evidence is there: the ratio of doctors to population, the ratio of acute hospital beds per person, the number of specialists, the amount of money we put into primary care. But the resources we do have aren’t deployed as efficiently as they ought to be. Co-operation in changing that is not always as forthcoming as it might be.
Hospital beds are not used as efficiently as they should and average length of stay, day of surgery admission and day case rates vary inexplicably from place to place. According to the OECD, which has no axe to grind, Irish doctors see fewer patients on average than their peers. There might be good reasons for all of this but it is still not as it should be and we need to change it.
Now that we are in a time of rising budgets again, I believe that it should be a basic principle that no additional resources should be provided to any service that cannot demonstrate that it is using its existing resources to maximum effect, whether that’s staff, beds or cash. The taxpayer deserves no less.
I also think the time has come for a ‘zero-budgeting’ exercise in health.
Rather than starting with a base, adding on for inflation and then working out how much extra resource we need to do more, we should start with zero and work out how much we really need and what our priorities really are.
At the start of the year, Minister Lynch and I set out our work programme for 2015. It contained 25 actions. The good news is that I am not going to go through them one by one but I do want to outline the five major themes.
First and foremost always is Healthy Ireland. We need to improve our health as individuals and as a nation. This is the best way to ensure we live long and healthy lives and the most effective way to keep health costs under control in the long term.
The Healthy Ireland survey is well underway. It is the first measure of Ireland’s health since 2007 and will be repeated annually to monitor progress. Minister Reilly’s legislation on plain-packaging on tobacco is now through the Oireachtas and subject to court challenge, will be implemented next year. All things going to plan, I will bring the Public Health Alcohol Bill through the Dáil and Seanad before Christmas and it will come into force over the course of 2016. It is the first public health legislation on alcohol in Ireland and among the most far-reaching in Europe. It includes minimum unit pricing to eliminate cheap alcohol, structural separation in shops to reduce availability and visibility, health warnings and calorie labelling and the regulation of advertising, sponsorship and marketing.
We will also update our polices and strategies on obesity, sexual health and physical activity including new legislation on calorie posting. I thank the IMO for their ongoing support for these measures. It makes a real difference.
The second theme is patient outcomes and patient safety. As you know, I have taken a personal interest in Emergency Department overcrowding and the Government has recently allocated more money to reduce delayed discharges by lifting the funding cap on the Fair Deal and funding 200 more convalescent and rehabilitation beds in community and district hospitals.
I do not think it this alone will solve the problem of overcrowding for a second. Money is only part of the solution. The really hard part is the rest – changing systems, pathways and practices. This will require some investment but it’s about a lot more than money. The Emergency Department Taskforce Report needs to be fully implemented and I am going to drive that personally. We will always have surges in demand, and all health services have patients on trolleys from time to time but trolley waits of 9, 12 and 24 hours represent a real patient safety risk and we all need to work together to alleviate it as a phenomenon in our hospitals.
I understand the distress and hardship that it is causing to patients and their families. I know that you are at the front line of their distress and are often abused for the shortcomings of the system. I welcome the IMO’s contribution to the Taskforce Report and ask for your ongoing engagement in implementing it.
Treatment delayed can be treatment denied and I share the IMO’s concerns about worsening waiting times for appointments, investigations and procedures. I have mandated the HSE to ensure than nobody is waiting more than 18 months for any of these by July and no more than 15 months by the end of the year. I know that may not seem very ambitious but within current resources, it is realistic and achievable in all but a small number of sub-specialties. I will continue to try to do better but any future waiting list initiatives need to be well designed and sustained. Some of the examples we have from the past are not to be followed and my strong preference is that we make maximum use of under-used capacity in our public hospitals, where it exists, and then turn to the private sector.
On patient safety, we will continue to develop and monitor the implementation on the National Clinical Effectiveness Guidelines and develop a better approach to the implementation of HIQA recommendations. In the Health Information Bill, we will legislate to protect open disclosure. Saying sorry is not an admission of liability. Open disclosure is health sector policy and I encourage all health service staff to observe it always.
The third theme is Universal Health. This summer will see the first phase implemented by extending GP care without fees to youngest and oldest in our society, those under 6 and over 70.
300,000 senior citizens and children, who currently have to pay their GP, will no longer have to. This will come as a relief to many young families and pensioners. These are parents and older people who work hard and have paid their taxes.
Education for children and free travel for senior citizens is not means-tested and healthcare should not be either. Means-tests and sickness test might appear fair on paper. In reality, they create many injustices and anomalies. There are always people just above the financial threshold no matter where you set it and there are always people who won’t satisfy the sickness test who are told to come back and apply again when you are sicker to submit more reports, more documents, bills and payslips. Let’s start putting a stop to all of that at least for children and senior citizens.
And so, I want to thank and congratulate the IMO GP committee for your leadership in endorsing this new contract. I know a lot of GPs are disgruntled after years of cutbacks and I know it won’t be easy to convince everyone to sign up, but you are doing the right thing for general practice and for patients, and history will remember you for it. This is, after all, the widest extension in eligibility in health care service since Erskine Childers brought in the first GMS contract almost half a century ago and wider than the Mother and Child Scheme before that.
But this is just phase one. I look forward to the commencement of talks soon on the new GP contract in accordance with the Memorandum of Understanding we have. I believe it should provide for a further expansion of GP care without fees including other school-going children in accordance with Government policy but I also want to see further progress on chronic disease management, warfarin clinics, a revised schedule of STCs and a medicines management programme. In short, I want GPs to be able to do all that we are trained to do.
With the encouragement of the IMO and the ICGP, I pushed hard to include diabetes in this year’s reforms and worked to ensure that any wellness checks would be simple and evidence-based. I want these to be the precursor to a new chronic disease management programme in the next contract covering the most common chronic diseases as a bundle – asthma, COPD, heart disease, diabetes and hypertension – maybe others. I also want to see the insurers covering more chronic disease management in practice and to encourage more adults to take up policies that refund part of their GP fees. That will form part of my ongoing discussions with them.
So long as there is good will and so long as it is understood that government makes policy and the Oireachtas makes law, you have my commitment and assurance that there will be no more unilateral announcements and no more draft contracts put out without consultation.
As Ray Walley said earlier in the week, the cycle of cuts to General Practice is now over. The Government is determined to commit more resources to primary care every year for so long as the economy is growing. Change is coming but it will come in a way that protects and improves practice income and at a pace that ensures that we do not overwhelm existing manpower or infrastructure. It will happen in a way that works.
Separately, we will press ahead this year in expanding GP access to ultrasound and the minor surgery pilot. If successful, they will be mainstreamed in 2016 and 2017. I know that many GPs have difficulties on an administrative level with PCRS.
My mother, who was also practice nurse and practice manager to my father, often told me that she could never quite work out what we were paid for and what we were not. With this is mind, I have mandated Dr Liam Twomey TD to engage with GPs and Practice Managers and PCRS to see if we can iron out some of the ongoing difficulties. I am confident we can.
As you know, I have General Practice is my DNA. I grew up over the shop and trained and worked as a GP Registrar. I believe in General Practice and I believe in a system of primary care lead by GPs. And I hope you believe me when I say it.
On Universal Health Insurance, I firmly believe that we need to make health insurance more affordable before we can make it universal. So, in the past few months, the Government, working with the insurers, has taken a number of actions to do that. These have included a reduction in stamp duty, the HIA levy, no further diminution of tax relief, discounts for young adults and this month, life-time community rating. It is already producing results. Some premiums have been reduced, others frozen and new affordable products are on offer. The number of people with insurance is rising again. I hope we can introduce further measures on affordability later in the year and my officials are already working on proposals in this space.
The work of the ESRI and HIA which is nearing conclusion, will allow us to develop a new road map to UHI, but it is clear that there is a lot of work still to be done such as the need for new financial systems in our hospitals and embedding activity-based funding. It’s not something to be rushed. If we have learned anything from the mistakes of the past it is that all health reforms should be thought through and change-managed and project-managed properly.
The fourth theme is reform. This includes greater investment in IT, which saw a 30% increase in budget this year to €55 million. Key projects include e-referral, putting waiting lists on-line and the issuing of the first individual health identifiers later this year. I am really enthusiastic about IHARP, the Irish hospital redesign programme being piloted in Tallaght. If it produces results, we will extend it to four or five more hospitals in the next phase.
I am also very much behind the Hospital Groups. The CEOs and their senior teams are now in place, the remaining boards will be in place by summer. Hospital Groups will be given legal status within the HSE this year and I will also publish legislation to establish the first hospital trust on a statutory basis – the Children’s Hospital Trust – before the end of the year.
I ask for your members’ co-operation with the development of the Hospital Groups and as you know there are hospital doctors and GPs on all the boards, though they are of course not representatives of any particular interest. Other reforms will include the publication of the Heads of a Bill on assisted human reproduction, a new Maternity Strategy and the third Cancer Strategy.
The fifth theme is investment in modern infrastructure and facilities. The most important of these is the new Children’s Hospital. The planning application will be lodged this summer and subject to An Bord Pleanala we could have planning permission by Christmas or in the early New Year. That means construction commencing next year, the children’s walk-in Emergency Departments and satellite centres in Blanchardstown and Tallaght opening in 2017, and the main hospital opening in 2019.
The design is amazing. You’re going to love it. The Starship hospital in New Zealand and Alder Hey Children’s Hospital in Liverpool don’t come close. It’s the biggest single health infrastructure project ever in the history of the State and is very exciting.
I am hugely enthusiastic about the Government’s plans to commemorate the events of 1916 but I can think of no better way to mark the centenary of the Easter Rising than to begin construction of the new hospital on one of the sites of the rebellion, the South Dublin Union, in 2016 recalling the proclamation’s promise to ‘cherish all of the children’ of our nation equally. Bear in mind, the children who attend there from 2019 onwards will probably be alive to see the hundredth anniversary of the new hospital and the two hundredth anniversary of the rising. It is that sort of project. I ask the IMO to come behind this project fully and to formally support that planning application when it is lodged. Temple Street and Crumlin do a fantastic job but they have outgrown their existing premises. We can afford no more delays.
Separately, the planning application for Holles St to move to St Vincent’s will also be lodged this year, we hope planning permission will be secured for the new Forensic Mental Health Campus in Portrane and the National Radiation Oncology project will continue to progress for St James and Beaumont. Needless to say, I could mention many other projects but these are the main ones.
As you know, this is conference season and the issue of pay restoration looms large at all of them.
Minister for Public Expenditure Brendan Howlin has announced plans to invite the public service unions to discussions on unwinding the FEMPI legislation, which reduced public sector pay. We promised to re-open talks after the Haddington Road Agreement. I understand those talks are likely to start in May.
The public sector, and especially medical staff, have played a pivotal role in the recovery. The talks will certainly be challenging. But the Government acknowledges the enormous contribution that the public sector has made, with FEMPI measures generating €2.2bn worth of savings.
Nevertheless, we are still borrowing to cover day to day expenditure. So any request for a reversal of pay cuts must be viewed from a cross-Government perspective. For example, in Health this year we have allocated €30 million to pay for new oral medicines which cure Hepatitis. We are expanding Acute Medical Assessment Units, providing funding for bilateral cochlear implants, and hiring more physiotherapists and occupational therapists in the community. That’s money that in years gone by might have gone into pay increases rather than services.
We cannot afford to repeat past mistakes.
But regular pay rises are part of a normal economy. That’s why the Government wants to formulate a sustainable policy on public sector pay, which can play its part on the economic recovery over the next few years.
And that’s why we need to draft an agreement that delivers for health sector staff, for patients, and for employers, as well as for the expanding economy. Last year’s Budget took the first steps, by removing more low paid workers from the USC net and other tax reductions.
As a member of the Cabinet, I would find it very hard to support a pay deal that comes at the expense of public services. There should never be a conflict between what is good for staff and what is good for patients and taxpayers but if such a conflict arises it is my duty to be on the side of taxpayers and patients and that is a judgment call I am ready to make. And, deep down, I know a lot of you, mindful of your oaths and ethical obligations will support me in that.
I do think that any new pay round should take account of market conditions. While we struggle to get applicants for some posts there are hundreds of applicants for others. This is even true within the health service. We operate in an international English-speaking labour market and we need to take account of that. I also know that parity between new entrants and pre-crisis employees will also be an issue in the talks.
You will be representing doctors at the talks. It’s a significant responsibility. It is not my role to dispense tactical advice but I would ask you to bear in mind the fact that there are political forces new on the scene that openly oppose any restoration of public service pay this side of 2021. There is a risk that they may be in a position to influence the next government or even be part of it. On the other side of the political spectrum, there are those on the left who propose a salary cap in the Public service of €100,000 and massive tax hikes for those who earn above that from private income.
The election of any of these forces is not in the interests of Irish doctors nor the health service. It is would be a mistake to assume that there will be a better deal on offer after the General Election.
I know that for many consultant colleagues, the issue of litigation and the high cost of indemnity is of real concern. It is of concern to me too. I am working with Minister Frances Fitzgerald on this matter and have met with the MPS on it in recent weeks. Legislation is already in train to introduce pre-action protocols so that litigation can be avoided more often and expedited where necessary.
Legislation is also in train for periodic payment orders. I am also very keen to examine once again a better way to deal with birth injuries than the current adversarial system which works for no one. I am also determined to set aside additional funding every year to increase the number of consultant obstetrician gynaecologists and senior midwives as one means of reducing the prevalence of birth injuries in the first place. That shall form a key part of the new Maternity Strategy and indeed €2 million has been set aside for 2015 in advance with several new post already advertised under the newly agreed pay scales.
I have been in touch with Trevor and IMO staff to help to ensure that consultants taking up these new positions have their experience and qualifications fully recognised in determining where they start on the incremental scale. I am doing my best but as you can appreciate, it is not straightforward and there are issues of precedent and other limitations that have to be observed. But I will keep involved in it.
I know for NCHD colleagues the long-standing failure to implement the European Working Times Directive is an open sore. Significant progress has been made in the past two years, particularly in relation to eliminating shifts in excess of 24 hours, a key requirement of your organisation, and may I say a perfectly reasonable demand. While compliance with this requirement has now reached nearly 95% it should be achieved in all instances.
Achieving full compliance with the 48 hour week, which stands at 68% at the end of January 2015 is a significant challenge, given the way we deliver healthcare and the nature of our acute hospital structures. However it has improved considerably, from 40% compliance in the last quarter of 2013, and the 30% level of compliance in 2011.
Last month, on a visit to Wexford General Hospital, I was presented with a copy of my time sheet from August 2003. I worked a 1 in 3 rota and an average of a 120 hour week. Not many here will be particularly surprised by that, so I don’t say it as a boast or to seek sympathy. Working those hours is not something I recommend. Thankfully, it is no longer the case in that post and there are now 7 interns where once there were 3. But it did get me thinking. I learned a lot in those long hours and I am concerned about having NCHDs completing specialist training with less than half the practical experience of their predecessors.
In the same vein, I find it hard to see how the Directive can be implemented without assigning an expanded scope of practice to nurses and therapists and remunerating them for it or how we can continue to provide 24 hour cover for all the services we currently do.
These are not new issues but the bullet will have to be bitten and that will require leadership both political and professional if we are to meet our European obligations.
When it comes to improving training, I am very committed to implementing the McCraith Reports, particularly when it comes to dedicated training time, certainty about rotations and the appointment of NCHD Leads. The first progress report has been published and there will be another one in six months’ time. If I am not being told the truth about implementation, I want to know about it.
I also strongly encourage you all to take part in the Medical Council’s ‘Your Training Counts’ surveys. They are of real value to us as policy-makers. What you don’t measure, you cannot improve.
Finally, I am also very keen to come to an agreement on a permanent contract for service posts this year. Doctors in service posts make an enormous contribution to our health service and I want their positions regularised, not as an ongoing alternative to appointing new consultants but more to give them the job and income security they are entitled to. I hope we can come to an agreement on that as a priority.
I would like to take this opportunity to commend our public health doctors for the expertise and leadership they provided to our cross sectoral response to the recent Ebola virus outbreak in West Africa.
Our public health doctors have and continue to provide strong leadership in trying to address some of the greatest threats to the health and wellbeing of our population, specifically in relation to smoking, alcohol and a growing obesity epidemic. Your support and advocacy for change in this area is a vital component in ensuring that this legislation is passed and more importantly that the measures are accepted and supported by the general public. Your help and support will be needed even more in the year ahead as we progress measures to tackle these problems.
Before I finish, I want to mention one non-medical matter, the referendum on marriage equality on May 22nd. There are about 5,000 doctors in Ireland and by the law of averages several hundred must be gay, lesbian or bisexual. Many are not ‘out’ in their workplace. While medicine is not a discriminatory profession, In the back of their mind is the concern that they may be treated differently by colleagues or patients. For reasons of professionalism, they are unlikely to raise the referendum in the workplace. But don’t think for a second that means that the referendum result is not important to them. It is. It is not just about equality. It is also a statement of acceptance by their peers. By you. A ‘No’ will make things much harder for the same reasons.
In my opinion, marriage is an institution that has stood the test of time precisely because it has adapted to the times – the abolition of divorce in the 1920s and it’s reintroduction as the right to remarry 70 years later, judicial separation, the succession act, the marital home act, the end of the marriage bar and the abolition of conjugal rights as a defence against marital rape all changed the legal definition of marriage but they did not weaken it.
Marriage is not so fragile an institution that it needs to be wrapped up in cotton wool and protected from change. Marriage can only be strengthened by extending it to loving committed couples of the same sex. I know that there are some among us here today who will vote ‘No’ out of conscience or religion conviction, I respect that. However, I am convinced that the vast majority of us here support the change. In a democracy decisions are made by those who turn up. The turnout in referendums rarely exceeds 50%. Please turn up on Friday, May 22nd and vote Yes for equality.
Delegates, colleagues, allow me to finish with a few words of thanks. Thanks to Trevor Duffy on his solid, constructive and thoughtful term as President. Trevor, like Matt Sadlier before you, you inherited a tough brief. But you steadied the ship, cleaned the decks and have put the IMO back into position as a body that represents doctors, influence policy and make agreements with government and others. I know we shall continue to be in touch, particularly on issues relating to the bright future of Connolly Hospital. Trevor, we are in your debt and thank you.
I also want to congratulate Ray Walley on his election as President. You have proven to be a tough negotiating partner in the last few months but an effective one. We will not always see eye to eye but I know we can do business and I want to wish you every success in your new role.
As we work to achieve a new system of health care in Ireland, including free GP care for the under 6’s, I’ve been encouraged by studying the example of the formation of the NHS in Britain.
In July 1948, two days before the new National Health Service came into effect, the Minister for Health, Nye Bevan, wrote an open letter to the medical profession.
Its message could just as easily be sent to Irish doctors in 2015:
We start together a new National Health Service. It has not has an altogether trouble free gestation! There have been understandable anxieties, inevitable in so great and novel and undertaking. Nor will there be overnight any miraculous removal of our more serious shortages of nurses and others and of modern replanned buildings or equipment. But the sooner we start, the sooner we can try together to see to these things and to secure the improvements we want.
In this comprehensive scheme – it will inevitably be you, and the other professions with you, on whom everything depends. My job is to give you all the facilities, resources, apparatus, and help I can, and then to leave you alone as professional men and women to use your skill and judgment without hindrance. Let us try to develop that partnership from now on. It remains only to wish you all good luck , relief – as experience of the scheme grows – from your lingering anxieties, and a sense of real professional opportunity. I wish you them all, most cordially.
Bevan’s breakthrough ensured that British people no longer needed to be fearful about their health, but could be safe and secure in the knowledge that they had the right to expert medical advice.
We face great challenges, but if we have a real partnership we can achieve great things.
Bevan believed that the reason you sought power was so that you could give it away. I want to give you the power to make Ireland a healthy nation, sharing your ‘2020 Vision for Health’.