Our plan for a world class health service DUP POLICY ON HEALTH AND SOCIAL CARE
Dear Friend Our vision is a sustainably financed Health and Social Care system that puts quality, safety and the patient at its centre by providing world class outcomes for our population. Health matters to each and every one of us in Northern Ireland. All of us, either directly or through a close friend or family member, relies on our Health and Social Care system on a regular basis. The importance of Health and Social Care to everyone in Northern Ireland has been reflected by the priority given to it by the Democratic Unionist Party in the last Assembly term. During the past 5 years, the DUP has produced a record to be proud of during its time in charge of the Department of Health, Social Services and Public Safety. People are living longer; We ve invested hundreds of millions of pounds more in Health; We have employed more doctors, nurses, midwives and allied health professionals; We ve delivered over 800 million in efficiency savings to reinvest in the frontline; We ve built new, state of the art health and social care facilities; and We ve developed new services like a HEMS air ambulance and a world leading mental trauma service and introduced the first infant vaccination programme for meningitis in the world. We recognise that our NHS in Northern Ireland is under pressure and faces a range of tough challenges now, and into the future. Yet, the focus of some on what isn t perfect within the system distracts us away from what is working well and the many improvements that have been made. Ours is a Health and Social Care system which, in spite of the many issues it must contend with, has improved performance and increased productivity over the past 5 years. Under DUP leadership: Our hospitals are providing more than 25,000 additional admissions for ill patients each year compared with 2010/11; The average length of stay in hospital has fallen from 6.7 days in 2011/12 to 6.0 days in 2014/15; The number of domiciliary care contact hours has increased by 12% from 2011 to 2014; and The Ambulance Service has responded to 13,000 more Category A emergency calls between 2010/11 and 2014/15.
1. TRANSFORMING OUR SYSTEM But we must continue to improve. Our Health and Social Care system was designed in a different era to deal with the problems facing society at that time. We need a new model, fit for the challenges of the 21st century. One that is more efficient, more productive and embraces innovation. One that realises the full potential of our integrated health and social care systems. One that addresses health inequalities in our population. One that is built upon the cornerstones of quality, safety, improving outcomes and care in the right place. And one that is anchored at all times to the founding principles of the NHS. This paper outlines the Democratic Unionist Party s vision for our Health and Social Care system. This is our plan for a world class NHS for Northern Ireland. Yours sincerely Arlene Foster Northern Ireland s Health and Social Care system faces a range of challenges now, and in the years and decades ahead. Some flow from the fact that we have a growing and ageing population. Others as a result of a related rise in the number of chronic conditions people are experiencing. More stem from the impact of many of us leading unhealthy lifestyles. Demand for Health and Social Care services is rising by around 5% each year. And all at a time when there is unprecedented pressure on public finances. It is evident that seeking to address the Health and Social Care needs of our citizens inside the present system is simply unsustainable. Radical reform is required. The Northern Ireland health and social care service must not be satisfied with good enough... with everyone working together, it could be amongst the best in the world Sir Liam Donaldson That s why the DUP has embarked upon the biggest shake up in our Health and Social Care system in a generation. The objective of this long term plan for Northern Ireland s NHS is to build the world class system that Sir Liam Donaldson indicated in his recent report was possible. The aim of reform should not be to make savings but rather to make Health and Social Care more efficient and thus more sustainable financially and, above all else, to put the patient at the heart of a system that produces better health outcomes for our population. Transforming Your Care was published in 2011. It included 99 proposals for change across the range of Health and Social Care services. Around half of the recommendations have been implemented already with the vast majority in progress. Some of the key areas in which work is being taken forward include establishing Integrated Care Partnerships, Ambulance Service Alternative Care Pathways which are helping paramedics to avoid transporting patients to hospital and are expected to reduce Emergency Department attendances by 6,000 in 2015/16 and an investment of over 1 million in the dnav project which is helping 700 Type 2 diabetics who require insulin in the South Eastern Trust area to improve their blood glucose control by using assistive technology. The DUP: strongly supports the Expert Panel in its continued endeavours and looks forward to it completing its work later in the year. We believe that the Panel has the potential to develop an implementation plan which, if agreed, can reshape our Health and Social Care system into one that is genuinely world class; will progress legislation through the Assembly to close the Health and Social Care Board, moving responsibility for commissioning services primarily to the Department with more autonomy for the Trusts in certain areas. As part of the reforms, the DUP will ensure that a strong Department of Health is responsible for holding Trusts
accountable for their performance and we will create a Performance Directorate to do this; will continue to invest in the transformation of Health and Social Care services by ensuring that a Transformation Fund of at least 30 million remains in place for each year of the next Assembly term; and will press ahead with plans to create an Improvement Institute and an Improvement Partnership to assist in driving improvement across Northern Ireland s Health Service. 2. INCREASING HEALTH SPENDING The Democratic Unionist Party has overseen a significant increase in spending on Health and Social Care in Northern Ireland both in terms of expenditure on day to day running and investment in capital projects. Since 2010/11, resource spending on Health and Social Care has increased from 4.3 billion annually to over 4.8 billion in 2015/16. When allocations via monitoring rounds are factored in, spending on Health and Social Care has risen by an average of over 160 million in each year of this Assembly term. NI HEALTH SPENDING (BILLION) 4.815 4.66 4.569 4.302 4.383 4.447 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 The DUP has demonstrated its deep commitment to the NHS by increasing spending on Health by 12% at a time whenever public sector budgets have been under serious restraint. Health and Social Care expenditure in Northern Ireland now accounts for almost ½ of the Executive s entire Budget and is, alongside Scotland, the highest spend on health per head of the population in the United Kingdom. Northern Ireland s spending on Health and Social Care as a proportion of our Gross Value Added (a measure of the value of goods and services in an economy) is also one of the highest in the UK. At 9.3% of total GVA spent on human health and social work activities, HM Treasury figures show Northern Ireland second only to Wales. Over the last 5 years, we ve also invested nearly 1.3 billion in Health and Social Care infrastructure projects. These have included schemes such as the redevelopment of the Ulster Hospital, the new build local hospital at Omagh, Health and Care Centres in Banbridge and Ballymena, a new Emergency Department at Antrim Area Hospital, the Critical Care Building at the Royal Victoria Hospital, new Ambulance Stations in Enniskillen and Ballymena, the new Rowan Sexual Assault Referral Centre in Antrim and the new Northern Ireland Hospice at Somerton Road in North Belfast and the new Mencap facility in Newtownbreda.
The DUP believes that further investment is needed in the frontline of NHS services to address short term pressures like waiting lists and also to enable the long term transformation of the overall system. Further spending on Health and Social Care should be aimed at putting the NHS in Northern Ireland on a sustainable footing for the future. The DUP: pledges to seek to increase spending on Health by at least 1 billion by the end of the next Assembly term; will continue to invest in improving Northern Ireland s Health and Social Care infrastructure including projects like a new Regional Mother and Children s Hospital at the Royal Victoria Hospital, further redevelopment at the Ulster Hospital, redevelopment of Craigavon Area Hospital and a Paediatric Centre of Excellence at Daisy Hill in Newry; will investigate the potential of establishing a grant based capital improvement scheme for Third Sector organisations to support and improve the work they do to assist our Health Service; will seek to increase the percentage of Health spending on prevention to 5% by the end of the next Assembly term; and will seek to deliver 75 million more efficiency savings in 2016/17. 3. ENABLING INNOVATION If Northern Ireland is to overcome the multiple challenges facing our Health and Social Care system, then it is clear that innovation will be a key component of the change that is required. Finding new ways to achieve better outcomes will be critical. Northern Ireland s Health and Social Care system is already alive with innovation, building on a rich heritage that includes Frank Pantridge s invention of the mobile defibrillator. It is that ability to innovate that we must capture if we are to conquer the challenges facing our NHS. The DUP wants to create an environment across Northern Ireland s NHS where innovation is encouraged at every opportunity and in every aspect of our Health and Social Care system. The DUP: will ensure that, while the first priority of the Department of Health will always be to provide high quality Health and Social Care services for our people, future Executive economic strategies will acknowledge and seek to realise the potential of Health in Northern Ireland as an economic driver; advance plans for a Health Innovation and Life Sciences Hub (HILS Hub) as a central hub for sustainable and effective interaction between various research and innovation centres in the HSC, the private sector, academia and economic development agencies; seek to build on the work of the NI Clinical Industry Collaborative to promote Northern Ireland as a destination for pharmaceutical research and trials; attempt to maximise Horizon 2020 funding for Northern Ireland led Health and Social Care projects; address issues with the procurement process that are preventing patients in Northern Ireland benefitting from the ground-breaking work of local businesses; and develop more Health focused SBRIs to capitalise on the Finance Minister s recently created fund; establish a HSC Innovation Fund to support community and voluntary sector projects which are innovative, collaborative and focused on early intervention; explore the potential of bringing the Portuguese Patient Innovation system to Northern Ireland. This scheme takes solutions that patient or caregivers puts forward to deal with challenges imposed by their health condition, including new or modified devices or aids, or low-cost alternatives to existing solutions, and helps to share the innovative solutions with others via an online platform; work with the Behavioural Insights Team to identify pilot projects, particularly in the field of public health, where behavioural economics could be used in Northern Ireland; and create, in conjunction with NESTA, a Policy Innovation Lab for Health and Social Care in Northern Ireland which will work with a wide range of partners to further develop, support and scale innovations and which uses social and digital innovations to significantly improve health and ageing.
4. SUPPORTING PRIMARY CARE Primary care practitioners are at the frontline in facing the challenges affecting our NHS. The DUP recognises the pressures facing GPs who have seen the number of consultations rise from 7.2 million in 2004 to 12.7 million in 2017. The DUP has been steadily implementing a plan to support Primary Care across Northern Ireland. This has included: Establishing a GP Led Working Group to examine the issues facing primary care; Increasing GP training places from 65 to 85, the biggest investment in GP training in a decade; Investing in a new initiative to place around 300 pharmacists inside GP practices; Developing a 10 million GP and Dentist Modernisation Fund which has helped GP practices in places like Carryduff and Enniskillen to upgrade their premises; Spending 3.1 million on supporting GP Out of Hours services in 2015/16; Financial support for GP Federations and investment in GP system leadership and management training; and An investment package of 17 million for the 2016/17 financial year including support to address additional demand, to support work on elective care, to invest in district nurses and health visitors and to encourage the development of online booking and repeat prescription systems. But we recognise that more needs to be done to bolster primary care so that it can continue to provide an excellent service for people in Northern Ireland. work progressively towards having 110 GPs a year in training by 2020; continue to support the development of GP Federations; invest in innovative schemes to address issues facing Primary Care; implement the recommendations of the GP Working Group; maintain a Financial Transactions Capital funded GP Modernisation Scheme; and support the Northern Ireland wide roll out of the physiotherapy direct access scheme and will develop similar projects in other specialisms. 5. INVESTING IN THE FRONTLINE As spending on Health and Social Care increases, it is imperative that the additional investment is used to address pressures at the frontline. The DUP has ensured that, in spite of the pressures on the Health budget, the additional investment in the Department has been focused on the frontline. For example, this has resulted in a huge increase in the numbers of frontline Health and Social care staff. Since 2011, there are now: 1,191 more Nurses and Midwives (9% increase) 523 more Allied Health Professionals (18% increase) 181 more Nursing Support Staff (5% increase) 275 more Consultants (21% increase) 46 more Ambulance Staff (4% increase) 296 more Social Services Staff (5% increase) 161 more Technical and Scientific Staff (8% increase) There has been an overall increase in the number of Health and Social Care staff of 3,270. This is an impressive increase in staff numbers at a time when budgets have been under pressure. Waiting lists have unfortunately risen considerably in the last year. After inheriting long waiting lists, the DUP invested in reducing the time people had to wait for outpatient appointments, diagnostic tests, operations, treatments and procedures. The failure of Sinn Fein and the SDLP to agree on welfare reform legislation cost the Executive around 200 million in Treasury fines, and the Department of Health was prevented from investing in independent sector and additional in-house activity, in order to balance the books. This, alongside the fact that referrals to hospitals have increased by 14% since 2011, hit waiting lists hard. The DUP believes the current waiting lists are unacceptable but we are now making good progress in reducing them. In November 2015, the then Finance Minister Arlene Foster allocated 40 million to the Department of Health to tackle waiting lists. The 40 million investment in waiting lists assisted around 60,000 to 70,000 patients to receive more than 30,000 Outpatient Appointments, around 9,000 Inpatient Day Cases, in the region of 15,000 Allied Health Professional Appointments and more than 10,000 Diagnostic Tests. The DUP believes that the momentum achieved by this substantial investment must continue into the next financial year and beyond. That s why we have already pledged an initial investment of a further 30 million specifically to address waiting lists. We expect this further 30 million to provide 25,000 more assessments, 12,000 more procedures and 50,000 more diagnostic tests.
The combined additional 70 million investment in tackling waiting lists will see around 150,000 people across Northern Ireland get the tests, appointments, treatments, operations and procedures they need. And the investment is having a positive impact already. Provisional figures for March 2016 show that those waiting more than 18 weeks for an outpatient appointment have fallen by 13% and those waiting longer than 26 weeks for an inpatient day case has fallen by 17%. This additional investment is on top of the several hundreds of millions of pounds spent by HSC Trusts each year on elective care which delivers around 60,000 inpatient/day cases and 1.5 million outpatient appointments. invest more resources in increasing frontline staff numbers and will strive to employ 1,500 more Nurses and Midwives, 200 more Consultants and 100 more GPs by the end of the next Assembly term; support the additional investment of a minimum of 80 million to tackle waiting lists in each year of the next Assembly term. This extra money will be focused on increasing capacity inside the NHS in Northern Ireland but will utilise the independent sector where and when appropriate. It will help deliver close to 200,000 appointments, treatments and procedures each year with the target of getting waiting lists well below 2013 levels by 2021; support nursing by implementing the recommendations of the Nursing Task Group, retaining Nursing Bursaries in Northern Ireland and continuing to increase the number of nurses and midwives in training and in practice; support the ongoing work of the new Unscheduled Care Clinical Network as it seeks to implement the changes flowing from the Task Group s recommendations. We will also ensure that Trusts have sufficient resources to deal with pressures on Emergency Departments and in particular that enough care packages and nursing home places are available at key times of the year; work with community pharmacy in Northern Ireland to develop an action plan for the sector that concentrates on how services like falls prevention, discharge medication reviews, long term conditions management and emergency supplies of prescription medicines out of hours can be taken forward; further increase expenditure on the Ambulance Service in 2016/17 by over 1 million and continue to invest in improving the ambulance fleet including rapid response vehicles; and pursue the potential for closer co-operation between the Fire and Rescue Service and the Ambulance Service especially in regard to first response and, where appropriate, co-location of new stations. 6. DELIVERING DIGITAL HEALTHCARE Medicine has benefited massively from advances in science and technology. People rightly expect the improvements technology has brought to other aspects of their lives mirrored in the NHS. The Health and Social Care system in Northern Ireland has embraced the opportunities presented by new technology especially in the area of digital healthcare. Developments in the last decade include: A Health and Care number for everyone in Northern Ireland; The regional X-ray system, NIPACS; and Computerisation, networking and the introduction of two-way electronic communication for all GP practices. Northern Ireland has been particularly to the fore in developing a successful Electronic Care Record. The NIECR was developed in conjunction with Orion Health and has won both the HSJ Award for Enhancing care by sharing data and information and EHI Award for Best use of IT to support integrated health services in recognition of its outstanding contribution to informatics. The Health Minister recently launched a new ehealth Strategy for Northern Ireland. The new ehealth Strategy includes the vision of a new Electronic Health and Care Record for Northern Ireland. The desire is to build on the success of the NIECR, using it as a foundation and take our digital health infrastructure to the next level. introduce a new Electronic Health and Care Record for Northern Ireland; continue to encourage more accessibility to online GP appointment booking and repeat prescription ordering systems with a view to ultimately developing a Northern Ireland wide e-prescription system similar to the systems that operate in places like Estonia where, by mid-2013, 95% of all prescriptions were being issued electronically; work to ensure that information on an initial set of conditions is available online via the NI Direct website by mid-2016; and continue to build on the excellent progress made to date by expanding our work in the area of connected health and strive to establish Northern Ireland as a global centre of excellence.
7. ENCOURAGING ACTIVE AND HEALTHY AGEING Improvements in many areas of health means that Northern Ireland s population is getting older. It is estimated that by 2061, 252,000 people in Northern Ireland will be aged 80 or over. That is an increase from 73,000 in 2014. Over half of Northern Ireland s population (53%) will be 65 plus by 2061. The fact that more of us are living well into old age is something to be celebrated. But it will undoubtedly create challenges for our Health and Social Care system. While many elderly people live happy and healthy lives, old age can bring a range of health related complications. Over one-third of Europe s population is estimated to have developed at least one chronic disease. Many will live with more than one. The rate of disability among those aged over 85 is 67% compared with only 5% among young adults. Dementia is a growing issue for our older population, with the incidence rate set to increase dramatically over the coming decades. This combination of acuity and frailty amongst what will become a sizeable section of our society has the potential to significantly affect our Health and Social Care expenditure. The DUP believes that the impact of our growing and ageing population on the Social Care system must be subjected to an open and honest public debate akin to that already taking place about remodelling the Health Service. Adult care and support plays a vital role within our Health and Social Care system. It helps tens of thousands of people every week in Northern Ireland maintain their independence and quality of life by supporting them to remain in their own homes as long as possible, or by caring for them in residential and nursing homes. It also ensures the smooth running of our hospitals by preventing unnecessary admission and facilitating timely discharge. But it must reform in order to be sustainable and to be able to withstand the challenges it will face. establish a Commission on Adult Care and Support to provide expert, independent analysis of the challenges facing the system and to think radically about what changes must be made to safeguard it for future generations. The Commission on Adult Care and Support will be tasked with producing a set of recommendations to reform the system and its funding structures to ensure its future sustainability; continue to showcase Northern Ireland as an exemplar in innovative solutions to help achieve active and healthy ageing but we also believe that there are lessons to be learned from other regions and states on how to improve the care we provide our older population. We will pay particular attention to best practice examples like the acclaimed Buurtzorg community care model in the Netherlands and Italy s new models of care in managing the chronic conditions of its ageing population, and we will actively examine the opportunity for rolling out similar models in Northern Ireland; work with independent healthcare providers to stabilise the sector so that it continues to play a key role in the Health and Social Care system; and ensure an ongoing focus on tackling dementia and will support the further implementation of the regional strategy and innovative approaches to improving services. 8. PROMOTING PUBLIC HEALTH Promoting good public health is the key early intervention and preventative measure. Making Life Better 2012 2023 is the Northern Ireland Executive s ten-year public health strategic framework. The Making Life Better framework seeks to create the conditions for individuals and communities to take control of their own lives and move towards a vision of Northern Ireland where all people are enabled and supported in achieving their full health and wellbeing potential and to reduce inequalities in health. The DUP believes that responsibility for resolving many of Northern Ireland s issues with poor public health does not solely lie with the Department of Health. Rather, these are society wide challenges that, from a government perspective, will need input from Departments like the Economy, Communities and others as much as Health. Good health is helped by having a good job and living in a suitable home as well as having access to appropriate healthcare. Making Life Better provides direction for policies and actions to improve the health and wellbeing of people in Northern Ireland building on the Investing for Health strategy (2002 2012) and retains a focus on the broad range of social, economic and environmental factors which influence health and wellbeing. support a continuation and amplification of the cross-departmental approach to tackling health inequalities in Northern Ireland, building on the progress made by the Making Life Better public health strategy, as part of the next Programme for Government. We will also consider the success of initiatives like South Australia s Health in All Policies (HiAP) and examine if a similar approach could work in Northern Ireland; seek the creation of a new public health model which focuses on prevention and early intervention rather than reaction as part of the remodelling of our Health and Social Care system being undertaken by the Expert Panel. The DUP also wants to see the impact of unemployment, bad housing and poor infrastructure can have on health outcomes recognised as part of the development of the next Programme for Government; and will introduce new Public Health legislation early in the new Assembly mandate.
9. BETTER MENTAL HEALTH Poor mental health affects around 1 in 4 people in Northern Ireland. Our prevalence of mental health problems is 25% higher than in England. Northern Ireland has, slowly but surely, been addressing our unacceptably high levels of poor mental health. The publication of the Bamford Review marked a turning point in our understanding and handling of mental health. Spending by Health and Social Care Trusts on mental health has grown by 17% since 2004/05. The DUP has increased mental health spending to a quarter of a billion pounds per year, a rise of 50 million since the Bamford Review. Research by the BBC recently showed that Northern Ireland was the only part of the UK to see an increase in spending on mental health by Trusts in the last two years. There has also been a positive switch in where that investment is being made. 57% of mental health expenditure is now in the community. In 2004/05 it was just 46%. Research published in March 2015 which was commissioned by the Commission for Victims and Survivors and prepared by Ulster University, includes an estimate that around 213,000 adults have mental health difficulties that appear to be directly related to the Troubles, and that potentially 60% of these people have not received treatment. Northern Ireland also has the highest rates of suicide in the UK. 10. IMPROVING HEALTH OUTCOMES Many health outcomes in Northern Ireland have been improving over the last number of years. Male life expectancy has increased by 1.3 years from 76.7 in 2007-09 to 78.0 in 2011-13; Female life expectancy has also increased over the same period from 81.3 to 82.3; Cancer mortality among those aged under 75 fell by 5% between 2005-09 and 2009-13; Smoking related mortality decreased by 7% between 2005-09 and 2009-13; and Between 2005-09 and 2009-13, avoidable mortality fell by 12%. The DUP wants to see a continual improvement in health outcomes across all conditions and diseases. We will do this through a combination of concerted investment and supporting innovative approaches. This is an outline of how the DUP proposes to improve health outcomes across a range of health conditions and diseases. will continue to increase spending on mental health each and every year of the next Assembly term with an increasing percentage of that expenditure being in a community setting; press ahead with our plans to create a Mental Trauma Service building upon the wealth of experience in mental trauma developed in Northern Ireland as a result of the Troubles and establish a world leading Service as a fitting and lasting legacy; seek to allocate resources to progressively implement the Mental Capacity Act which was an international first establishing a fused approach for mental health and mental capacity law. We will introduce the numerous sets of regulations and codes of practice that are required and engage in significant stakeholder and professional involvement, along with training and the delivery of awareness-raising programmes; continue to focus on tackling suicide, produce a new suicide prevention strategy, encourage greater Cross- Departmental cooperation, modernise the Lifeline service and ensure that Northern Ireland s spend on suicide remains the highest in the UK; continue to support innovative campaigns like Change Your Mind and focus on destigmatising mental health; appoint mental health champions with a focus not just on health but also other parts of the public sector like education; take forward the review of postnatal care, update the regional guidance for perinatal mental health care, implement the recommendations of an RQIA review of Perinatal Mental Health Services and develop plans for a specialist regional mother and baby unit; seek to improve early intervention and day support, and further enhance community services in the short term while continuing to progress the possibility of a specialist inpatient eating disorders unit in Northern Ireland. The DUP will; focus our energies on beating cancer by continuing to increase investment in cancer care by at least an additional 10% more, and we will introduce a new comprehensive cancer plan for the next decade. We will endeavour to improve 5-year cancer survival rates by 20 percentage points from the establishment of devolved government, continue to promote awareness and prevention, establish further innovative new services and provide more nurse specialists; ensure the increased use of Primary PCI, further reduce the mortality rate from cardiovascular disease and continue to implement the Community Resuscitation Strategy; further reform stroke services in Northern Ireland with an emphasis on specialist assessment of patients with suspected high risk TIAs available on an outpatient basis seven days a week, assessment for clot busting drugs should happen in specialist units supported by telemedicine where necessary and the clot retrieval service in the Royal Victoria Hospital should be extended to deliver assessment and treatment 24 hours a day and seven days a week for suitable patients; support the development of education, information and mentoring for non-specialists such as GPs, a pilot regional referral management service where GPs can refer people to specialists, thus reducing the number of outpatient appointments, enhanced recruitment of neurological specialists including consultants and nurses and an expansion in imaging capacity to ensure timely diagnostic support for people suffering from MS; seek to improve Northern Ireland s compliance with the IBD Standards by increasing the number of specialist nurses and establishing an IBD Registry; develop and progressively implement the new Diabetes Strategic Framework and seek to encourage the adoption of innovative ways of tackling and managing diabetes such as dnav;
continue to build on the progress indicated in the first Progress Report on the UK Strategy for Rare Diseases from the UK Rare Disease Forum by ensuring that the NI Rare Diseases Implementation Plan is implemented; implement annual advertising campaigns with the aim of increasing donor rates and will implement the recommendations of the newly established Clinical Advisory Group on Organ Donation; and implement the changes to the IFR process to improve access to specialist drugs in Northern Ireland and will work with stakeholders to give further consideration to the funding of life-saving and life-enhancing medications.
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