HSE director says we must get away from hospital obsession

Ireland is “hospital obsessed”, and this must change, the HSE’s director of clinical strategy has told health managers.

HSE director says we must get away from hospital obsession

“We need to provide solutions beyond the hospital setting,” said Áine Carrroll, HSE national director of clinical strategy and programmes division.

“We use our hospitals as a default position for every health complaint, ranging from acute health episodes to domestic violence issues.

“That is not the best solution for good sustainable healthcare. In fact, it can cause harm.”

Dr Carroll was speaking to Health Manager, the journal of the Health Management Institute of Ireland.

Around the world, she said, 25% of patients suffered harm by being in a hospital system, so it was wrong for Ireland to continue with a hospital centric model.

Dr Carroll said Ireland faced real challenges with its ageing population, with chronic diseases, obesity and with a ‘cultural attitude’ to alcohol consumption.

“We have significant problems with health inequality... and we need to think societally about how we tackle these and the social determinants of health,” she said.

“We also have issues with a fragmented healthcare system and services that are often organised around the needs and demands of hospitals rather than patients and that is a real problem.

“Patients have said... we are not providing patient-centred health care and we have listened to that.”

However, ‘slow incremental change’ was vital to sustain any desired change, and if they wanted a different performance, the system must be modified.

Change began with the National Clinical Programmes pursuing the quadruple aim — better outcomes, improved the clinical experience, lower costs, and better patient experience.

“You cannot have improved patient experience without improved clinician experience, and I would say improved management experience also,” said Dr Carroll.

More than 30 national clinical programmes had been established since 2010, and they were having a remarkable impact on the Irish healthcare system.

The work of the programmes had ensured that:

  • More than 87,000 people with diabetes were screened as part of the national retinal screening programme;
  • An 82.3% day of surgery had been achieved for planned/elective trauma and orthopaedic surgery in 2015 compared to only 34.6% in 2010;
  • Twenty-two severely obese adults with diabetes had bariatric surgery in Galway University Hospital in 2016;
  • There had been a 40% increase in the number of new patients seen for dermatology related issues since 2009;
  • Over 1,700 patients had been accepted to COPD outreach programmes across 12 hospital sites in 2016;
  • 11 Injury Units were now seeing almost 90,000 patients with injuries such as broken bones, dislocations, sprains, strains, wounds, scalds and minor burns;
  • A total of 2,000 staff members had already completed the Adult National Sepsis eLearning module launched in September 2016, increasing competency and expertise on sepsis recognition, escalation and treatment;
  • An 11% thrombolysis rate for stroke patients was achieved by the end of 2015, compared to 1% in 2008;
  • Over 80,000 patients had been seen at musculoskeletal clinics and removed from consultant waiting lists.

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