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Readers Blog: Healthcare in critical need of reform

The health service needs critical and and comprehensive reform. This Government either commits to reform now or continues to inflict misery on patients and their families.

Delayed treatment, which is commonplace in public hospitals, is an abuse of, patients and an infringement of their right to efficient, effective and timely healthcare.

The recently published SlainteCare report give a vision of a fair, equitable and safe health service that provides universal public care to all, based on medical need, independent of one’s income or ability to pay.

It demands political support from the Taoiseach who says he has unfinished business in health. It also demands legislative change to guarantee managerial and clinical performance, accountability and transparency.

Most importantly, it demands better patient outcomes comparable to international best practice.

We must understand why we need to radically change the way we provide health services. The service is fragmented, incoherent and lacking in governance and accountability.

We spend a lot of money on health yet patients get poor value and an inferior service compared to many countries.

In hospitals, many parts of the service provide excellent care but other areas struggle to achieve the optimal standard because of bed shortages, theatre space and particularly ICU beds.

The effect of lack of investment over decades is obvious with crumbling infrastructure, staff recruitment and retention problems, poor working conditions and low morale. Staff must be respected if we are to retain and recruit the best.

In the community, where most healthcare should be provided, the lack of GPs and public health nurses, together with physiotherapists, occupational therapists, psychologists and other personnel is directing unnecessary and avoidable referrals to an already over-stretched hospital service.

The failure to integrate services and to embrace IT leads to disjointed services which frustrate patients and staff, and leads to long waiting lists, trolley queues, and poor patient outcomes.

Patients’ needs must come first mand remain in focus at all times. The SlainteCare reform reorientates the health service from concentrating care in hospitals by delivering most care in primary and community care.

Integrating care is an essential and central feature of its recommendations and will lead to substantial cost savings, greater efficiency and better patient outcomes.

Hospitals should be freed of unnecessary work and allowed to deliver acute, complex, and specialist care.

Such reorientation would attract staff allowing them to work to the maximum of their professional training, having career satisfaction and acceptable working conditions. SlainteCare embraces the requirements of improving care, improving health and being cost effective.

Our ageing population will place increasing pressure on our health services due chronic illnesses and greater medical needs. Chronic illness is best managed in GP-led primary care and community care; only complex cases need hospital referral.

We must redouble our efforts to deliver the messages about healthy living, provide education in health promotion and disease avoidance and empower people to manage, as much as possible, their lives and illnesses.

The SlainteCare reform blueprint challenges everyone working in the health service to work differently and engage in cultural change starting with the minister through to the HSE, department, hospital management, consultants and GPs and all health professionals and carers.

This demands a lot from people but it promises fairness and equality in return. The one group who will not oppose this reform are the patients, who should be the main focus of their health services.

Removing private care from public hospitals is an essential element of the the reform programme. Everyone is entitled to free public care but having health insurance should not trump clinical need or confer any advantage in the public system.

Elective private care in public hospitals is an obstruction to reform yet it props up the public system financially. Universal GP care with minimal charge at the point of access will improve population health and and remove financial barriers to care.

Both of these reforms will require new public contracts and a substantial increase in consultant, GP, nurse, and other health professionals to supply the increased demand for services and provide for the present unmet need.

SlainteCare will cost money to reform and transform our health service, but it is going to be far more costly if we do not address the issues that make our system inefficient and which delivers unending waiting lists and very poor patient outcomes.

SlainteCare proposes the creation of a National Health Fund with ring-fenced funding to give sustainability and transparency to spending. Thus we need to move to multi-annual budgeting to give certainty to planned health reform.

Legislation is another prerequisite to SlainteCare reform. No longer can we have a shrug-of-the-shoulder style of management where no-one is responsible or accountable when targets are missed or patients suffer on ever-lengthening waiting lists.

System failure is no longer an acceptable excuse. Legislation must be introduced which require standards in management and clinical governance performance from everyone starting with the minister and working down.

Finally, in order to prevent SlainteCare being quietly shelved and forgotten, the reform programme recommends a dedicated Implementation group be set up immediately consisting of experts in change management who would drive reform forward.

Political buy-in, driven by the Taoiseach and overseen by a Cabinet sub committee, is essential. The government has no choice other than to start implementing its recommendations as people demand an accountable equitable and fair health service.

Dr Michael Harty TD

Chairman of the Joint Oireachtas Health Committee

Member of the Future of Health Care Committee


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