Sláintecare must become our “north star”

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As I write this reflection for the Health Manager Journal, I realise that it is almost 22 months since the first case of COVID-19 was detected in Ireland, writes. Paul Reid, HSE Chief Executive Officer.

Paul Reid
Paul Reid

We knew back then that the virus was likely to pose a significant health risk to vulnerable people and we also knew that it would be a major disruptor of normal health service provision. However, I still find it hard to believe just how profoundly the ordinary course of our lives have changed in that relatively short period of time.

As a citizen, and as a public servant, I have always believed in the importance of public bodies communicating clearly and often with the people they were created to serve. When I took up the post of CEO, I had not envisaged that I would be talking week-on-week about vaccination numbers, epidemiological reports and testing and tracing statistics. I had hoped to be talking about the major systemic issues confronting our health service.

We all know that these major issues are. Waiting lists for many medical specialties, diagnostic services, and medical procedures to alleviate discomfort and pain are way too long. Our hospitals are still filling gaps in primary healthcare provision when the ideal is much more care in the community. People who are born with special needs and who benefit most from therapeutic care while still in early childhood are not getting services when they need them. Some of our infrastructure, i.e. our buildings and our clinical equipment have seen better days and are in need of upgrade and major investment. Our staff are under relentless pressure. They are tired and I suspect some may have reached a point where they may be contemplating an alternative career to the one that they love.

It has become ever more apparent since this pandemic hit that healthcare in Ireland is an ecosystem of which the statutory, voluntary, private hospital, and community health practitioners are interconnected and interdependent parts

Resolving these complex and interconnected issues will require a number of inputs which are in short supply, namely dedicated time and resources, and ideally a public consensus about how and where we should begin, and about how long this is realistically going to take.

We are extremely fortunate to have political consensus on many of the issues I referred to above, because of Sláintecare. It can often be forgotten the historic achievement that it was to have secured cross-party agreement on a subject as broad and as potentially divisive as our national health service. Most significantly for the HSE it means that we have long-term assurance about the future direction of health policy. This greatly supports incremental, year-on-year planning.  

I feel that as health managers we have a duty, not just to the Oireachtas but to the people of this country, to ensure that the historic consensus around Sláintecare is not wasted. This exceptionally significant strategy must become our “north star” as we get on with the task of sequencing and then implementing a complex but hugely exciting programme of work. We have been given the privilege, the mandate and the responsibility of bringing about a system of universal healthcare for the people of this country within the lifetime of the Strategy.  I think that we also owe it to our health care workers to create a health system that is better organised, highly networked, well-staffed and equipped, and as a result, much less stressful to work in. Achieving universal healthcare would be a fitting reward for the heroic sacrifices which all our staff are making day in, day out in the midst of a global pandemic, to restore seriously ill people to health and to support those living with chronic conditions.

We submitted National Service Plan (NSP) for 2022 to the Minister for approval on November 22, 2021, which is within the timeframe provided for in legislation. As the NSP has not yet been approved I will not discuss it in any great detail. However, I might instead share with you some of the priorities for 2022 which the Minister has communicated to the HSE.

The most urgent priority is to make progress on addressing unacceptably high waiting lists, and this will be progressed through the Multi-Annual Waiting List Reform Plan, developed jointly between the Department and the HSE this year. Considerable emphasis has been placed on advancing national strategies, including Women’s Health, National Maternity Strategy, Cancer Strategy, Trauma Strategy, Dementia Care, Mental Health Strategy, Palliative Care, and Paediatric Care, including the new Children’s Hospital (CHI). Improving access to and enhancing specialist disability services has also been highlighted as a significant priority area.

You have achieved the near impossible task of keeping many core services running despite having to allocate substantial staff and resources to support COVID-specific services

The Minister has also asked the HSE to redouble its efforts to grow total bed and ICU capacity, and this in turn will mean investment in both acute hospital and ‘step-down’ beds. We will also need to concentrate on community capacity, through the Enhanced Community care (ECC) Programme, the new Community Health Networks (CHNs), and by investing further in the chronic disease management programme.

Sláintecare also features prominently in the Minister’s letter in terms of adopting a population health management approach to service planning and funding, and also implementing Regional Health Areas (RHAs) next year. Those of you who work in the system will appreciate that the current Hospital Group/Community Healthcare Organisation structures do not readily lend themselves to achieving “integrated care.”

It is often forgotten that as well as being a clinical necessity there is a legal requirement on the HSE to integrate the delivery of health and personal social services. Achieving this involves far broader considerations than the traditional debate on joining-up the ‘acute’ and the ‘community’ system. It has become ever more apparent since this pandemic hit that healthcare in Ireland is an ecosystem of which the statutory, voluntary, private hospital, and community health practitioners are interconnected and interdependent parts.

Designing integrated care means that every organisation’s role needs to be both understood and respected; that the full capacity of our health ecosystem is utilised; and that we support one another to the fullest extent possible in the provision of person-centred care. It is timely in my view that our thinking about integration has evolved in this way, and it resonates too with the shift that is underway towards universal healthcare.

In summary, it is clear that together we are going to have to chart a pathway to achieving our ambitions for a better health service despite COVID-19.  Essential healthcare cannot wait for the virus to run its course. This will be very challenging, but we have already learned a great deal about how to better organise our health resources to support diagnosis, admission, discharge, rehabilitation, monitoring, and everything in between. COVID-19 has forced a change of mindset whereby our hospitals are quite properly reserved for emergencies, for those undergoing scheduled medical procedures, and for managing conditions that require close clinical observation. Now, we have learned to think first about delivering care in the community or indeed at home whenever possible. Over time this will result in a far better experience for patients and their families.

I wish to conclude my reflection by expressing my sincere appreciation to our healthcare managers for their sterling work over the course of last year and before. As I have said previously our managerial and administrative colleagues may have legitimate cause to complain that their contribution does not get the recognition that some of our other colleagues do.  

Many of our healthcare managers have tremendous organisational capability and this has been particularly evident during our pandemic response. You have achieved the near impossible task of keeping many core services running despite having to allocate substantial staff and resources to support COVID-specific services. This is no small achievement, and it is also illustrative of a strong relationships between managerial, clinical and support staff right across our heath system. I hope that you all have an opportunity to enjoy some essential downtime with your families over the Christmas period, and I am very grateful to you all for your continued support.