Our experience, in the Saolta University Healthcare Group, over the last two years both reaffirmed the need for the reforms outlined in Sláintecare and confirmed the rationale behind the strategy’s recommendations, HMI President, Tony Canavan told the 30th anniversary conference of the Hospital Managers Physicians of Lithuania in Vilnius in May, writes Maureen Browne.
Infrastructure
“Covid 19 shone a critical light on the limitations of our hospital infrastructure. The quality of our hospital accommodation made the management of Covid very problematic. Too much of our accommodation is based on multi bed wards (up to 14 beds in some cases) with patients sharing toilet and washing facilities.
“The third wave of Covid 19 brought us perilously close to the brink, in terms of Critical Care capacity. We had contingency plans in place which were activated to a significant extent but stopped just short of the widespread re-deployment of non-ICU staff from areas such as theatre. It was good that we had those plans in place. It was better that we didn’t have to use them. Again, Covid 19 highlighted something that our intensivists have been saying for some time. We need more Critical Care beds.
“But the pandemic also taught us the importance of our ICUs working together; sharing experiences, information and expertise; transferring patients as required, in order to manage demand on individual sites and in order to ensure access to the most appropriate care when required. Communication between our ICUs worked very well during Covid and shared problem solving became the norm with patient care as the single common denominator.”
Technology
Mr. Canavan said Covid taught us about the importance of making sure that the right people had access to the right information about a patient at the right time and in the right place. This need was crying out for a technological solution and we were steadily progressing towards it.
“We may not have an EPR across the country by the end of the decade, but we will have moved significantly on that journey. It has to happen if hospital and community services are to continue to integrate effectively. If we want clinicians to provide care along pathways that extend from the community into the hospital and back out, we have to make patient level information readily available to them at each step of that pathway.
“Covid 19 increased the pace of change with the implementation of technological solutions in areas such as communication and information transfer. We have great examples of telemedicine solutions that we have talked about for years and would have eventually implemented. Necessity, driven by Covid, meant that these solutions were implemented much more quickly.
Sláintecare Integration
“Covid 19 resulted in a greater integration of care between hospitals and community. We have many examples of this, but one of the best is the way in which our medical and nursing staff actively reached out and continue to do so to provide expert input into the care being provided in Long Term Care facilities in the community. LTC facilities were hit very hard by Covid in the first year. The interventions from our clinicians resulted in most of the LTC facilities in our catchment area remaining open, lives were saved and residents were provided with care and dignity at the end of their days when this was required. The outreach to LTC facilities was an incredible expression of collegiality and a determination to do what was right for patients.”
Not alone will we have to adapt to new ways of working ourselves, we will also have to become agents for change.
Challenges
Mr. Canavan said that implementing the changes that were emerging because of Sláintecare and being driven by our learning from Covid 19, would be challenging for healthcare managers. “Not alone will we have to adapt to new ways of working ourselves, we will also have to become agents for change, leading our own staff through the difficulties that will emerge in the hope and anticipation that they will lead us to a better more sustainable service.
“Changes in structures will create opportunities for healthcare managers to engage more actively with the people we serve. While this is an opportunity, it is also a significant challenge for health care managers. We will have to hone our communication skills and learn the lessons of Covid, so that we can play our part in maintaining the solidarity that has built up between patients and their health services. We need to bring patients along with us, not just to deliver on Sláintecare but to address the problems that have become endemic in our system. The starting point for this engagement has to be that the patient is not merely a passive recipient of the care that we tell him that he needs. We need to ensure that our perspective is one of patients as active partners in the management of their own health.
“When we look back over the last two years we see that the Irish people themselves played a pivotal role in the way we managed our way through the pandemic. In the early days there was a focus on ‘flattening the curve’. This was a way of describing the role that every member of the public could play to ensure that the pace of spread of the virus was reduced to a level that meant that our health services could cope with the additional demands that were placed on it. We saw very high and sustained levels of compliance with public health measures and when the vaccination became available, we saw very high levels of uptake, 92% of all adults by August 2021. During that time, a very significant degree of solidarity developed between the general public and their health services. The question that arises now is how do we maintain that solidarity in the face of the ongoing challenges that our health service faces.”
Mr. Canavan said communication within the health services and with the wider public was key to generating and maintaining this sense of solidarity. “Of particular value was the role played by clinicians, explaining what was happening and the measures that we were taking. However, lay managers also played a key communications role ensuring a consistent and credible voice was heard when most needed. Again, how do we carry this learning forward.
Sláintecare – Reorganisation
“Sláintecare recognises the flaws in the way we organise and deliver healthcare currently and how these contribute to the access issues described above. Sláintecare is an ambitious plan. At its core, it aims to create a single tier health service with universal coverage for all of its citizens. It also aims to shift the focus of our health service away from an unhealthy reliance on hospitals to provide a range of care that could be better provided in a different setting. It aims to build on the progress that has been made within our hospital system to rationalise our approach to cancer diagnosis and treatment, trauma care, specialist cardiology services and a range of others.
“This shift has already started to happen. Over the last five years there has been a significant investment in Primary Care Centres located in the community and serving as a base for clinicians such as GPs, Public Health Nurses, a range of therapies and others. Many of these new primary care centres also accommodate our community mental health services. Over the last two years in particular we have seen a very significant increase in the annual allocation to the health services from central government. The spend on public health services has increased from 16 billion per annum before Covid to in excess of 20 billion this year. Much of this increase directed towards the community, building capacity.
“We have an integrated care programme for older people which sees hospital based consultants holding regular clinics in primary care centres to which GPs can refer directly. Creating an alternative pathway outside of the hospital is helping patients to live at home safely for longer. We are working on similar pathways of care for Cardiology, Respiratory Medicine and Endocrinology.
Sláintecare – Regional Health Areas
“Since 2005, Ireland has had a very centralised approach to the delivery of healthcare. We have a single national system which tries to manage the delivery of all health services across the whole country. Sláintecare recognises that it is not possible to do this efficiently and so we are now moving to a more decentralised model over the course of the next 18 months. The new model is based on the establishment of six geographic regions. Each region will have its own structure for the delivery of services to its population and will have a significant degree of autonomy in how it does this. Critically, this approach will bring decision making closer to where patients access our services.
