Looking to 2023 – a focus on safety and equity

Dr Peter Lachman
Dr Peter Lachman

As we come to the last blog for the year, I think we should start looking at the pressing issues that we will be facing in the coming year, writes Dr. Peter Lachman.

The challenges will be great, with the rising cost of living fuelled by inflation, the war in Europe and energy instability meaning that we will have to do more for less. Managers in the healthcare service will have to decide where to make efficiencies, while ensuring that high quality, person-centred and safe care is protected. While this is a constant challenge and has been so during the COVID pandemic, the new challenges of doing more for less will remain. There are many areas of care that need to be enhanced over the next few years. I will cover two that need to be addressed as a matter of urgency.
The first area to protect is Patient Safety, as this is a focus that is often under threat when there are efficiency savings. The HSE has a strategy to improve patient safety which provides all managers with a paradigm to improve patient safety across Ireland. Every organisation will have common and specific safety challenges. The first step for leaders and managers is the protection of all healthcare workers, as physically and psychologically safe healthcare providers can and will provide safe healthcare for the people for whom they care. The OECD has published several assessments of the economics of patient safety. Each of these assessments makes the case that patient safety in hospital, primary and ambulatory care and long term care is more cost effective than dealing with safety events. A recent update  provides guidance of how to implement cost effective safety interventions, and the fifth publication recently issued to mark the WHO Patient Safety Day is on the economics of medication safety. All of these publications provide a high level overview of how patient safety is a good investment, besides being a moral imperative. All managers will benefit from considering the option of making patient safety the foundation of the business planning strategy for the coming year. This will require providing the workforce with the skills and knowledge to deliver safe care, as well as an investment in human factors implementation across the system.
The second area I would like to highlight is that of ensuring that we place equity at the core of all that we do. This is because of the social determinants of health that impact on health outcomes around the world. The COVID pandemic exposed the fragility of health services in dealing with social determinants and how the pandemic affected the disadvantaged in society the most, as noted in a WHO report. In Ireland the Economic and Social Research Institute (ESRI) has just published a report on mortality in Ireland, Unequal Chances? Inequalities in Mortality in Ireland. The report demonstrates that inequity exists in every health service and that Ireland is no exception. Although the data is not as extensive as we would need, the report noted that there has been improvement in health outcomes, but that when one assesses mortality the disadvantaged have worse outcomes, for example “the perinatal mortality rate for unemployed mothers was between 1.6 and 2.2 times the rate of mothers in the higher professional group, and this rate remained elevated throughout the period 2000-2019”. There is a wealth of data in the report and a challenge to all in healthcare. Firstly, do we know the health inequity in our service and are we segmenting data to find out? If not, can we make this a priority for 2023? Secondly, we need to ask the question are our services closing the gap in healthcare outcomes and if not, what can we do to close the gap. Although we cannot change many of the underlying causes, we can start by doing more for those who need it. The pursuit of equity must be a priority for 2023.
I have raised two challenges for the coming year and I hope each one becomes a focus for all of us, as we address resource allocation in these difficult times.