New Modernised Care Pathways Cut Waiting Lists

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Deirdre McNamara
Deirdre McNamara

The Modernised Care Pathways are a multi-annual scheduled care reform initiative that seeks to implement, operationalise and optimise clinically redesigned patient pathways. These pathways aim to transition care from the acute hospitals to consultant-led specialist multi-disciplinary teams, often in the community closer to the patient’s home, thereby freeing up acute hospital consultant capacity to treat higher acuity patients.

Deirdre McNamara, Director of Strategic Programmes, which has oversight of the Modernised Care Pathways told the HMI seminar in April that the key principles of the programme were to facilitate additional activity in the system, reduce waiting times, move closer to delivery of Sláintecare maximum wait time targets, and improve the patient experience. This in turn contributed to the focus of addressing challenges to accessing care, part of the overall HSE waiting list action plan.

Successful delivery of this complex programme of work required the collaboration and commitment of a wide range of stakeholders across the system. The Strategic Programmes Office (SPO) was engaging regularly and meaningfully with stakeholders via informational webinars, meetings and memoranda, query responses, site visits, and special events.

“We set up an integrated implementation group with representation from the Community Health Organisations and the Hospital Groups – which will transition to the new Health Regions – who have a leadership role in local implementation.   We hope that the new integrated care structure under the Regional Executive Officers will be a very positive development in the implementation of pathways. We report into the Department of Health and the HSE Waiting List Taskforce, which meets monthly and once a month we report into the Ministerial Taskforce.”

Deirdre McNamara referenced several cases highlighting the impact of the Modernised Care Pathways across the system.

Ophthalmology at Ballincollig Regional Eye Clinic: 

  • A collaborative waiting list initiative for Ophthalmology between RVEEH, SSWHG and CHO 4 commenced in March. The aim of the initiative was to offer 200 of the longest waiters from the OPD Cataract waiting list in SSWHG appointments at Saturday clinics in the RVEEH for pre-operative assessment and Cataract surgery, with post operative care provided locally by the Community Integrated Eye Care Team in Ballincollig (CHO4). To date, 15 of the longest waiters have received cataract surgery at the first clinic and a further 19 are booked to receive cataract surgery at the second clinic. 
  • In the Cork Region, following the establishment of the Community Integrated Eye Care Team and the paediatric eye care pathway, there was a 64% reduction in the paediatric waiting list in the year ( 3234 March 2023 v 1174 in March 2024).  A Waitlist blitz initiative in October 2023 significantly contributed to this reduction.  Clinic attendance has risen by around 28% compared to the same period last year.
  • The reduction in the numbers of children on the waiting list combined with reduced waiting times for high priority referrals(from 16 weeks down to less than 4 weeks) due to the implementation of an on-demand nurse screening,  has enabled 86 Children on the acute hospital waiting list to be transferred  to the Community service where appointments will be issued in accordance of priority, optimising this integrated care model.

Paediatric Eye Care Nationally:

  • A total of 964 new patients were seen across five CHOs in March consisting of 47 removals from acute waiting lists and 917 new patients from community lists. The year-to-date total is 3,202 for this pathway with 163 removals from acute waiting lists and 3,039 additional new patients. There are currently no waiting lists for children’s eye appointments in several, with all children receiving appointments within the HSE recommended time frames.

Continence and Urinary Health Pathway in CHO 2:

  • This pathway is operational and prioritising patients on the OPD Waiting List prior to accepting direct referrals. Since December 1, 2023, all patients referred to OPD in GUH with urinary incontinence have been referred to the community pathway in CHO2 and will be seen within the next 4-6 weeks. These patients would normally wait more than 2 years to be seen in the hospital OPD.

Type 2 Diabetes Mellitus (T2DM) Ambulatory Care Pathway in Galway:

  • It is now reported (April 24) that there are no patients waiting longer than 4 weeks for Diabetes initial assessment in Galway Acute and Ambulatory Care Hub. The Integrated Care Consultant has reduced waiting times from 21-24 months to <1 month since last October 2023. The MCP is driving reductions in OPD waiting lists through OPD referral avoidance and through removing patients from the OPD waiting list. This hub has reduced referrals for Diabetes to OPD in Galway by 66%.

Orthopaedics:

  • Nationally, the virtual Fracture Assessment Clinic has resulted in over 11,000 patients being discharged by Multidisciplinary Teams, releasing consultant capacity for higher acuity patients (May – December 2023).

In 2023, the focus was on seven priority pathways across Urology, Orthopaedics and Ophthalmology which delivered 37,401 additional activity, with an investment of €11.5M to support sites in the implementation of the Modernised Care Pathways. 

In 2024, the focus is on scaling up activity across the current 28 operational pathways, with two more expected to go live in April over a total of 85 sites, with 186 WTEs recruited to support delivery of the pathways. So far in 2024, a total of 4,047 new patients have been removed from acute hospital waiting lists, 16,016 additional new patients were seen (including waiting list removals) and 13,981 patients were reviewed via the new Modernised Care Pathways.

“We will be scaling this up to over 100 sites in the second quarter of 2024 and we have over €22 million to support the MCPs in 2024. Now that we have recruited so many people, it is important to measure what additional activity and improved access we have as a result. We need to demonstrate added value and to scale up performance.”

Deirdre McNamara is Director of Strategic Programmes, Office of the Chief Clinical Officer, HSE.

The Strategic Programmes Office provides structured support and leadership in the delivery of key programmes that drive change in the provision of healthcare in Ireland, under the remit of the Chief Clinical Officer. These programmes of work involve senior stakeholder management and patient representatives, unite core competencies in the operational and clinical environments, and comprise major change management initiatives that span the HSE system wide.

Deirdre provides programme leadership for a range of collaborative strategic programmes including: the Modernised Care Pathways Implementation Programme, the National Perioperative Patient Pathway Enhancement Programme, the establishment of Acute Virtual Wards, the Implementation of the National Strategy for Accelerating Genetic and Genomic Medicine, and the National Diagnostic Radiology Review. 

The Strategic Programmes Office (SPO) within the Office of the Chief Clinical Officer:

  • Acts as an incubator for innovative new programmes of priority
  • Brings together internal and external stakeholders
  • Unites core competencies in the operational and clinical environments
  • Engages directly with patients and service users
  • Drives major change initiatives that improve healthcare service delivery and span the HSE system-wide.

The seminar was chaired by HMI Council Member, Sharon Morrow and supported by GSK.