It is easy to criticise the work of the HSE, but the strategies being put in place will bring long-term benefits, writes Liam Downey.
THE 2007 annual report for the Health Service Executive shows that the volume of services delivered by the HSE was, in most cases, substantially above the targets set for the year in the National Service Plan, and well above the levels provided in 2006.
These increased output levels were achieved within the overall HSE financial allocation. This is important to underline, because often during the past year the situation has been portrayed as one of widespread cutbacks and reductions in service. This simply was not the case.
In relation to capital spending, the full allocation of capital for the year was spent on a range of critical projects. I want to draw particular attention to this because, in the past, the health service has been criticised for slippage on capital projects and spending.
It is necessary to recognise these achievements, both in service delivery and overall financial management, because they are often characterised as competing and irreconcilable objectives.
When we manage service delivery to contain cost, we are sometimes accused of being financially rather than patient driven, but equally, if we exceed our allocation, we can also be criticised for poor budgetary management. Essential cost and headcount containment is often described as cutbacks. The challenge we constantly face is to manage services we provide for patients and clients within the financial resources provided by the Oireachtas and ultimately the taxpayers while, at the same time, optimising them.
In 2007 we managed, I believe, to achieve an appropriate balance.
Good progress was also made last year on the reform agenda within the health services. This involved a variety of initiatives, including reconfiguration of services to deliver better quality, changing work practices, and better measurement and monitoring of outputs in order to improve services for patients. Although much of this is difficult and challenging to implement, we have established a clear direction and platform for change in many key areas.
Having said that, it is also clear that there are very many major challenges ahead.
The ambitious reform programme which is under way is happening at a time of considerable population and demographic change. The Irish population has grown by 20 per cent over the past 11 years and will be 15 per cent higher again by 2016, while the Irish birth rate was the highest in 25 years in 2007.
People are living longer, the population is growing, expectations and demands for services are increasing and medical costs are rising. As people get older they are also more likely to suffer from chronic illness and disease.
It is important that we take notice of such trends as we plan our future health service.
The HSE's strategy for meeting the increasing demand for health and social care is to shift appropriate activity from a hospital-based system to primary, community, long-term care, rehabilitation and chronic disease management services, in line with international best practice.
When all appropriate services are rebalanced in this way, people will be able to access many services in the community, which are at present predominately available through the hospital system. In addition to delivering greater quality of care and convenience, the shift will provide for much more effective use of available resources.
It will take some years to complete this change, but many initiatives to support the strategy are already under way. In particular, the increased investment in primary and community care, improved diagnostic support services and the reconfiguration of hospital services are essential elements of the approach.
In addition to these structural changes there is also a necessity to change the way we do things in terms of work systems and use of technology, along with other factors, to enable the planned shift in direction.
It is imperative to take the opportunity, while our population is still relatively young and before the predicted demographic trends manifest themselves, to put the new model of care in place. A continuation of the present approach is simply not sustainable in the longer term.
Implementing these changes is a difficult task in any circumstances. However, to make them happen in our environment requires the active support and co-operation of all stakeholders.
It is understandable in the face of significant change that people will express their concerns and fears and that this at times is manifested through resistance and indeed criticism of those who are leading the change.
During the past year we have provided, through our own data and external inputs, the evidence to enable better understanding of the reasons for the planned changes and the benefits for patients. We are determined to continue to highlight and address the necessary reforms. At the same time we are committed to working actively on the task of engagement and persuasion with stakeholders, internally and externally, to enable the changes to happen as effectively and quickly as possible.
A recent article in The Irish Timesreferred to a report conducted last year by Prof Anthony Staines, professor of public health at Dublin City University, and a colleague. Although the report found that the public had a positive perception of the health service, Prof Staines believes it was ignored by the media because it "conflicts with their master narrative".
Too often in commentary on health matters there is a tendency to dwell on the negative stories and, on the basis of individual events, to draw conclusions about the overall level and quality of service. This is not an accurate reflection of the performance of the service and the many improvements that have already been made, and is unfair to the dedicated people who work very diligently on a daily basis to provide these services. It is also at variance with the patient experience and data on health outcomes. We know that life expectancy for men is now four years greater than it was in 1996, while for women it is now three years greater than at that time. We also know that an independent survey carried out last year indicated very high satisfaction levels among people who actually used the services.
Delivering the health service reform programme is critical for all citizens and indeed for future generations. For that reason, although perhaps contentious now, it can be ultimately very rewarding and potentially hugely beneficial. I hope that we can now start to move on to a greater level of understanding, support and common purpose between all the players and those of influence in this work. This requires a willingness to look beyond, to some extent, the various interest groups and to recognise positive developments and the potential benefits of proposed changes. The prize is huge - the health and wellbeing of this and future generations.
Liam Downey is chairman of the board of the Health Service Executive