Moving healthcare out of the hospital and into the community

In January of this year, Ireland was named as the worst of 36 countries surveyed in terms of ease of access to a healthcare system, with Irish patients waiting longer for emergency treatment than in any other country in Europe.

In the same month, Tony O’Brien, director general of the HSE, acknowledged that Ireland’s health service was no longer “fit for purpose” and indicated the HSE would require about €9 billion in capital spending over the next 10 years to overcome both historic and existing deficiencies.

With a record 666,000 people waiting for treatment on hospital waiting lists, O'Brien is hopeful the Future of Healthcare Committee set up by Minister for Health Simon Harris will be "a starting point" for the changes needed to shift the model of healthcare away from the current hospital-centric focus towards the community.

The Irish healthcare system ranked 21st in the 2016 Euro Health Consumer Index, the same as 2015, below lower-income countries such as Macedonia, Croatia and Slovenia. The annual report by Swedish firm Health Consumer Powerhouse noted that after its 2015 edition was published, the Irish Department of Health and the HSE set a target of no patient having to wait longer than 18 months for a specialist appointment. Even if and when that target was reached, it would still be the worst waiting-time situation in Europe, according to the report.

The Oireachtas Future of Healthcare Committee was established to agree an all-party 10-year plan for the future of the Irish health service and to identify a pathway to a universal single-tier health service.

The second interim report of the committee, which was published in January of this year, notes: “There is widespread agreement that the healthcare system should move in the direction of an integrated care model. Diagnosis, treatment, disease management and step-down care should be provided at the lowest possible level of complexity, with secondary care only being utilised when necessary. The perspective from all groups is that in order to facilitate integrated care, electronic health records are an essential investment, and primary and social care services need to be strengthened.”

There are 99 Primary Care Centres around the country and a further 37 are under construction. Of these, 17 centres are expected to open in 2017 and 11 in 2018.

Better patient outcomes

John Pike, head of PR and communications at Medtronic UK and Ireland, explains they have shifted to a value-based healthcare approach by developing therapies and innovations that result in better patient outcomes.

“We look at the pathway the patient takes through the hospital to try and find a way to make their journey more efficient, and to get more patients treated. We work with the clinical teams in the hospital to map out the entire patient journey, look at where the delays are in the process and make the system more efficient,” he says.

One partnership between Medtronic's business entity, Integrated Health Solutions (IHS) and the University Hospital of South Manchester NHS Foundation Trust, has resulted in an average of 100 extra heart patients being treated every month. IHS took over the hospital's four catheterisation (cath) labs, providing care to 100 extra patients each month using the same resources, while significantly reducing its waiting list, and enabling the hospital to self-fund a fifth cath lab that treats 1,200 extra patients a month.

Ger Brennan, managing director for Human Health at MSD Ireland, welcomes the establishment of the all-party committee, saying significant changes are needed to shift the emphasis from secondary to primary care, not least in the GP contract. He says changing the way in which healthcare in Ireland is funded is a challenge in itself, but the funding needs to follow the patient.

“A lot more could be done at primary care by GPs and pharmacists. Patients don’t want to see their GP all the time, our research has shown that they are very happy to see a pharmacist where appropriate. There is a lot of discussion about increasing the services of pharmacists and I believe the Minister is on board with this.”

Brennan highlights the problem of recruitment and retention of primary care physicians, with many emigrating for better quality of life and higher pay.

He welcomes the introduction of the Individual Health Identifier under the Government’s eHealth strategy, which will be used to safely identify each individual and enable the linking of their current health records from different systems to give a complete medical history.

“Moving to a unique identifier represents a fundamental change in how Irish healthcare is delivered. It connects everybody, and enables outcome measures. It takes information sitting in thousands of folders in hospitals all over the country and puts it into one safe system,” says Brennan.

With technology expected to play a pivotal role in the healthcare systems of the future, Shane Tickell, chief executive of IMS MAXIMS, an Irish-founded clinical technology company, highlights the need to move from a system where staff are still scribbling patient information on scraps of paper, towards personalised precision healthcare for individual patients.

Digital transformation

The company’s systems and solutions are in use in the NHS Foundation Trust and in private hospitals across the UK and further afield, and Tickell is keen to assist in the digital transformation of the HSE, headed up by Richard Corbridge, chief information officer .

IMS MAXIMS has recently launched a fully integrated vital signs app designed to improve patient outcomes by enabling staff to respond to a patient’s condition from anywhere in the hospital before it becomes life-threatening.

St Vincent’s University Hospital, Dublin, has partnered with IMS MAXIMS to implement a new, easy-to-use Emergency Department system that allows real-time tracking of a patient journey and provides an instant overview of a patient’s status. In the UK, IMS MAXIMS’ open-source electronic patient record system has been deployed by Taunton and Somerset NHS Foundation Trust, named as one of 12 Global Digital Exemplars in the NHS.

Karl McDermott, head of ICT at telecommunications company Three, says its GP Online service, launched in March 2017 in conjunction with the National Association of GPs, is being piloted by six surgeries in Ireland. They hope to have 100 family doctors on the system by the end of the year.

"What's different about this system is that patients will be able to organise a video consultation with their own doctor – there are a number of GP video applications on the market, but this is the only one that allows you to organise a consultation with your own GP, assuming he/she is signed up. You can book the consultation and pay the fee online from your own Samsung or Apple phone or device," he explains.

Three also provides the Healthmail secure email service to the HSE, which allows GPs to quickly communicate information into the hospitals, without the need for faxes or letters. The data is secure and encrypted and more recently, pharmacists have begun to access the service.

McDermott notes: “The other big area that is growing rapidly is the Internet of Things, such as the use of wearable devices and telemedicine which gives doctors access to patient data generated themselves at home, like blood pressure and heart rate monitors. It’s all about communication, and these systems allow doctors to set thresholds and communicate with their patients.”