HSE 'outreach' decision criticised

A Dublin consultant respiratory physician has severely criticised the HSE for funding a private firm to provide an outreach service in the homes of patients that he claims he was already providing at a much lower cost.

Dr Finbarr O'Connell said he was shocked when the HSE refused to expand the award-winning respiratory outreach programme he runs at St James's and instead funded Tara Healthcare's Hospital in The Home (HITH) scheme.

The chief executive of Tara Healthcare Ltd, Mr Chay Bowes, said Dr O'Connell's criticism of the HITH scheme was ill informed and out of date. He said Dr O'Connell's service without doubt was a viable and worthwhile one, but to compare the two services was "to compare a house cat and a puma".

Dr O'Connell said: "We have a model that reduces the length of a patient's stay in hospital from 10 and a half to one and a half days. In late 2005, at the height of the trolley crisis, we told the HSE if they doubled our funding, we would double the number of discharges. We had three years' data at this stage showing the effectiveness of our model and its value for money and firmly believed the HSE would support the expansion of the service but they funded a private company instead."

He claims that the HSE is paying up to €7 million for only one phase of a service that was already being provided at St James's at no extra cost. They have one nurse and physiotherapist dealing with 100 discharges a year.

Mr Bowes said the HITH service had been one of the most innovative and successful initiatives of the HSE in past years. "This internationally renowned and proven method of care has been further developed by Tara Healthcare to make our service the most comprehensive service available in Europe with no other service offering comparable levels of clinical care in the patient's home.

"Since its inception eight months ago, this programme has treated more than 1,000 patients with diverse and complex medical conditions including endocarditis, osteomyelitis, urinary tract infections, pyelonephritis, deep venous thrombosis, bronchial infections and pneumonias," he explained.

Mr Bowes said these were not conditions that could be safely treated as part of an "outreach" programme such as that run by Dr O'Connell which only has applications to chronic obstructive pulmonary disease (COPD) patients adhering to strict inclusion criteria staffed by a limited number of nurses and a physiotherapist remotely supported by doctors.

"In its first eight months, 7,000 bed days have been saved by our programme, the programme has been enthusiastically embraced by the medical fraternity in Dublin. To date, all six Dublin hospitals have participated with over 150 referring physicians and surgeons from across a referral population of over 1.2 million people.

"Dr O'Connell's programme covers respiratory patients of St James's Hospital alone, does not serve the rest of the city or county and is strictly limited in the type and severity of conditions it can treat," he said.

He said Dr O'Connell's estimations of the cost of the HITH programme were incorrect, and internal evaluations so far indicated that HITH care was certainly as favourable and, for certain disease groups, significantly cheaper than in-patient care.

A spokesman for the HSE said they were expanding and improving the range of community care services they provided as part of an overall reform of the health services.

"This includes new types of community services to provide care for an ageing Irish population where non-hospital services will increasingly be instrumental in the way the HSE provides social and health care. Hospital in the Home is one of these new initiatives. At the moment it is being run on a pilot basis," he explained.