Radical reform in health is not an optional extra

 Dr James Reilly. Photograph: Eric Luke

Dr James Reilly. Photograph: Eric Luke


The coalition Government has embarked upon one of the most radical programmes of healthcare reform since the formation of the UK’s NHS in 1948. Our goal is clear. To dismantle Ireland’s unfair and inefficient two-tier model of healthcare and replace it with a comprehensive system of Universal Health Insurance (UHI), starting in 2016. We are seeking to deliver as much reform in five years as the NHS delivered over the past 25.

Radical reform in health is, in my view, not some optional extra. It is absolutely essential. Modern medicine is allowing people to live healthier lives for longer and society is all the richer for it. But we are delivering 21st Century medicine in health systems that owe more to the 19th Century than the new millennium.

This combination of scientific progress, on the one hand, and institutional paralysis on the other hand, is driving up healthcare costs across the globe, including Ireland.

There are only two possible responses: Either large-scale rationing of healthcare, which is socially divisive and economically damaging, or radical reform of the way in which healthcare is delivered.

Major reforms
Our Future Health reform programme is, of courses, not the first attempt to change the Irish health system. The creation of the Health Service Executive (HSE) almost a decade ago was also presented by then Minister for Health, Micheál Martin, as a major reform. In reality, the changes made were mostly superficial. The inefficient, hospital-focused model of healthcare was largely preserved and all key decision-making centralised into a “command and control” system of governance.

Future Health is specifically designed to dismantle this failed model of healthcare and hand power back to patients and professionals. Its underlying vision is of an integrated health service which is built around the needs of the patient rather than the preferences of the system’s administrators.

In order to help turn this vision into reality, the Government has decided to reorganise all of Ireland’s adult public hospitals into six groups which will, over time, become self-governing trusts. It will be the biggest change in how our hospitals are managed since the foundation of the State. The objective is to create networks of hospitals which are big enough to offer patients a full range of high quality services safely, yet small enough to be flexible and adaptive.

The response from healthcare professionals to date has been extremely encouraging. People working in the system know better than anyone that change is required. As importantly, they want to be involved in that change.

In a recent article, Dr Jacky Jones accepted that the creation of these hospital groups would in all likelihood improve outcomes for patients. But she pointed out that the absence of comprehensive clinical data on outcomes would make it very hard to measure and analyse any such change in outcomes. I completely agree.

Fixated system
The health system has been fixated, for far too long, on measuring inputs – the number of beds, the number of procedures, the hours worked – and has done too little to measure what matters most: outcomes for patients. I am determined that this will change.

First, the department is currently working with other key stakeholders to develop a number of quality and patient safety outcome-focused indicators, with the intention of publicly reporting these indicators. The HSE has also developed an Irish Hospital Mortality Index which will also be made public in the near future.

Second, patient quality indicators will be built into all hospital contracts in the future. Once the HSE is abolished, a new Healthcare Commissioning Agency (HCA) will be established, which will commission services from providers such as hospital groups. We have looked at how other countries, such as Germany, have successfully used commissioning to drive improvements in patient outcomes.

Third, we will develop outcome measures for both primary and community care, which will also be built into future commissioning contracts.

I came into politics to do one thing and one thing only. To create a health system that truly puts the patient at its centre. We’re not there yet but significant progress is being made. We can and must give the Irish people the kind of patient-centred health service that they both need and deserve.

We have some of the best doctors and nurses in the world and some of the best managers in the world are Irish men and women. So why don’t we have one of the best health services in the world? Because it has evolved in a chaotic fashion over the years. We aim to change that. Notwithstanding the huge challenge involved, we intend to create a health service that patients have access to in a timely fashion, always feel safe in and that those who work in it always feel proud.

Future Health programme dohc.ie/

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