Commissioning would improve health service, says Hiqa

Ireland should seek to move to a commissioning model of care similar to that used by the NHS in Britain, the Health Information and Quality Authority (Hiqa) has said.

The healthcare watchdog told an Oireachtas committee that commissioning had its challenges in the UK, but improved the efficiency and accountability of institutions.

Commissioning occurs when healthcare facilities such as hospitals, private clinics and voluntary institutions compete to provide services from the individual up to the national level. In the NHS it is known as the “internal market”.

Speaking at the Oireachtas committee on the future of healthcare , Hiqa chief executive Phelim Quinn described the current approach to the health service as "disjointed and reactionary".

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This included a failure to assess current requirements or to provide a coherent plan for the future.

There needed to be a move away from the current hospital-based model of care, he stated, towards primary and community care, and this move should be expedited.

He told the committee that effective commissioning arrangements at both local and national level “not only ensure that services are designed and delivered to meet the needs of individuals and communities, but also instil a culture of accountability in the health and social care systems”.

Better service

The current model of legacy block funding for healthcare organisations he said, was not specified to the needs of individuals and a commissioning body could deliver a better service.

In the case of commissioning, he said by way of example that the process could find the best care for an elderly person from the available options locally.

However, he acknowledged that some commissioning decisions would result in the rationalisation of services and “will require courageous choices”.

When questioned by Fine Gael TD Kate O'Connell as to what he meant by "courageous choices", he responded that services should be provided according to population need.

Committee chairperson Róisín Shortall said commissioning was not necessarily something that would be approved. Sinn Féin TD Louise O’Reilly said bidding to provide healthcare could lead to privatisation and would not be supported by her party.

In its statement to the committee, Hiqa envisaged that all domiciliary care services should be subject to statutory regulation.

Hiqa director of regulations Mary Dunnion said it would have "tragic, unintended consequences" if people felt that they could not look after their own relatives at home. This would not be the case, she stressed.