Covid-19 pandemic shows HSE capable of rapid and radical change

I have never seen so much change implemented so quickly in such a short period

 St Vincent’s hospital in Dublin.  Last year demonstrated the HSE’s core values and purpose. We worked together to care for people, to be effective, to change lives, to transform how we delivered our services and protect the public’s health. Photograph: Alan Betson

St Vincent’s hospital in Dublin. Last year demonstrated the HSE’s core values and purpose. We worked together to care for people, to be effective, to change lives, to transform how we delivered our services and protect the public’s health. Photograph: Alan Betson

 

The pandemic has brought the greatest collective focus on our health service that I have ever seen. Issues such as illness prevention, physical and mental wellbeing, testing and treatment in the community, hospital care and intensive care are in the news, in our conversations and in our minds every day.

Of course, these issues were always there. When there was no pandemic, there were still challenges facing primary care, we had busy hospitals and intensive care units and a constant need for more effective public health campaigns about avoiding illness and guarding our health.

‘He is a leader. He is prepared to take the responsibility and is not afraid of it.’ Above, Paul Reid, director general of the HSE. Photograph: Nick Bradshaw
Paul Reid is director general of the Health Service Executive. File photograph: Nick Bradshaw

The difference is that healthcare problems, crises and tragedies are usually experienced as individual issues. However, during the pandemic, they became shared. Usually we experience the health issues facing us, our families and friends, as personal challenges. But the pandemic has brought a collective focus on the health service, and its strengths and weaknesses.

For the HSE, it is an important moment. It has often been said about healthcare in Ireland that when you receive it it is generally very good. People have nothing but praise for the staff who support them and for the care they get. The complaint is about access. The speed of it and the fairness of it.

This week the HSE has published its corporate plan 2021-24. Based on the principles of Sláintecare, it has been developed by the board of the HSE and endorsed by the Minister of Health. But really, its content owes a huge amount to research and to conversations we have had with our staff, with many individuals and organisations who engage with, us and most importantly with the public.

Familiar issues

The plan sets out a vision for changing and developing our health service over the next few years. It addresses familiar issues such as waiting times, the need to shift care from hospital to community and to improve financial controls. The issues are indeed familiar, but now the circumstances are different.

Most of the changes and innovation put in place during Covid-19 are strongly aligned with the principles of Sláintecare to bring care to where people need it

First, we have Sláintecare, a clear policy roadmap agreed upon and bought into by all political parties and across our stakeholder groups. This vision for Ireland’s health system emerged from the all-party Oireachtas Committee on the Future of Healthcare. It is a 10-year plan to ensure more care is provided at home or close to home, that people can get access to care when they need it and that nobody is denied access to necessary care for financial reasons.

Secondly, the pandemic has shown us that some of the necessary changes can be made in our health service and made quickly. Having led senior teams in private, public, not for profit, central and local government sectors, I have never seen so much change implemented so quickly by so many, over such a short period of time.

Most of the changes and innovation put in place during Covid-19 are strongly aligned with the principles of Sláintecare to bring care to where people need it. This innovation strengthened our community services and enhanced our flow through in hospitals. Some examples include:

Community assessment hubs, to support safe assessment of Covid in the community.

Community intervention teams, supporting care for older people.

Access to diagnostics for GPs, to reduce hospital visits.

Remote outpatient clinics, supporting safer pathways.

Health and telehealth initiatives for remote monitoring of care.

Many of these initiatives are funded in this year’s 2021 service plan, starting quickly and ambitiously to embed the benefits for the future.

Come with a price tag

Many of the Sláintecare changes do come with a price tag. We recognise the budget pressures and we will work hard to deserve and to secure the additional resources to deliver this plan. The national service plan which we announced last week showed a 21 per cent increase in spending on the health service in 2021 compared to the 2020 national service plan. We are, of course, very grateful for this confidence in us and for the funding. Now we need to show it is value for the taxpayer.

When you exclude additional funding to deal with the pandemic, this increase still represents an underlying increase of 10.6 per cent in health spending compared to last year.

We want to use this spending, and the lessons learned during the past year, to accelerate the reform programme. We have built on our collective experiences of living with and working in a Covid-19 environment; learning from new ways of working with a relentless “one team” focus on patients, service users, families and the public. Of necessity we are supporting our people to develop skills and to innovate faster than we have ever done. This includes colleagues that the HSE works with such as GPs, those who work in the voluntary sector and in the social care sector. All have been as dedicated and committed through the pandemic as our own staff. We owe all of them our gratitude.

We worked together to care for people, to be effective, to change lives, to transform how we delivered our services and protect the public’s health

The corporate plan itself has six high-level objectives:

To respond to the Covid-19 pandemic.

To enhance primary and community services and reduce the need for people to attend hospital.

To reduce the number of people waiting for services.

To prioritise early interventions and improve access to person-centred mental health services.

To reimagine disability services; and to enhance levels of prevention and early intervention in children’s health, harmful alcohol use and obesity.

These are high-level aspirations, but the plan also contains specific performance indicators for each one. The Taoiseach said recently that he would like a legacy of the pandemic being the embedding of this year’s additional spending on health into the future. However, he said he needed to see that this spending was delivering real change and value. We are determined to show this.

Last year demonstrated the HSE’s core values and purpose. We worked together to care for people, to be effective, to change lives, to transform how we delivered our services and protect the public’s health. We developed new ways of working, a new sense of purpose and I think we earned some additional trust. We can’t let any of these things go.

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