Structural changes in the HSE will replace a model of care that has changed little in the past 30 years, writes PROF BRENDAN DRUMM
THERE HAS been speculation that the organisational modifications the Health Service Executive (HSE) will be making during the coming 18 months signal a new direction. They do not. They are evolutionary and entirely appropriate for an organisation like the HSE that is developing and responding to the community's needs.
Irish taxpayers have invested heavily in healthcare during the last 10 years. However, much of this resource has supported a model of providing care that has changed little in the past 30 years, and has no place in a modern health service.
Traditionally, our hospitals and their staff have operated as totally separate entities to our community and social care services (eg physiotherapists, public health nursing, social workers, and occupational therapists). They in turn have operated separately to the General Practitioner service.
The result is that, for example, a patient with diabetes who has also had a stroke, leading to some incapacity, and depression, will have easy access to his/her GP. But this GP will have little or no organised link to the community and social care services. It is then, more or less, up to the patient to organise access to rehabilitation in one location, mental health services in another and social supports, such as home care, through another access point.
Clearly this is frustrating for the patient, as he/she will have to join multiple waiting lists and recount their medical history requirement at each location. It is also frustrating for the healthcare professionals in the community, who are doing their best in their own areas of expertise but with limited co-ordination between them.
If the patient has to be admitted to hospital, he/she has to begin the process again with a new group of doctors, therapists and social workers.
At the heart of our transformation programme, launched in 2006, is the development of fully integrated healthcare - the essence of a modern health service.
Greater integration between hospital and community services, greater involvement of clinicians (consultants, nurses, doctors, therapists, social workers, etc) in planning services, and more decision-making at local level will strengthen our ability to deliver excellent integrated care, more efficiently, right across the country.
Central to all integrated health services are health professionals working in teams. This involves health professionals (regardless of whether they are hospital based, community based or both), actively sharing information, planning care and arranging tests and treatments that are delay-free and deliver the best value and convenience for patients and clients.
For example, the same physiotherapy and occupational therapy department should care for patients both in the hospital and community, allowing more convenience and a supportive transition from hospital to home - and also enabling more care to be provided at home.
Thanks to the work of many dedicated health professionals, managers and staff, first class integrated care already exists in parts of the country. This reinforces my belief that with the right local leadership and team working, we are well capable of delivering first class services to everyone and get better value from the resources that are invested in the public health service.
Indeed, if the level of excellence being achieved in many parts of the country today was available everywhere, we would have an outstanding health service. Our challenge is to make sure that the excellence we have is replicated right across the country.
Single leadership for our hospital and community services is required. The modifications we are introducing to the way we are organised during the next 18 months will achieve this.
The National Hospitals Office and Primary, Community and Continuing Care Directorates will come under the leadership of a single national director of integrated service delivery. Every decision we make in the HSE can be 100 per cent focused on improving access and ensuring that patients and their families do not have to navigate through various parts of the health service.
Bringing clinical leadership into the organisation at national level, and the creation of a Clinical Care and Quality Directorate, is equally significant. I cannot overstate the importance of having clinicians involved in planning and managing care services, at both national and regional level. We know from experience that when services have significant design and management leadership from clinicians they can deliver far better results.
The changes we are planning to make at area level will involve appointing area directors and area clinical leaders. This will enable local clinicians and managers take full accountability and responsibility for all the health and social care services provided in their area under the direction of a single senior executive. It would have been ideal to be able to announce at this stage how many areas we will have, but additional work and consultation on the ground is required before we settle on the final number.
While we will be devolving more responsibility and accountability locally, it is important to recognise that area structures will not be autonomous entities. They will operate in accordance with the HSE's national strategic direction, standards, operational policies, budgets or employment controls.
I have stressed continuously the need for the HSE to evolve and develop in a way that supports fully integrated care. That is what we are doing as an organisation. The modifications we are introducing do not signal a change of direction for the HSE.
They are focused on improving access and delivering better value for patients and clients, and strengthening our capacity to deliver a modern health service.
While fully integrated care is our goal, it would be naive to suggest that providing it everywhere could come about at the flick of a switch. It demands that the tens of thousands of staff working in the HSE and HSE-funded agencies agree to do things differently.
I believe that we are on the right path and, with the continued commitment and enthusiasm of staff, are transforming our health service into one that truly serves the needs of patients, clients and their families.
• Prof Brendan Drumm is chief executive of the Health Service Executive