OPINION:If we keep compromising in the face of resistance to change we will never have a modern health service, writes BRENDAN DRUMM
THE CHANGE programme initiated by the Health Service Executive in 2006 is essential – many health services had developed in a way that was unsustainable, both in relation to quality and their escalating cost.
Change is messy; it is difficult, complicated and creates uncertainty. A lot of the resistance to change in the health sector has been masqueraded as being in the interests of patients. On the basis that the anonymous taxpayer is picking up the bill, maintaining the status quo has often been portrayed as the best and only option.
It is not surprising that the public is often confused and frustrated by the seemingly endless quarrelling and the pace of change. The events surrounding the changes being made to community pharmacy services reflect this history. Pharmacists provide excellent services in communities across the country and, like other service providers, they have an important role to play in the overall change programme. When the HSE’s transformation programme meets resistance, the easy option would be for us to compromise or water down decisions. If we adopted this approach we would pay a very heavy price in that we would never have a modern health service.
We have not allowed the size of the challenge or criticism from vested interests to deflect us from our goal, which is to improve the quality of services and access to them.
The challenge for the public is to look beyond the headlines: who are the real potential winners and losers in these situations? In the vast majority of cases change will result in better quality, access and value. When the status quo wins, patients, clients and taxpayers generally lose out.
When the HSE started on this journey the conventional wisdom was that the solution to the problems in the health service was more of the same: more staff and more hospital beds. We were persistently criticised for arguing that more of the same was not only unsustainable but could not deliver a modern health service.
For example it made no sense to invest in more public hospital beds when the evidence showed us that 30-40 per cent of patients in acute hospitals could be better cared for in their own homes or their local communities.
Through the commitment of health professionals across the country to new ways of doing things, we are now providing far more hospital care than ever before with fewer hospital beds. For example year on year to the end of June there has been a 45 per cent reduction in the number of people waiting over 12 months for inpatient treatment.
Today a huge number of healthcare professionals (clinical, management and administrative staff) rather than resisting change, are leading change. Staff are willing to be more flexible. Consultants, through the clinical director structure, established as part of the new consultant contract, are leading local, regional and national change.
GPs are now supporting the development of primary care teams which can deliver up to 90 per cent of the health and social care needs that a community will ever need. We will have over 500 primary care teams in place by the end of 2011, each looking after the needs of approximately 8,000 people. GPs, nurses and allied health professionals across the country are leading a quiet revolution in the provision of community-based care through primary care teams. Coupled with this we are reconfiguring our hospitals. Small hospitals cannot deliver complex care but can provide excellent services in areas such as diagnostics, day case procedures, out patient services and minor injury services. Larger hospitals are being developed to concentrate on complex care.
New medical assessment units are allowing patients to be assessed and fully investigated without having to be admitted to hospital. The reorganisation of cancer services, through the National Cancer Control Programme, and the changes being made to the way hospital services are organised in the northeast, midwest and south characterise this commitment to change.
Reducing the price of medicines issued through the community pharmacy network is just one of a series of transformational changes being introduced. We are also reducing our operating costs and driving procurement efficiency across the business. In 2008 we delivered cost reductions in excess of €280 million without impacting on the level of services provided to the public. This year as well as repeating this €280 million savings we have set an additional target of €250 million again without service reductions.
Further savings in the cost of medicines need to be made with the introduction of reference pricing. This will involve establishing a fixed price which the State is willing to pay for each specific medication irrespective of whether it is branded or generic (ie no brand name).
We have achieved significant progress in transforming services. With the increasing buy-in from health professionals across the country this progress will continue.
The public needs to be constantly aware that they fund the health service from their own pockets, week in week out. When it comes to the transformation of health and social care services, we must always ask who will be the real winners and losers if resistance to change prevails.
- Prof Brendan Drumm is chief executive of the HSE