Shifting the emphasis to community services is the key to a sustainable health service, argues Prof Brendan Drumm
The health service is not in crisis. There are parts of it that need attention, but it is unfair to ignore the fact that every day thousands of people receive excellent public healthcare.
Last year we commissioned the first ever national satisfaction survey among people who use our services; 90 per cent said that they were happy with the quality of the care they received.
These results are consistent with those from a patient survey published in 2005 by the Irish Society for Quality & Safety in Healthcare. This showed that 93 per cent of patients were confident about the treatments and services they received in hospital; nine out of 10 said that they would recommend their hospital to a friend if they needed similar care.
Independent research among those who used our emergency services last year again delivered similar results; nine out of 10 patients said that they were treated with dignity and respect.
There are individual cases where our services fail to provide care up to the standard we would want. But to use such examples to represent the whole health service is unfair to patients, staff and the community.
Brian Goggin, chief executive of the Bank of Ireland, recently warned that there was a real danger that we were going to talk the economy into a downturn. The same applies to health - there is a real danger we are going to talk our public health service into a crisis.
Let me take the issue of acute beds as an example. People have told me time and again that the difficulties that sometimes face our healthcare system can be addressed with more acute beds.
Last year we commissioned a review of how we use our acute beds. Are we using these pieces of infrastructure, which cost €5,000 to €7,000 a week, efficiently? The answer is that, in a significant number of cases, we are not.
We found that, on average, 13 per cent, and in some hospitals up to 34 per cent, of patients who had been admitted did not need admission.
We found that four out of every 10 patients who were being cared for in an acute bed on a particular day could have been treated in an alternative and more appropriate setting, most of them at home. For almost 20 per cent of hospitals, half of their patients could, on the day they were surveyed, have received their treatment outside the acute hospital setting. For elective surgery patients, we found three in every four had been admitted earlier than they should have been.
These findings illustrate why consultants can face problems in accessing an acute bed for their patients. We have to address the high level of inappropriate admissions and hospital stays. Building more acute hospital beds will simply expand a system that is not serving patients efficiently.
The way to improve access to our acute beds is to tackle inefficient hospital processes and develop our community-based facilities.
Within the community, people need to have greater access to:
* Diagnostics such as ultra-sound and x-rays and assessments outside of hospitals;
* Non-acute beds with therapy supports, such as physiotherapy and occupational therapy.
* Home-based care, including GP support, therapies, specialist nursing, community nursing and home-care packages.
We are putting these types of facilities in place. We have made access to private-sector diagnostic services through GPs much easier, and this is having a significant impact on waiting times. It means that more people are receiving care in the setting appropriate to their condition.
Preliminary results from the recently-introduced Hospital in the Home service show that patients with chronic lung disease who have breathing difficulties and are treated by this service need, on average, nine days of treatment. Patients such as these who are admitted to hospital for treatment on average need 12 days of treatment. So not only can we keep people at home, where they will be more comfortable, we can achieve results at least as good as with hospital care.
What should a health service of the future look like? At its heart would be co-location. Not the co-location we have heard so much about in recent months, but a co-location of primary (GP) and community services; a one-stop-shop approach to providing public integrated care outside the acute hospital setting.
Large numbers of people who now have to travel long distances to hospitals for care for conditions such as diabetes and chronic lung disease, or who require therapy supports such as a physiotherapist or a dietician, or x-rays and scans, will receive care much more conveniently in these centres, close to their homes.
We are planning to establish 500 primary care teams during the coming years, each serving a population of about 8,000 to 10,000 people. So far, we have established about 100 teams.
Our hospitals will become centres of excellence and they will provide results on a par with those available through the most advanced health services around the world.
Central to this vision for the future will be the relationship that patients have with the health service. They will have one main point of contact - a key worker. This worker, as part of their local service, will be their advocate and will help them and guide them through the service, so that when they need one or more services these will be organised around the patient's needs rather than patients having to join a new waiting list for each part of the service they require, such as a dietician, occupational therapist or social worker.
Can we deliver on this? Yes we can. Firstly, we now have a single national health and social care system. We are in a much stronger position to resist being distracted by local interests and pressures, which have in the past compromised and slowed decision-making.
Secondly, all our staff share a desire to make a difference to help those who are the most vulnerable.
The public deserves a new world-class health service that will take us into a new era of healthcare.
If we are to provide this we must put our own particular interests aside and individually and collectively support the health transformation programme. Our focus must be on creating the future and not on protecting the past.
• Brendan Drumm is chief executive officer of the Health Service Executive