Treating the majority of patients in the community rather than in hospitals is the fundamental building block for the future of the health service, according to a briefing document prepared for new Minister for Health Simon Harris.
The document is highly critical of governance in the Health Service Executive and the running of hospitals and raises questions about the role of private medicine in the public system.
It contrasts the 24/7 needs of major hospitals with the traditional five-day week patterns of staff such as radiographers, theatre support staff and laboratory staff, which results in limited out-of-hours use of high-tech equipment.
Consultants’ contracts
“The alignment of incentives for consultants and the dual nature of many consultants’ contracts are widely regarded as problematic,” it says.
Private health insurance is an important “driver of activity” in the health system. “It is widely believed, for example, that private health insurance is relevant to the incentives and working patterns of some hospital consultants.”
The document says its purpose is to inform the task of developing a “clear and coherent” agenda for action to improve the health service. “A more responsive and improved health service is achievable, but only on the basis of a more effective and integrated model of care.”
It says the starting point for this is the development of comprehensive primary care “not least because the existing system is unsustainable”.
Four out of 10 people aged over 50 have a chronic disease and 11 per cent have more than one, it points out. Chronic disease accounts for 80 per cent of all GP visits, 40 per cent of hospital admissions and 75 per cent of hospital bed days.
Problems with emergency department overcrowding and waiting lists are largely due to an “outdated model of care” focused on providing episodic treatment rather than ongoing treatment for chronic conditions.
Disease management
“We have to do more to maintain health and wellbeing, but we also have to be better at managing disease. Chronic disease is ongoing and continuous, so care models also need to be continuous, reliable and capable of addressing and responding to the many and sometimes complex needs of patients,” it says.
Existing primary care is “fragmented and insufficiently developed” to meet growing needs equitably and developing services requires enhanced deployment of staff and resources, it says.
The document is highly critical of hospital services developed along a historical pattern of “service gaps, geographical inequities, inefficiencies, duplication, quality issues and a system preoccupied with institutional or workforce concerns rather than planning and a prioritisation of services around population health needs”.
It says there needs to be much stronger linkage and integration between hospitals and primary care.
