PLANS TO save up to 450 lives a year through the reorganisation of the treatment of chronic diseases that account for 80 per cent of healthcare costs, have been unveiled at a HSE briefing in Dublin yesterday.
Consultant specialists chosen by their peers and dealing with strokes, heart attacks, diabetes and pulmonary disease, aim to nationalise “existing best practice locally” through a national programme on chronic diseases.
The national clinical programme for stroke treatment aims to “save a life a day” and prevent at least one stroke a day, with implementation by December 2012.
Prof Peter Kelly, joint leader of the programme said: “We are already spending this money on stroke in a way that is not providing the services as effectively or as efficiently to provide the benefits we think can be achieved”.
The specialists want to have stroke units in all acute hospitals. Such units exist at the Mater and St James’s hospitals in Dublin.
Prof Kelly said: “Stroke is the third commonest cause of death in the country. It kills as many people each year as lung and breast cancer combined.” He said: “5 per cent of all bed days are used by people with stroke” and costs up to €1 billion a year. Of 33 acute hospitals in the State, 17 have a stroke unit. It is also proposed that a stroke register be established, and that out-patient care be provided in certain cases. Dr Joe Harbison, joint director of the stroke programme, said it was possible to “re-arrange the sequence in which things are done provided everybody buys in to the plan”.
Prof Richard Firth, director of the diabetes programme, said the disease used up to 15 per cent of health spending. Up to 150,000 people have diabetes, with 25 per cent undiagnosed. Most of the cost comes from hospitalisation for complications of disease. “The sad thing is these complications are completely preventable”. Diabetes “is the commonest cause of blindness in working life adults, the commonest cause of amputation”.
The specialists want to create a database to screen people for eye and foot testing, and recall those screened annually. “Every day somebody loses a toe, foot or limb from diabetes and 95 per cent of these are preceded by foot ulcers and 80 per cent of these can be prevented.” The “hospital cost of a foot ulcer in a diabetic is between €9,000 and €23,000”. He said “for a relatively small outlay, we can train practice nurses to grade the risk of a foot becoming ulcerated.”
Cardiologist Prof Kieran Daly, director of the acute coronary syndrome programmes said it was planned to standardise the treatment of heart attacks and begin rolling out a national programme in 2011. “If this is put in place, the length of time any individual will spend in hospital will be reduced by anywhere from 40 per cent or 50 per cent. So we’re going to save perhaps 1,800 day beds a year.” He said: “If you collapse in Eccles Street outside the Mater hospital you’re in a very different situation than if you collapse in Belmullet, Co Mayo”. It would be necessary to “identify nationally which hospitals will have the 24/7 facility to deal with these patients and have appropriately trained staff.”
Dr Tim McDonnell, director of the chronic obstructive pulmonary disease programme, said there was an average of 12,000 hospital admissions for pulmonary disease annually with an average hospital stay for each admission of 10 days.
The group aims to improve early recognition of problems and be able to provide care for patients at home. “A lot of these things are available already in Beaumont, St James’s and Mullingar.” It was a question of “taking best practice and nationalising it”.
