Drumm outlines major healthcare revamp

HSE CEO Prof Brendan Drumm has outlined the health executive's plans for reorganising how care is to be delivered between hospitals and the community.

He said the changes will result in rapid access for patients to all hospital facilities. The plan also involves concentrating major acute care in 18 acute hospitals.

Addressing a conference in Dublin yesterday which discussed the HSE's plans for revamping the health service, Prof Drumm said the next step involved setting up 18 integrated service areas (ISAs).

Each of these areas will include a hospital capable of providing the bulk of acute services for the local population, including 24/7 emergency care, and will have close links with local primary care teams staffed by GPs and other community-based health professionals.

Prof Drumm said in each ISA, people working in hospitals will know the primary care team they are serving and the people in these teams can expect rapid access to all hospital facilities for their patients.

"The journey back and forth for patients and clients between community care and hospital care will be effective and seamless and open lines of communication will markedly reduce the need for patients to repeatedly return to outpatients or other services."

He said the plan is to devolve control closer to where care is provided and maximise the impact of resources. Staff and service users will be involved more actively in the development of local services.

Prof Drumm acknowledged that there was criticism of the concept of primary care teams on the basis that some teams were operating across different premises, as their new facilities were not yet built.

He said for some in sparsely populated areas, operating across different premises was the most practical option.

"The reality is that every team has to start at some point and cannot be expected to reach full speed on day one."

Prof Drumm said there were currently 230 teams and by 2013 there will be a primary care team for every 8,000 to 10,000 people.

He said the new integrated model of care will allow all the services a patient with a chronic disease needs to dovetail together with all of the health professionals involved, at hospital and community level, communicating clearly and working as one team rather than as a series of unconnected isolated teams.

Prof Drumm said the HSE had had to reduce expenditure in recent years because of the financial challenges the country faces.

The HSE's pursuit of better value had enabled it to reduce costs by almost €1 billion and still increase the level of service provided. Drug costs, he said, had been markedly reduced.

Prof Drumm said health services across the world were facing the challenge of providing care to more people with less funding. He said other countries were taking a keen interest in what the HSE was doing to reform services.

He said the health service still had a lot of changes to make in the way staff worked and was organised.

The conference was told that the HSE has set up specific clinical care programmes nationally to improve care pathways for the following chronic illnesses: stroke; acute coronary syndrome; heart failure; asthma/lung disease; diabetes; epilepsy, mental health and elderly care.

The meeting also heard of progress on hospital reconfiguration and reorganisation in different parts of the country. Reconfiguration was progressing in the north-east, mid-west and south, and a plan is being drawn up to reorganise services in the midlands.

The conference was also told that a study on small hospitals in the south, mid-west and north-east found that the single most common reason for attending emergency departments in these hospitals was for management of minor injuries.

The meeting was also told that the HSE is changing the way it funds services. For example, it will target funding at the effective treatment of diabetes patients in the community and will pay for improvements in this area with a view to reducing the reliance on hospital care for these patients.

[Posted: Thu 29/04/2010]