Better healthcare in Ireland

Damien McCallion, formerly Chief Operations Officer of Health Service Executive (HSE), now Chief Technology and Transformation Officer, HSE, says that the future model of healthcare in Ireland cannot be resolved within the health service alone.

Describing evidence-based healthcare policy as a core pillar of public services transformation in the State, McCallion indicates a recognition of the need to base policy on evidence so as to avoid negative impact on people’s lives.

Offering a snapshot of the nation’s health based on the Department of Health’s Health In Ireland Key Trends 2023 report, he says that improvement in life expectancy (now approximately two years above the EU-27 average), of the five-year survival rates from breast, cervical, colorectal and lung cancer, and 10 per cent reduction in all-cause mortality rates in the past decade, are key indicators of the substantial improvement the collective effort of improved public services is having on the State’s health and wellbeing.

However, indicators also point to the need to prioritise solutions to meet future demand. According to recent CSO estimates, Ireland’s population is projected to grow from 5.2 million to 5.8-6.4 million in the next two decades depending on what migration scenario unfolds. Within that population demographic, the number of 65 to 85 year olds will grow by 66-71 per cent, while the number of over 85s is set to grow by 164-169 per cent. McCallion explains that in 2042, more than one-in-five people are expected to be over 65.

As a result, the population increase is expected to drive a 25 per cent increase in emergency department attendance, a 60 per cent increase in overnight bed stays, and 116 per cent increase in homecare services, for the health service.

“It is absolutely clear that we cannot resolve the future model for healthcare in this country within the health service alone.”

Damien McCallion, HSE

Outlining a recognised need to focus resources and investment to meet future demand, while also meeting current pressures, McCallion points to improved cancer survival rates as an exemplar of how a strong policy and strategic framework underpins improved outcomes for patients and service users. Developed in 2017, Ireland’s National Cancer Strategy is being implemented and has delivered an over 10 per cent reduction in mortality from cancer in the last decade and improvements in cancer survival which now match OECD counterparts.

Policy

Turning to the policy being delivered to meet current and future challenges, McCallion describes Sláintecare’s all-of-government design as “very powerful” in its creation of a common direction of travel, while acknowledging that progress requires the retention of buy-in from political stakeholders and the public that they represent.

Sláintecare prioritised two reform programmes. Improving safe, timely access to care, and promoting health and wellbeing is focused on integration, safety, prevention, shift of care to the right, location, productivity, extra capacity and achieving Sláintecare waiting time targets. Within the programme a number of projects are geared towards these areas.

McCallion explains: “A major project is around capacity and that centres on beds and resources, but also on education, workforce planning and lots of other areas. For example, we have a huge challenge in our disability services today where there are some 700 therapist vacancies.

“We have increased the numbers of therapists we educate year on year but that is a four year cycle, and so, we have to look at what we can do in terms of developing new roles such as therapy assistants, or increase international recruitment to bridge those gaps in disability services.

“Interestingly, the big challenge here does not lie with funding or migration. The therapists we are educating are being sought across the health service, as we seek to develop of child and youth mental health services and our older person services. There is a real alignment needed across the health sector in this regard and that work is progressing.”
Other projects identified by McCallion under the umbrella of improving safe, timely access to care, and promoting health and wellbeing include the streamlining of care pathways from prevention to discharge, the development of elective ambulatory care centres in Dublin, Cork, and Galway and surgical hubs in other regions, as well as the implementation of a multi-annual waiting list reduction plan.

The second reform programme, addressing health inequalities, is centred on a move towards universal healthcare and includes programmes such as developing a population health approach for service planning and funding; rolling out the Sláintecare Healthy Communities Programme; and developing regional health areas.

McCallion says: “It is absolutely clear that we cannot resolve the future model for healthcare in this country within the health service alone.”

Turning to how the HSE is delivering on its ambitions. McCallion outlines a constant context, led by the Minister of Health, on whether the organisation can do more or better with the resources they have.

To this end, he says: “Post-pandemic, every healthcare system is facing a challenge where by the effort staff put in and the environment they worked in had a psychological impact, but are being asked to go again as waiting lists and emergency pressures grow. It is a really tough environment and our role is to try and support them through that.

“Some of the initiatives that we are taking forward include efforts to grow our service over six days to drive more out of the system from the resources we have. In addition, we are introducing innovation where possible, such as the integration of new technologies for better outcomes.”

Outlining a number of priority areas and enablers across the key themes of infrastructure, workforce, technology, and organisation, McCallion says that achieving these ambitions will be rooted in four core principles of:

• aligning hospital-based and community-based services to deliver joined-up, integrated care closer to home;

• clarifying and strengthen corporate and clinical governance and accountability at all levels;

• supporting a population-based approach to service planning and delivery; and

• balancing national consistency with local autonomy to maintain consistent quality of care across the country.

Concluding, he says: “Clearly the demand for health and social care is rising post-pandemic with an ageing society and projected increased demand for all services. Having a strong policy and strategic framework in the form of Sláintecare is important in delivering better healthcare alongside specific policies and strategies, which have improved outcomes for patients and service users.

“Improving access to services and shifting majority of care to the community is vital over the next 20 years given our ageing population. To achieve this, there is a need to invest in capacity, workforce, new ways of working and digitisation at scale, in order to improve access and ensure continued safety of our health and social care services for our patients and service users, while focusing on value, and improved patient outcomes.”