It is generally accepted internationally that healthcare costs are rising and will continue to do so into the future. It is therefore important to make the most efficient use of resources in healthcare delivery. This requires, inter alia, increasing emphasis on models of care that treat patients at the lowest level of complexity and provide safe quality services at the least possible cost. This is particularly important in the light of increased demand for services arising from population growth, increased levels of chronic disease, increased demand for drugs and new costly medical technologies and treatments.
That is why the Government is committed to ending the present unfair, unequal and inefficient two-tier health system and to introducing a single-tier system, supported by universal health insurance which will provide access according to need rather than ability to pay. The reformed system will deliver best outcomes for available resources and will treat patients at the lowest level of complexity that is safe, timely, effective and efficient and as close to home as possible.
Primary Care is widely recognised as a cost effective way to deliver essential health care services and the implementation of the Primary Care Strategy is a priority for this Government. The Strategy involves a move away from the older hospital centred model to focusing on the delivery of care in the community and home. In a developed primary care system, 90 to 95 per cent of people’s day-to-day health and social care needs can be met in the primary care setting, providing ‘the right care, in the right place, at the right time’, where people have direct access to integrated multidisciplinary teams of GPs, nurses, physiotherapists, occupational therapists and other health care disciplines thus avoiding more expensive acute treatment. Since this Government came into power in March 2011, 37 primary care centres have opened and infrastructure development is underway or at an advanced planning stage at a further 43 locations where delivery is expected over the period 2014 to 2016/early 2017. The HSE also plans to enhance the services of existing Community Intervention Teams during 2014 with an increased emphasis on helping people avoid hospital admission or return home earlier.
The Department of Health and the HSE are also focussed on implementing the Government’s reform programme for acute hospitals including establishment of acute hospitals into a small number of groups, each with its own governance and management, to provide an optimum configuration for hospital services for the delivery of high quality, safe patient care in a cost effective manner.
The Special Delivery Unit works intensively with management and staff in acute hospitals to embed process/system improvements at hospital level, to monitor and audit these improvements, to validate waiting lists and to capitalise on additional productivity arising from the Haddington Road Agreement. Hospitals, in conjunction with the HSE National Clinical Programmes, seek to ensure that patients' average length of stay is within the national targets established by the Clinical Programmes, and monitor such activity regularly.
A key part of this is proactive management of discharge planning, with patients moving to lower acuity beds at other facilities, such as smaller hospitals or nursing homes, for rehabilitation and convalescence if appropriate. Other measures which positively affect cost containment include ongoing improvement in the management of clinical pathways for patients, and optimisation of the use of Medical Assessment Units / Minor Injury Units / Urgent Care Centres, as alternatives to over-reliance on Emergency Departments.
In addition, I am also keen to shift the emphasis towards health prevention, promotion and improvement in the years ahead. This has already begun through the Healthy Ireland policy framework which represents a whole-of-Government and cross-sectoral approach to addressing the growing demands on health services due to the increase in the incidence of chronic illnesses and an ageing population. Protecting health and putting in place targeted, cross-sectoral and cost-effective prevention programmes and policies will assist in reducing the prospect of unaffordable future health costs which will certainly arise if current health trends are not addressed.
