Health

Social Justice Ireland's analysis and critique of healtcare in Ireland

Social Justice Ireland published its latest analysis and critique of healthcare in Ireland as well as its policy proposals in the annual Socio-Economic Review published in May, 2011. The full text can be accessed here.
 

Expert Group Report on Resource Allocation, Financing and Sustainabioity in Health Care

There are three documents in this series:

HSE Service Plan reveals Government's failure to address core challenge

The HSE's Service Plan for 2010 reveals the HSE's targets for hospital, community and primary care services.  The failure of Government (not the HSE) to support the initiatives required to provide a comprehensive network of primary care teams across the country means that the healthcare system will continue failing to provide the core structural development required. A close reading of this Service Plan suggests Government is continuing its drive to privatise large parts of the healthcare system.

The Plan provides details on how the HSE plans to maintain access to appropriate treatments and services for patients and clients during 2010 despite huge cuts in its budget. The budget allocation for the HSE in 2010 is €14.07bn, a decrease of €668m on the 2009 outturn.

The 2010 Service Plan includes an additional €230 million for demand-led schemes such as medical cards, €117 million for the Fair Deal nursing homes support scheme, €10 million for home care packages for older people and €20 million for the National Cancer Control Programme. It also proposes a reduction of 33,313 in emergency admissions to hospitals in 2010.

The plan has a target of €106 million in savings to be made in non-pay areas. It also has a target of increased income collection from within the healthcare system which is €745 million higher than in 2009.

The HSE Service Plan for 2010 is available here.

Healthcare policy must prioritise Primary Care Teams, community supports and social care infrastructure

Ending the ongoing spiral of healthcare crises in Ireland requires that Primary Care Teams (PCTs) and the linked community supports and social care infrastructure must be put at the centre of healthcare policy and resourced adequately according to Social Justice Ireland’s latest Policy Briefing. This approach would enable communities to look after their own people locally with their families and friends where they want to be according to Social Justice Ireland.  

Healthcare is a social right that every person should enjoy. People should be assured that care in their times of vulnerability is guaranteed.  This is patently not the case at present. Major change is required.

Social Justice Ireland's Policy Briefing on Healthcare states that if everyone in Ireland is to be sure they can access healthcare in the most appropriate manner when needed then Primary Care Teams (PCTs) must be in place in all parts of the country.  It also requires that these PCTs be fully operational and working in an integrated manner and that they be adequately funded.
A Primary Care Team (PCT) is a team of health and social care professionals (catering for a population of 7,000-10,000 people) who work closely together to meet the needs of people living in a community. These professionals include GPs and their Practice Nurses, Community Nursing i.e. Public Health Nurses and Community Registered General Nurses, physiotherapists, occupational therapists and home care service staff. These provide the first point of contact when individuals need to access the health system. 518 PCTs would be needed to cover the whole country.
In practice this approach requires that Primary Care Teams be closely linked to community supports such as home care packages, home helps, sheltered housing, meals on wheels and day care centres. It also requires that social care infrastructure and services be in place and adequately resourced. In practice these Primary Care Teams should also be linked to services in areas such as local government and education to ensure a joined-up service is delivered in the local community.
Ireland has become over-focused on the acute hospital system. This must change and we need to focus instead on prioritising community-based health and social services.
According to Social Justice Ireland’s Policy Briefing on Healthcare, community-based health and social services must become more:
  • Accessible and acceptable to the community they serve;
  • Responsive to the needs  of the local community and its particular set of requirements;
  • Developed to a position of dominance in relation to acute hospital services and be accepted as the primary health and social care option to be accessed by the community;
  • Supportive of local people in their efforts to build caring communities.
These goals can be achieved in a reasonably short time period.
For this to happen however, in the overall context of health service delivery, there will be a need to:
  • Integrate the acute hospital care system
  • Integrate the community-based service system
  • Integrate both hospital and community systems to ensure that there is a consistent and seamless approach to service delivery where the person is at the centre of the service.
  • Develop and enhance a social care model of service focused on supporting local communities in improving the overall health and wellbeing of the population.

The standard of care provided is dependent, among other things, on the resources made available which in turn is dependent on the expectations of the society.

For years Ireland has struggled to deliver a fair and equitable healthcare system in which people could have trust.  Social Justice Ireland welcomes the new Government’s commitment to produce a one-tier healthcare system. Budget 2012 is a good opportunity to move in this direction.

The full text of Social Justice Ireland's Policy Briefing on Healthcare may be accessed here.

 

Irish Government's proposed healthcare structure raises serious questions about efficiency, integration, prevention etc.

The Government has decided on the structure of the healthcare system which is to follow the dissolution of the HSE. The full Government statement is reproduced below. There are serious questions that arise from the structure proposed by Government. Will it be more efficient than the HSE? Will it deliver an integrated system? Will it give priority to the development of REAL Primary Care Teams.
 
FULL TEXT OF GOVERNMENT STATEMENT
Cabinet approves drafting of legislation for new HSE governance – December 20, 2011The Government has today (December 20, 2011) approved the drafting of legislation involving significant changes in the governance in the Health Service Executive.
The legislation, once implemented, will replace the current Board /Chief Executive structure with a Directorate (or Transitional Governance Structure)b
 
Backdrop
The Government is committed to a radical reform of the health services which will see the introduction of Universal Health Insurance (UHI). The putting in place of a new Directorate in the HSE is a key component in the move towards UHI.
The Programme for Government commits to the HSE ceasing to exist over time. This legislative change is the first step in a process of transformation which will require detailed planning. This initial step is designed to avoid disruptive change at a difficult and challenging time for health and social services. Legislation which will have the cumulative effect of abolishing the HSE will be brought forward on a sequential basis, as part of the overall health reform programme, with functions transferring elsewhere as part of the move towards a system of Universal Health Insurance. In addition, functions relating to child protection will transfer from the HSE to the proposed new Children and Families Support Agency.
 
Purchaser of Services – Provider of Services
 
This fundamental alteration of the operation of the health services will see an organisational division between those assets charged with purchasing health/social services and those assets charged with providing the health/social services. This in turn will allow the implementation of a full ‘Money Follows the Patient’ system where providers are paid on the basis of services delivered. It is the view of Government that the interests of citizens in securing high quality health care in an effective, efficient manner will be best achieved in this way.
In order to achieve a new degree of transparency, accountability and efficiency – prior to its abolition – the HSE will be re-organised along Service Lines. The new Directorate structure involves the identification of clear areas of priority and the establishment of responsible directors for those Service Lines.
 
Seven Directors
 
The following seven areas will be the subject of a Directorship: -
Hospital Care, Primary Care, Mental Health, Children and Family Services, Social Care, Public Health and Corporate/Shared Services.
Seven key individuals will be appointed as Directors, one of the seven will be appointed as the Director General. The Minister for Health will determine the precise functions of the Directors.
The Minister will bring forward detailed proposals at a later date for the re-organisation of the HSE at the directorate, regional and local level in a manner which facilitates a smooth transition from the current structure to the structures required under UHI.
 
Clarity, accountability
 
The purpose of this new Directorate team will be twofold; to run the health services as they exist and to prepare for the transformation required in the move to Universal Health Insurance.
The clear identification of the seven directorates or seven Service Lines will provide (as already alluded to) considerable clarity related to the delivery of the relevant services under the responsibility of the Directors and greater financial transparency and accountability in assessing those services.
It is proposed that the persons to take up the Directorates will be a combination of re-assigning existing HSE directors as well assigning persons to be identified by internal competition.
 
Priority Legislation
 
 The legislation to give effect to these changes will be given a clear priority by the Government in the New Year. With the passing of the legislation the Minister for Health will provide a clear statement on the precise timeline for further reform in the run up to UHI.
 
Other related developments
 
A White Paper setting out how UHI will be implemented will be published before the end of next year.
The Primary Care Fund, as provided for in the Programme for Government, will be established as a matter of priority. Its early establishment will support the roll-out of free GP care beginning in 2012. The Integrated Care Agency and the Hospital Care Purchase Agency, which are likewise provided for in the Programme for Government, will also be established during 2012.

Article printed from healthupdates: http://healthupdate.gov.ie
 

Long-term care spending set to double or triple by 2050 - OECD

Spending on long-term care in OECD countries is set to double, even triple, by 2050, driven by ageing populations. Governments need to make their long-term care policies more affordable and provide better support for family careers and professionals, according to a new OECD report. This is a very significant report in the context of Ireland's 'Fair Deal' programme providing long-term care for older people does not have sufficient funding.

“Help Wanted? Providing and paying for long-term care” says that half of all people who need long-term care are over 80 years old. And the share of the population in this age group in OECD countries will reach nearly one in ten by 2050, up sharply from one in 25 in 2010. This percentage will reach 17% in Japan and 15% in Germany by 2050.
 

 

Spending on long-term care, which now accounts for 1.5% of GDP on average across the OECD, will rise accordingly. Sweden and the Netherlands today spend the most, at 3.5% and 3.6% respectively of GDP, while Portugal (0.1%), the Czech Republic (0.2%) and the Slovak Republic (0.2%) spend the least.
“With costs rising fast, countries must get better value for money from their spending on long-term care,” said OECD Secretary-General Angel Gurría. “The piecemeal policies in place in many countries must be overhauled in order to boost productivity and support family carers who are the backbone of long-term care systems.”
Major reforms to attract more care workers and retain them in the sector should be put in place quickly. Most long-term care careers are dead-end jobs with a high turnover and low pay and benefits, says the OECD. And caring for others comes at a price: caregivers are less likely to have a job than the average person and, if they do, it’s more likely to be part-time with fewer hours. They also face an increased risk of poverty and are more likely to suffer from mental health problems.
A country profile of long-term care in Ireland forms part of this study and may be accessed directly here.
Upgrading the status of the long-term care workforce by improving pay and working conditions is key. Germany, the Netherlands, Sweden and Norway have boosted retention through recent initiatives along these lines. In Belgium, the Netherlands and Sweden, collective labour agreements that recognise years of experience in wage levels have also proved effective.
To meet future demand, countries will also need to attract more migrants who already make up a substantial part of long-term care workers in many OECD countries: from around one in four in Australia, the UK and the US, for example, to one in two in Austria, Greece, Israel and Italy.
In many countries, migrants are paid less than native-born workers, despite often being more qualified.  One proposal would be to extend work permits to care workers in immigration quotas, as happens in Australia and Canada. Offering education and training, especially language skills, would also help.
Governments will need to find a balance between offering access to good-quality care and making their systems financially sustainable, the report says. Around 70% of long-term care users receive services at home, but spending in institutional care accounts for 62% of total spending. Respite care, encouraging part-time work and paying benefits to family carers can all be cost-effective policies, reducing demand for expensive institutional care.
Long-term care is too expensive for all but the richest to afford. Even people with above- average incomes could end up spending 60% of their disposable income on care costs. Countries have to spread the burden of such high costs, either by targeting universal benefits to those most in need of care or via public-private partnerships.
Private insurance could play a role in some countries, the report notes, but is likely to remain a niche market unless made compulsory. In the US and France, the largest such markets in the OECD, 5% and 15% respectively of people aged over 40 have a long-term care policy.

 

 

 

Policy Briefing on Healthcare, published June 7, 2011 - Full Text

Social Justice Ireland published a Policy Briefing on Healthcare on June 7, 2011.  The full text of the Briefing may be accessed here.

Proposed new healthcare structure could reduce effectiveness and increase costs and bureaucracy

The new healthcare structure proposed by Government could reduce effectiveness and incrases costs and bureaucracy.

The Government’s proposal to introduce a new system of seven directorates to replace the HSE will fail to deliver an integrated healthcare system for users of the service at local level. Instead, there are real concerns that the new approach will increase rather than reduce costs and bureaucracy. Instead of an integrated system based on Primary Care Teams at local level we could see seven ‘silos’ competing for resources and producing a splintered system that is neither effective, sustainable nor viable in the long term. In practice the proposed new approach could see the structure taking resources away from care.
Social Justice Ireland believes that reform of the healthcare system is necessary but is seriously concerned that the proposed new structure will see each directorate establish its own bureaucracy at national, regional and local levels. This is a recipe for increasing bureaucracy and a disincentive to integration in the healthcare system when the opposite is what is required.
 
Following the last Cabinet meeting of 2011 the Minister for Health announced that there would be seven new directorates established covering: hospital care, primary care, mental health, children and family services, social care, public health and corporate/shared services. While each of these areas is crucially important in the delivery of a holistic healthcare system establishing directorates as proposed has the potential to completely undermine the development and effectiveness of Primary Care Teams at local level. 
 
Government’s restructuring of the HSE should support and not impede the development of a comprehensive system of effective Primary Care Teams at local level. The establishment of seven new Directorates could well produce the opposite.

 
Primary care teams
Ireland’s healthcare system has struggled for many years to provide an effective and efficient response to the health needs of its population.   Primary care teams are the cornerstone of any new system that hopes to deliver an effective, integrated, user-friendly service for people.   It draws the health professionals in an area together into a team that provides a one-stop shop where people can go locally rather than heading directly to the accident and emergency unit in the nearest hospital.   A very large proportion of those who go to accident and emergency units should not be there.
 
The HSE has been developing Primary Care Teams and Social Care Networks as the basic ‘building blocks’ of local public health care provision. We understand a Primary Care Team (or “PCT”) to be a team of health professionals (catering for a population of 7-10,000) who work closely together and with the local community to meet the needs of people living in that community. These professionals include GPs and Practice Nurses, community nursing i.e. public health nurses and community RGNs, physiotherapists, occupational therapists and home-care staff. They provide the first point of contact when a person needs to access the health system. When fully developed, it is expected that 519 primary care teams could cover the whole country. PCTs are also expected to link in with other community-based disciplines to ensure that health and social needs are addressed.  These include: speech & language therapists, dieticians, area medical officers, community welfare officers, addiction counsellors, community mental health nursing, consultant psychiatrists, etc. PCTs provide a single point of contact between the person and the health system. They facilitate navigation ‘in’, ‘around’ and ‘out’ of the health system.

The former Government had committed to putting 500 Primary Care Teams in place by 2012. Progress has been made but more is required if this essential development is to be secured.  The proposed new structure for Ireland’s healthcare system should be focused on delivering an integrated service at local level in an efficient and effective manner according to Social Justice Ireland.
 
A more detailed analysis of Ireland's healthcare system published by Social Justice Ireland may be accessed here.
 
A Policy Briefing on healthcare published by Social Justice Ireland may be accessed here.