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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.

Social Justice Irelands Policy  Briefing on Healthcare can be accessed here  

Social Justice Irelands Futher Analysis of Healthcare can be accessed here