Structural reform is only one step forward on the road to overhauling healthcare, writes Michael Lyons.
The chief executives of the country's health boards agree with - and indeed have prompted - many of the recommendations in the Prospectus and Brennan reports as constructive means of streamlining healthcare delivery. We hope the National Hospitals Office will allow the development of a modern, streamlined network of hospitals and enable some much- needed joined-up thinking in the delivery of acute hospital services.
However, it is vital that the important links between hospital and community services locally are continued and strengthened. There must be easy movement of patients back and forth between community and hospital services. A major challenge for the new hospitals' agency will be to build on the work of the health boards and the Eastern Regional Health Authority (ERHA) to ensure patients move effortlessly between the acute and primary care services.
We welcome the renewed determination to avoid the duplication of support services through an expansion of the shared services concept. Shared services allow health agencies to pool their resources in the provision of financial, payroll, purchasing and technological services to avoid duplication and waste.
It is also very significant that the issue of equity will be addressed through national services planning and allocation of resources.
But it must be emphasised that the changes required in the health services are not just structural. Structural reform is only one step forward on the road to an improved healthcare system.
We would also hope that progress will be made on the very important issue of flexibility in working hours for all those involved in healthcare to ensure that the most appropriately qualified person is always available to deal with clients and patients. Notwithstanding the valuable role consultants play in our hospital services, change will be severely limited unless the contractual issues as identified by Brennan are implemented fully.
We welcome a much greater involvement by consultants in the management of resources. Our acute hospitals ought to be staffed by appropriately trained doctors on site at all times. The patient should have the right to see the appropriate doctor in the appropriate setting at the appropriate time.
Furthermore, our health services remain under-funded. We accept that a large amount of additional funding has been invested in our health services in recent years and has produced measurable social dividends year on year. However, spending on the Irish health services is at present only 6.8 per cent of GDP compared to the EU average of 9.3 per cent and 12.9 per cent in the US. Indeed the National Health Strategy recognised the need for further additional investment and promised an extra 3,000 acute care beds, and 5,000 additional places for older people, as well as the need for extra investment in all health and personal social services. We urge the Government to respond to the needs set out in the health strategy in tandem with structural reforms.
Information technology is also central to any reform. We believe that in the €9 billion a year complex service sector we are managing, modern enterprise-wide information systems are a necessity. Yet the current level of investment in IT is less than one-half of 1 per cent of turnover. Other developed countries are spending more than six times that in the healthcare area, and the more progressive countries, a good deal more. In recent times, there has been a strong emphasis on accountability, performance indicators and governance and we are delighted that this is going to be developed and strengthened further by the new Health Services Executive. The Office for Health Management, established in 1997 to facilitate management and organisation development for health and personal services has made a major difference.
I would like to emphasise that in recent years the Irish health services have delivered better, safer and more effective treatments to an ever-increasing number of people.
Every health service is a people service and the quality of service users experience depends crucially on the skills, knowledge, experience, dedication and team work of the staff who deliver the service. In Ireland we are fortunate in having a health services workforce as good as the best in the world.
The scale of change programme should not be underestimated and requires the continued goodwill and commitment of our staff and human resources investment at significantly increased levels, comparable with industry best practice.
The health services are very labour-intensive and our staff are well-educated and trained and represent our best asset. It is vital that we ensure a continued emphasis on the development of leadership capacity and a managerial culture.
Our overriding concern is to ensure that patients and users of our health services will achieve improved results from their use of our services and that our dedicated and committed staff will achieve greater professional fulfilment.
Michael Lyons is chief executive of the Eastern Regional Health Authority and chair of the National Health Board Chief Executives Group.
