OPINION:Our health service is moving in a sustainable direction from quality and financial viewpoints, writes BRENDAN DRUMM
AN IRISH Timeseditorial on Monday, October 26th, referencing a recently published ESRI report on future healthcare demands, suggested there has been little restructuring of health services since the Health Service Executive (HSE) was established.
While some would wish this was the case, it does not reflect reality. In 2005, we said the approach being adopted by our health service was unsustainable and inefficient in terms of taxpayers’ funds being spent. We were severely criticised for this stance by many institutions, politicians and representative bodies. The conventional wisdom was all our problems would be magically solved if we spent more money and had 3,000 more acute hospital beds, equal to building five new Tallaght hospitals.
The HSE transformation programme was and is based on getting a marked increase in productivity and better value from the existing hospital system. This is allied to building a world-class community-based primary care service. It is also focused on cutting costs through productivity improvements and significant reductions in major areas of spend such as drug costs.
While at the time I was branded utopian, it is reassuring that the findings of this particular ESRI report and its emphasis on developing community services now confirms the HSE’s programme, launched in 2006, as the right way forward.
The most fundamental need for the health services is to measure what each person and unit provides in return for public money. We have established a unique HealthStat programme to measure this and we have confirmed poor performance by units is often linked with more, not less, investment compared to better-performing units. This measurement system is publicly available with monthly updates on the website www.hse.ie under the HealthStat link.
This transparency and the transformation programme overall is realising many public benefits even as investment comes under pressure.
For the first time, Ireland is succeeding in restructuring our hospitals so they can concentrate on providing acute hospital care and enabling smaller hospitals transfer care such as intensive care and cancer care, that must, for quality and safety reasons, be provided in larger hospitals.
We now operate with almost 1,000 fewer acute beds yet are treating more patients, especially day-case patients (up 24 per cent between 2005 and 2008).
Our increase in productivity has seen a cut in waiting times for elective procedures. In the last year alone, the number of people waiting over six months for inpatient care is down 20 per cent and 29 per cent for day-case care.
I would be among the first to acknowledge waiting times must come down further, but this should not mask what staff are actually achieving.
Outside hospitals, we have advanced the creation of primary care teams across the country and developed many new long-stay facilities. New state-of-the-art primary care centres are appearing in locations from Letterkenny to Mallow and from Ringsend to Achill Island. By the end of 2012, our primary care infrastructure will be world-class. These centres are being occupied by skilled teams of primary care professionals – including GPs, public health nurses, physiotherapists, occupational therapists and so on – who can meet up to 95 per cent of the care their local communities will need.
While increasing productivity and output, the HSE has reduced spending by hundreds of millions of euro per year in the past three years. Our focus on reducing drug costs met huge resistance across the political spectrum and from other quarters, including some media. Despite this we persisted, with the support of the Minister for Health and Children. Thanks to the perseverance of HSE staff we have delivered drug savings of close to €200 million per year.
There will always be dispute on the success of transformation programmes which, by their nature, are ongoing processes. Many powerful interests are affected by such change and these are often the most vociferous.
When people criticise the HSE’s programme, it is always interesting to see what they have gained from the old system with patients having to wait long periods for services. Improving access and cutting waiting times for public patients can have a big impact on professional incomes.
To get an impartial perspective on how much change has happened and is happening, perhaps it is time, almost five years on, to have the HSE’s work reviewed by an independent body. I am confident such a review would confirm Irish health services have changed markedly for the better and, more importantly, are moving in a sustainable direction from a quality and financial perspective.
Brendan Drumm is chief executive officer of the Health Service Executive