Sir, – As referred to in your editorial (March 29th) and other Irish Times reports, Minister for Health Simon Harris proposes to integrate hospital and community-based health services across specific catchment areas under a single management structure. This is welcome, but remarkably is being presented as a new approach by Irish health services.
The proposed approach is precisely the structure implemented by the HSE’s transformation programme between 2005 and 2010. Integrated service areas were established in locations such as Galway, Donegal and Sligo and Kerry, with ongoing rollout across the country. Establishing such structures in Dublin is particularly challenging because of the difference in governance between the voluntary hospitals under the direction of their individual boards and most community-based services provided by the HSE. Despite this challenge, major voluntary hospitals in Dublin accepted the need for integration and were willing participants in planning the rollout of integrated care in Dublin.
Following the completion of my term as HSE chief executive in late 2010, the provision of care through integrated hospital and community providers continued to be expanded under the direction of the new chief executive Cathal Magee and the board of the HSE. However, following his appointment as minister for health, Dr James Reilly, presumably with the support of government, discontinued this approach. The new government’s approach was the opposite, ie to totally disintegrate health services providers. New hospital groups were established to govern hospitals and new community health organisations established to govern community-based services. Even more remarkably, the areas covered by each governance structure did not overlap.
High-quality care requires that a patient’s care is provided in a continuum across the hospital and community. Most patient problems do not change based on where they lie. Services in many other countries, including the NHS, are now following the same approach outlined in the HSE transformation programme in 2006. Mr Harris is to be lauded for acknowledging this and deserves our full support. Unfortunately the decisions made by the previous government have resulted in a hiatus of six years in pursuing what he now identifies as the correct approach.
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Politicians regularly demand that there is accountability by clinicians and managers in health services for the affect on the public of the decisions they make. Dressing up the establishment of an integrated care delivery system as a new approach to Irish health service delivery can only be interpreted as an attempt by Government to avoid accountability for undermining the HSE, including many highly committed clinician leaders and managers across the country in pursuing this approach in the past.
Change, as we know, is difficult, and leaders of change in health services operate in a dangerous space professionally. What hope is there in obtaining the essential support of clinicians and managers for this much-needed change in health services delivery until there is an honest acknowledgement of the undermining of their previous efforts? By doing so, Minister for Health Simon Harris can help to establish confidence in his and the present Government’s commitment to support change leaders. – Yours, etc,
BRENDAN DRUMM, MD
(HSE chief executive
2005-2010),
University College Dublin,
Belfield, Dublin 4.