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13th national Health Summit, Croke Park, Dublin

Health promotion funding is the ‘hardest thing’ to achieve, reveals HSE Director General

Maintained or increased funding for health promotion is the “hardest thing” to achieve in discussions with Government departments, the HSE Director General has revealed.

Mr Tony O’Brien told the 13th National Health Summit in Croke Park, Dublin, earlier this month that making the case for health promotion spending is the biggest challenge during the annual Estimates process.

“The hardest, hardest thing for us in our discussions with the Government departments we deal with is to even retain or increase the proportion of spend for health and wellbeing or health promotion, whatever terminology we care to use,” said Mr O’Brien.

“We know the value of this because the figures show, for example, the impact we have had on smoking.”

Initiatives such as the QUIT campaign featuring the late Gerry Collins had made a big impact, with many thousands giving up smoking, he said.

“We have seen the obesity figures. We are effectively in opposition to a huge pro-sugar marketing machine and unless we up our game, we will not win that battle. Yet every year the hardest thing for the health system to win is resources for health promotion.”

Also speaking at the Summit, Deputy Róisín Shortall, Chairperson of the Oireachtas Committee on the Future of Healthcare, said there was a high level of agreement among Committee members over the importance of health promotion.

“I think ultimately, we will have to move towards a situation where there is a dedicated budget in relation to health promotion,” said Deputy Shortall.

Dr Orlaith O’Reilly from the HSE’s Health and Wellbeing Team told the Summit that she was “delighted that the Committee is taking this as a priority”.

She added: “But can we ensure that realistic funding streams actually go to prevention, because it is always going to be last in the queue. When push comes to shove, it is the first thing that falls off the agenda.”

Dublin Midlands CEO foresees ‘accountable autonomy’ model

A “clear strategy” for the future of the Dublin Midlands Hospital Group should be completed by the end of next month, the Group’s CEO told the 13th National Health Summit in Croke Park, Dublin, earlier this month.

Dr Susan O’Reilly said that much progress had been made in the Group over the last two years but admitted “we haven’t got there yet”.

“We are still in a somewhat dysfunctional overall governance system, which is evolving,” she commented.

Dr O’Reilly speculated that the final form of governance that the Group will adopt would be akin to the traditional voluntary sector governance structure.

“This is a new governing structure and I think it should in the longer run represent the best elements of what we call the ‘voluntary’ hospitals, a type of accountable autonomy,” she told the Summit.

The range of different governing structures in Ireland made change more difficult, she said.

“We have a variety of governing structures in Ireland. Private hospital system, voluntary, statutory — it is a ‘dog’s breakfast’ for governance,” said Dr O’Reilly.

“You would never design a healthcare system starting from where we are today. How you get out of that situation is a long-term challenge and I don’t think we are there yet.”

Dr O’Reilly said it is important that legislation is passed to allow the Hospital Group boards to be fully established.

In December, a spokesperson for the Department of Health confirmed to the Medical Independent (MI) that legislation on Hospital Groups had been delayed awaiting the final report of the Oireachtas Committee on the Future of Healthcare.

“An Oireachtas All-Party Committee has been established to develop a single, long-term vision for healthcare over a 10-year period.  As previously stated by Minister [Simon] Harris, it is important that those discussions are progressed before further consideration is given to the issue of establishing Hospital Groups on a legislative basis or any other significant structural reforms to the health service,” the spokesperson told MI.

“Until the legislation is advanced, Hospital Groups will continue to operate within the existing policy and accountability frameworks of the Department of Health and the HSE.”

The Committee is due to deliver its final report in April.

O’Brien ‘not surprised’ by RTÉ Investigates programme

Health sector workers would not have been especially surprised by some of the revelations from the recent RTÉ Investigates programme on waiting lists, the head of the HSE has said.

Mr Tony O’Brien told the 13th National Health Summit in Croke Park on 7 February that people working in healthcare are acutely aware of the issues of long waiting and associated patient suffering. 

“First of all, those of us who work in healthcare are much less surprised by what we saw in that programme than perhaps other people who watched it,” said Mr O’Brien.

“We are very acutely aware of the numbers of people waiting for care, the length of time they are waiting and the very significant impact it has on their lives.

“This is one of the reasons why we have been focused on bringing down the longest waiting times across the board.  Recognising what is often referred to as ‘elective care’ or ‘scheduled care’ belies the fact that people are enduring and suffering pain and sometimes the worsening of their symptoms the longer they wait.”

The RTÉ Investigates programme, Living on the List, aired on Monday 6 February. Minister for Health Simon Harris described himself as “ashamed and heartbroken” after watching the programme. He was due to speak at the Health Summit, which took place the day after the broadcast, but cancelled at short notice, citing Dáil business associated with the RTÉ programme.

Speaking at the Summit, Mr O’Brien praised the work of the programme, which he said “has shone a light on something that society needs to be fully aware of and needs to empower the health system to address in a more effective way.

“There are two things. First of all, obviously we need to ensure the resources that are there are always used effectively. But also, we do have a fundamental issue that our healthcare system is not of the right size and shape to meet needs and the Minister himself acknowledged yesterday that there is a capacity issue.

 “We have a range of solutions available, but we need to match the resources to those solutions.”

Ireland needs to enhance its number of advanced nurses, especially in primary care — OECD expert

The low number of Advanced Nurse Practitioners (ANP) is a problem for the Irish health service, particularly primary care, a leading OECD health economist said in Dublin recently.

Mr Gaetan Lafortune, Senior Economist in the OECD Health Division, told the 13th National Health Summit in Croke Park, Dublin, that increasing ANP numbers should be a key aim.

“Another issue in Ireland, particularly if you want to strengthen primary care, is advanced practice nurses,” said Mr Lafortune.

“In terms of [advanced] nurse practitioners, it all started in the US and my own country Canada in the 1960s. It was only later that it really kicked-in in a few other countries.

“But for some reason this role doesn’t seem to be picking up in Ireland,” he said, noting that “very few nurses” are becoming ANPs.

 Last month, the Medical Independent (MI) revealed that a policy paper on advanced nurse/midwife practice was being developed at the Department of Health, which aims to significantly increase numbers.

According to recent figures, there are 207 active ANPs and six active Advanced Midwife Practitioners (AMPs) registered with the Nursing and Midwifery Board of Ireland (NMBI). Approximately 35,000 whole-time equivalent nurses and midwives are employed in the public health service alone.

Overall, 36 new ANPs were registered last year, the same figure as in 2015 and up from 21 new registrations in 2014, according to details released by the NMBI to MI.

Following his presentation, Mr Lafortune was also asked about the amount of administration costs in health systems. He said that, looking to the evidence, single-payer systems tended to have less administrative costs.

“The general pattern is that countries that have single-payer systems, an NHS type of system, spend much less in terms of administration than countries that have multi-payer and multi-health insurers. That is the general pattern,” he said, “with the US obviously being the worst in terms of the share of health money allocated to administration.”

Amendments to paramedic education urged at Summit

The need for significant changes in the education system for paramedics was raised at the recent 13th National Health Summit in Croke Park.

“The ambulance service in this country transports roughly 350,000 patients to hospital every year. Why? Because they ring 999,” Mr Brian Power from the Pre-Hospital Emergency Care Council (PHECC) told the Summit.

“That can range from a cut finger to a cardiac arrest. But there is no way at this point in time that paramedics are able to leave people at home or bring them to the GP.

“We need to look at this. In other jurisdictions they have developed community paramedics and developed other streams of paramedics. But unfortunately, at this point in time there is a shortage of paramedics in this country.

“But we need to move now to tertiary education for paramedics. We need to develop paramedicine in higher education.”

If these changes were not made to the education structure for paramedics, problems with hospital capacity would continue, he outlined.

“We need to stop bringing everybody to hospital just because they ring 999,” said Mr Power.

“Why do they ring 999? Because they have a perceived emergency. Our advanced paramedics are treating [some] patients with 40-odd medications, so surely they have some clinical knowledge where they are able to make decisions about where patients could go.”

The PHECC has made a submission to the Oireachtas Committee on the Future of Healthcare, which highlighted international trends in respect of critical care paramedics.

“In countries such as Australia, New Zealand, South Africa and Canada, specialist paramedics operate with the goal of initiating and maintaining tertiary-level emergency and ICU level of care for patients with the greatest clinical need,” read the submission.

“These paramedics can also facilitate the patients’ transport by air, land and sea to the most appropriate medical facility.”

Saolta Clinical Director warns of the need for new hospital in Galway

Plans need to be developed for a new replacement hospital in Galway, the Group Clinical Director of Saolta University Health Care Group has warned.

Dr Pat Nash, who was speaking at the 13th National Health Summit in Croke Park earlier this month, added that the emergency department (ED) at University Hospital Galway (UHG) is experiencing serious difficulties and is “overwhelmed”.

 “Our emergency department is overwhelmed; it is one of the busiest in the country and probably one of the smallest in the country,” Dr Nash told the Summit.

“It is overwhelmed. That is key for planning; we need to be planning for change. You need to be looking at the impact on other hospitals.

“We live and work in a reactive environment. We need a new ED, we need a new build, we need a new hospital in Galway to be able to plan for the future because the current hospital isn’t going to be fit-for-purpose over the next 30 or 40 years.”

Problems at the hospital have been highlighted in recent years.  In December 2015, speaking in the Dáil, Taoiseach Enda Kenny described the ED at UHG as “not fit-for-purpose”.

Separately, Dr Nash told the Summit that he “would be open” to the concept of GPs working out of smaller hospitals within the Saolta group.

Dr Nash was asked at the Summit whether GPs could be facilitated to use hospital facilities to treat cases such as pneumonia and dehydration to help prevent the capacity bottleneck at bigger hospitals in the west of Ireland.

“Yes, I suppose so, but I don’t want to talk for GPs because I don’t represent them,” said Dr Nash in response. 

“[I don’t know] whether there is a willingness to do that now and if they want access to the hospital.

“Do GPs want access to the hospital? I suppose some do. I would be quite open to that model.”

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