Healthcare reform built in partnership

The RCPI Leadership Forum explored how collaboration and medical leadership can strengthen the future of healthcare delivery.

In April, the RCPI held its annual Leadership Forum under the theme ‘The future of healthcare in Ireland – collaboration and leadership’.

The event brought together senior clinicians, system leaders, and policymakers to reflect on the leadership required to deliver meaningful, sustained progress, and change.

Population growth, an ageing population, clinical advances, global mobility of the healthcare workforce, and rising expectations contribute to a complex healthcare environment.

Advancing healthcare to meet these demands requires medical education, training, and practice that evolves at pace, informed by science, research, technology, innovation, and clinical leadership. 

The Leadership Forum, convened by RCPI President Dr Diarmuid O’Shea, set an ambitious agenda focused on standards of excellence in training, education, and delivery into the future.

Opening the meeting, Dr O’Shea emphasised the role of partnership in achieving meaningful progress across the health service.

“Partnership is the foundation on which a successful, thriving, and responsive healthcare system is built,” he said.

“We improve healthcare by listening, by working together, and by ensuring that those closest to patients are empowered to lead change.”

The Forum highlighted leadership voices from across the HSE, Department of Health, and RCPI’s faculties and institutes, inviting participants to share their own perspectives and insights from the frontlines of clinical practice.

Engagement

One of the speakers was the new HSE CEO Ms Anne O’Connor. She offered an important system perspective, drawing on her decades of experience in healthcare. Her contribution underscored the significance of the Leadership Forum as a platform to promote coherence across national ambition and operational delivery.

Ms O’Connor said change is driven by factors that are largely beyond the control of any single institution or profession. She cited public needs, scientific and technological advancements, and the global mobility of the healthcare workforce. Ms O’Connor also acknowledged the vital role of doctors in navigating these global challenges.

“What is distinct in Ireland is that we are still small enough and sufficiently connected with each other to make deliberate, coherent choices about how our system evolves nationally,” she said.

“Decisions made in one part of the system have repercussions everywhere. So the cost of not having an integrated system of healthcare is felt in individual hospitals, clinics, and communities. That is why engagement between the leadership of the health service and the people in this room really matters.

“Change that does not meaningfully engage clinicians fails. Reform must be built with clinicians, using their professional judgment, mobilising clinical insight, and sharing responsibility.”

The shift in underlying demand cannot only be addressed by will. As Ms O’Connor said: “A system that survives through effort alone eventually exhausts the people who sustain it.”

Prof Mary Horgan, Chief Medical Officer, Department of Health, reinforced this message, encouraging a more critical and innovative approach to healthcare design.

“It isn’t about doing the same thing all the time – it’s about doing things differently with the resources we have,” stated Prof Horgan. She highlighted the role of digital transformation, multidisciplinary collaboration, and community-based care in improving outcomes for patients.

Sustaining service excellence into the future was brought into sharp focus by a data-informed presentation from Prof Anto O’Regan, Medical Director, HSE National Doctors Training and Planning (NDTP), and RCPI President-Designate (see panel p12).

In his talk, Prof O’Regan positioned the medical workforce as a critical enabler of service improvement.

Prof Ed McKone, Dean of the RCPI Institute of Medicine, noted the increasing demand for consultants in general internal medicine. Prof McKone outlined the work that the RCPI is undertaking in general internal medicine training, following an extensive formal review. He highlighted training site consistency, programme size, exposure to specialties, and geographical equity. The work arising from the review will ensure that trainees are confident and ready to transition directly to higher specialist training, according to Prof McKone.

Dr Suzanne O’Sullivan, Chair of the RCPI Institute of Obstetricians and Gynaecologists, explored the vital role of patient partnership as healthcare training and practice evolves. She also reflected on the evolution of obstetrics and gynaecology, highlighting the need to address the current challenge of the consultant contract in relation to obstetrics and gynaecology and the growing complexity of service needs distinct to those specialties.

Ms Rachel Kenna, Chief Nursing Officer, Department of Health, reinforced the need for strong governance frameworks that enable collaboration across disciplines, with the patient firmly at the centre of care.

Reimagining care

A wide-ranging panel discussion, moderated by Prof Trevor Duffy, RCPI Director of Healthcare Leadership, emphasised that progress depends on sustained alignment across leadership, training, workforce planning, multidisciplinary teams, and compassionate patient-centred care.

Dr Colm Henry, HSE Chief Clinical Officer, joined the panel. He highlighted how the needs of the population are fast outpacing expectations and challenged participants to consider how care must evolve. The panellists highlighted the growing need for integrated approaches that focus on prevention and care in the community.

Prof McKone noted that healthcare systems often remain organised around clinics.

“We need to identify when patients need to be seen in clinics and when they need to be seen in the community,” Prof McKone said. He discussed how care can be distributed into the community when the structures support this and where it is best for the patient.

Prof O’Regan echoed this view, arguing that acute care models remain too heavily centred on hospital admission.

“Acute care in the community and urgent care centres should be developed and evolved,” he said.

Strengthening communication between primary and secondary care, while reinforcing the role of the generalist clinician and GP, are vital in creating a system focused on early intervention and prevention rather than hospitalisation.

Ms Kenna touched on the role of consultant-led virtual care and emphasised the importance of building broader multidisciplinary teams.

“Consultant-led care needs to build partnerships with advanced practitioners and health and social care professionals to have a workforce that is responsive,” she said.

As increasing numbers of patients are managed remotely, medical leadership must expand beyond traditional boundaries and support interprofessional training and collaboration.

For Prof Horgan, progress has already been achieved in relation to workforce redesign. She pointed to the expanding role of advanced nurse practitioners and pharmacists as examples.

“Pharmacists delivered half the flu vaccines to children, and we’ve never had so many people in Ireland vaccinated against the flu,” she noted, highlighting how existing skills can be better used to improve both access and outcomes.

Future

There was a clear appetite to embrace innovation in healthcare and balance this with a focus on ‘the human in medicine’. Technology-enabled services are as much part of healthcare delivery as the professionals who work within the system, but the advent of artificial intelligence in healthcare has brought fresh concerns about the risk of healthcare becoming transactional.

Prof Horgan stressed the continuing importance of listening to patients and understanding their concerns. “Hearing their stories and what their concerns are should be fundamental to being a doctor,” she said.

The future workforce was another key focus. Panellists discussed the need for more flexible training pathways, greater use of simulation, and stronger mentorship structures for trainees, balancing professional and family responsibilities. There was broad agreement that training must better reflect modern healthcare realities and prepare clinicians to work across settings, specialties, and professions.

Prof McKone highlighted advances in internal medicine training that are providing consistency across the training year and providing mentorship as a core tenet of training that will support doctors across their career trajectory.

Closing the session, RCPI CEO Ms Audrey Houlihan observed that despite the significant challenges facing the health service, there was clear optimism about the future.

“We face many challenges in our healthcare system,” she said. “But it is inspiring that everyone is committed to addressing those challenges for better patient care. The future of healthcare is bright in the hands of very capable clinician leaders.”

The Leadership Forum painted a picture of healthcare that is more connected, more community-based and more collaborative, while remaining firmly grounded in the humanity that lies at the heart of medicine.

This article was produced by the RCPI.