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National Health Summit 2018

Sláintecare Executive Director must have ‘autonomy’, National Health Summit hears 

It is vital that the new Executive Director of the Sláintecare Programme Office has “autonomy” to be effective, the recent 14th National Health Summit in Croke Park heard. 

Minister for Health Simon Harris told the Summit that the new Executive Director should be appointed by April. 

Also speaking at the conference, CEO of the University of Limerick Hospitals Group Ms Colette Cowan said the new Executive Director should have a role similar to the one previously played at the National Cancer Control Programme (NCCP) by Prof Tom Keane, who oversaw major reform and reconfiguration of the HSE’s cancer services. This comparison was made by a number of speakers at the Summit. 

“I think it is important for the new Executive Director, whoever he or she is, and I am hoping it will be something like the cancer programme and it will work,” said Ms Cowan. 

“I think what we have to acknowledge first is to welcome the document [Sláintecare Report]. It is a foundation stone to start somewhere on the development of integration and care.” 

Mr Paul Gordan, Policy and Affairs Manager at the Irish Cancer Society, said the Sláintecare Programme Office “needs someone who has the level of autonomy that [Prof] Tom Keane did. The NCCP was very unique. It was almost another agency outside the HSE. 

“It is important that they are granted that autonomy by the Department and the Minister. But we are in a different situation. That was a majority Fianna Fáil government supported by Greens and Independents. We are in a very different political situation now. The Minister does not really have as much leeway to provide political cover if there is an unpopular decision in one of his colleagues’ constituencies. 

“There is a need for the head of Government to really lead on this. That is not something we have seen much of yet. Basically, I think Taoiseach [Leo] Varadkar has not really made up his mind, or he is not quite convinced that the public will is there to pay for it… I think the next election may define where Sláintecare goes.” 

Speaking on the morning of the Summit, Minister Harris reaffirmed his personal commitment to the Sláintecare Report. He added that his official draft response to the report is currently circulating among other Departments. 

“I have tasked my Department, in collaboration with the HSE, to develop a draft implementation plan that will set out our ambitions for the next decade. This plan will provide clear and concrete actions in the immediate years ahead,” said Minister Harris. 

“There is an awful lot in Sláintecare, it is a really good document in my point of view; it is a 10-year document. So I think we need to identify clear actions we are going to take. 

“I intend to bring proposals to Government shortly in relation to that implementation plan and I have now shared a draft plan with colleagues in the Department of the Taoiseach and colleagues in the Department of Public Expenditure.” 

Minister Harris said he expected the report into the impact of the removal of private practice from public hospital settings (which is recommended in Sláintecare) will be completed “towards the end of this year”. 

Last week, the IHCA said that the removal of private practice income from public hospitals would have a devastating effect on hospital operating budgets, crippling their ability to treat an ever-increasing number of patients. It also claimed the cost of implementing Sláintecare’s proposals had been understated and will actually cost the taxpayer €20 billion if implemented over 10 years, compared with the €2.8 billion stated in the report. 

Review of Hospital Groups and Community Health Organisations on way — Minister Harris 

The Department of Health is launching a “consultation process” to look at how to align the HSE’s Hospital Groups and Community Health Organisations, the Minister for Health Simon Harris told the 2018 National Health Summit in Croke Park, Dublin. 

In his speech on the morning of the Summit, which took place on 8 February, Minister Harris said he believed that the current health system is too bureaucratic. 

“I understand there is no ‘magic wand’ that creates perfect structures. No structure will fix all the challenges faced by any health service. But what I do know is that the wrong structures will impede the delivery of reform,” he said. 

“I think the Irish health service has become far too bureaucratic for a country our size. I think there are far too many layers and far too many structures that often don’t complement each other, and often get in the way of each other. 

“I welcome the conclusions in the Sláintecare Report that there is now a need for a much bigger alignment between Hospitals Groups and our Community Health Organisations. Our current structures need to evolve, to ensure a better balance between central decision-making and local flexibility. 

“I think that perhaps the pendulum swung too far with the establishment of the HSE and we now need to rebalance that to get that balance right.” 

He confirmed the Department will now undertake a consultation process on how to align Hospitals Groups and Community Health Organisations. 

“We have planned our first phase of stakeholder engagements for this month and we will launch a broader public consultation next month.” 

Also speaking at the Summit, Ms Colette Cowan, CEO of the University of Limerick Hospitals Group, said that there is “some integration in place in clinical care programmes over the years and other examples in primary care. But its not embodied in Groups [currently] working very closely.” 

Importance of advances in artificial intelligence and robotics for healthcare raised at Summit 

Artificial intelligence (AI) and robotics will play an increasing role in the provision of healthcare in Ireland, Dr Conor McGinn, Assistant Professor in the School of Engineering in Trinity College Dublin, told the 2018 National Health Summit in Croke Park. 

Dr McGinn brought the prototype ‘Stevie the Robot’ to the Summit and he demonstrated some of the applications of Stevie to delegates. It is envisioned that the robot will eventually provide support in care home and community settings. 

The Robotics and Innovation Lab at Trinity has integrated previous research in the areas of human-robot interaction, AI and robot design to develop Stevie. The robot has been designed to be highly social and it can communicate through a variety of modalities, such as speech, gesture and facial expression. Stevie has a range of sensors, including a 360-degree camera, RGB depth sensor, microphone and laser scanner. 

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Minister for Health Simon Harris and ‘Stevie the Robot’ at the recent National Health Summit                                                          Photo: Maura Hickey, Sunday Business Post

Also speaking at the conference, Minister for Health Simon Harris predicted that innovation and eHealth would become more important in the healthcare system, in the coming decades. 

“To improve the practical accessibility of our system, we must also invest in eHealth and a new data strategy to support health workers in co-ordinating patient care and to bring patient records and data closer to the patient,” said Minister Harris. 

“This will include the roll-out of electronic health records and ePrescribing. Ireland has not yet fully realised the potential that eHealth and technology can deliver in transforming care. 

“Digital technology must be at the heart of delivering new models of care. 

“We must ensure that the type of technology enablement that is seen in other sectors, such as mobile banking, retail, and communications, is appropriately deployed to benefit our health services.” 

‘Honest conversation’ is needed around taxes and healthcare 

Taxes will have to increase if the Sláintecare reform package is to be implemented in full, a leading economist told the recent National Health Summit in Croke Park. 

In his address to the Summit, Dr Brian Turner from the Department of Economics, Cork University Business School, University College Cork (UCC) said an “honest conversation” needs to take place around the plan and taxes. 

“If Sláintecare proposals are implemented in full, we will have a better health system — no question about it,” Dr Turner told delegates at the conference. “Funding and reform will have to go hand-in-hand. It will be more equitable.” 

But the Cork-based economist added: “We are going to require a lot of extra funding. 

“I think it is safe to say it will come from taxation rather than a redesign of our system of health insurance. There is going to be a need for more taxation. 

“That raises a couple of questions, such as ring-fenced taxation versus general taxation.” 

Dr Turner noted that another recession in the future is inevitable. “We need to ensure that our healthcare resources are protected in the face of that. 

“So in that way, we need an honest discussion about healthcare. This is going to be about us paying more taxes. So the idea that we are going to spend all of this extra money on our healthcare system and no (increase) in taxes at the same time — it’s just not going to happen. Simple. It is a ‘square peg, round hole’ scenario.” 

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Dr Brian Turner, UCC                                  Photo: Maura Hickey, Sunday Business Post

He said that the current figures for capital expenditure outlined in the Sláintecare Report “could be a little conservative” for the amount of public hospital beds outlined as needed by the recently-published health service capacity review. 

Also speaking at the Summit, Dr Maev-Ann Wren from the Economic and Social Research Institute (ESRI) told delegates that the demand for healthcare services in the coming years will continue to increase. 

“In Ireland, we tend to import what appears to be wisdom from other countries, but where the underlying reality is very different. That’s why I think it is so important that we have a foundation of Irish-based data and research on which to base our health policy,” Dr Wren said. 

Highlighting the most recent population statistics, Dr Wren noted that there will be significant increases in the number of people aged 65 and older, and particularly 80 years and older, by 2030. This will lead to an increasing need for health resources across the board, particularly in home care, she noted. 

In his own speech, Minister for Health Simon Harris said that Dr Wren and the ESRI painted a “very stark picture of the projected increases in demand for healthcare over the next decade as a result of our changing demography and other factors”. 

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