Proposed restructuring of health services does not go far enough – Irish Hospital Consultants Association

The Irish Hospital Consultants Association (IHCA) has voiced concerns that the proposed restructuring of healthcare services does not go far enough.

The proposals published earlier today seek greater alignment between community and hospital healthcare services, based on common geographic areas but not a full integration of these services.

President of the IHCA, Dr. Donal O’Hanlon commented: “For this realignment to work effectively all hospital and community health services should be merged, and not just aligned, into one organisation within specific geographic areas.

This would create a real opportunity to put in place an efficient management structure at a significantly reduced cost. If structures are not merged the service will continue to be poorly integrated and burdened with additional layers of redundant bureaucracy, which will divert resources from frontline patient care services”.

With the proposed reforms limited to just a geographic alignment of existing hospital groups and community health organisations areas (CHOs), rather than a genuine integration of these services, there is a risk that an opportunity for real and meaningful reform will be lost.

If structures are not merged the service will continue to be poorly integrated and burdened with additional layers of redundant bureaucracy. This will lead to scare resources being diverted away from frontline patient care services.

This existing lack of integration between hospital and community services is already evident across the provision of care to patients. The issue of large numbers of patients who have been clinically discharged from hospitals and are ready to leave hospital but cannot do so due to the lack of homecare or nursing home supports is just one example of this lack of integration.

In the case of delivering promised increased bed allocations across our health services, the IHCA believe that  merged regional health groups are also critical  to implement the addition of a minimum of 2,600 acute hospital beds and 4,500 additional step down residential beds, as outlined by Government in the National Development Plan 2018-2027.

Today’s proposal risks the creation of a further layer of administrative and bureaucracy. The cost and efficiency implications of this are also a worry for the IHCA. Instead, the integration of both services would have the effect of ensuring that this scenario is avoided, and monies diverted to frontline services.

According to Dr. O’Hanlon: “Merging the administration and governance of community and hospital services would remove duplication of bureaucracy, and establish functioning independent boards that promote effective, accessible and accountable governance, providing better co-ordination and delivery of services.

The merger of structures should also replace the current institution based budgetary focus with one that is centred on patient care and outcomes”.

On the new boards and governance for such new integrated organisations, Dr. O’Hanlon also noted that:

Hospital Groups and Community Health Organisations should be fully merged and have fully functioning boards that prioritise the delivery of safe, high-quality, timely care to patients.

Membership of these boards should be drawn from a diversity of backgrounds and sectors and include non-executive directors and executive directors, including hospital consultants.

The boards should include patient representatives as co-participants in resource allocation, decision making and formulation of strategy”.

Fair resource allocation is also an important issue which must be addressed and should be linked to population served.  Currently there are significant regional disparities between the Hospital Groups and CHOs across the regions, including the number of hospital beds, operating theatres, step down and rehabilitation beds, access to acute mental health services, and indeed whole-time equivalent clinicians.

Dr. O’Hanlon concluded: “While we welcome all efforts to make our health services work better for patients.

Today’s proposals need to go further and take a more ambitious view.

We must ensure that our health services work together holistically.

This approach must be hard-wired from the start with structures which ensure that patients can access and move between health care services across their lifetime and with ease as and when they need them. Today’s proposals, as currently outlined, do not guarantee that this will be the case”.

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