Ireland needs a new commissioning model

The main priorities for the new 10 year plan for health policy in Ireland should include a commissioning model, evidence-based decision-making, the use of eHealth systems, the protection of vulnerable people, expediting integrated care and the use of alternative care models that allow people to stay in their own homes, according to HIQA.

Phelim Quinn
Phelim Quinn

There was a reticence to actually recalibrate the current focus on acute hospital services to the provision of health and social care services in more appropriate ways such as through primary and community care, HIQA Chief Executive, Phelim Quinn told the Oireachtas Future of Healthcare Committee.

He said many of the major problems currently evident in our health and social care system could be addressed through the introduction of a strong commissioning model, at both local and national levels.  This would not only ensure that services were designed and delivered to meet the needs of individuals and communities, but also instil a culture of accountability in the health and social care system.

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There was a reticence to actually recalibrate the current focus on acute hospital services to the provision of health and social care services in more appropriate ways.

Implementing a national commissioning approach would involve a radical review of the current health and social care service funding model and allow for the discontinuation of the ineffective practice of legacy block funding.

Some commissioning decisions would result in the rationalisation of services and would require courageous choices.

He said a commissioning framework would allow for effective oversight of service provision and hold providers accountable for the delivery of safe, quality services.

“One important element of ensuring more seamless integration of care between primary and secondary services is geographical and service alignment. Aligning primary and secondary services will ensure that care is coordinated, managed and comprehensible for patients in terms of care pathways.

“There is a consensus that Ireland needs to move away from the current hospital-centric model of care and to introduce integrated care pathways across primary, community and secondary health and social care structures. HIQA believes this should be expedited.”

Mr. Quinn said that HIQA believed that now was the time to introduce safeguarding legislation to protect at-risk adults from abuse and neglect. While national safeguarding protocols were in place following recent high-profile revelations of abuse, these did not go far enough to ensure the safety and rights of vulnerable people.

The introduction of safeguarding legislation would provide for explicit powers of investigation and prosecution, define the roles for statutory agencies and give clear definitions of offences in respect of the abuse of vulnerable adults.

The HIQA Chief said they believed that measures needed to be taken to ensure that people being cared for at home were receiving safe and high-quality care.

“While HIQA advocates the extension of homecare packages, we are aware of the specific vulnerabilities of people in receipt of personal care and support services within their own homes. Therefore, we must extend statutory regulation to cover all domiciliary care services and other community-based social services in order to ensure that vulnerable people are safe and receiving the best possible support.”

He said society needed to explore alternative models for the delivery of social care services. Consideration must also be given to ways of supporting older people and people with disabilities to remain in, or as close as possible to, their own homes.

If universal healthcare was to be implemented effectively, agreement must be reached on what treatments and technologies should be included in the standardised basket of care to be provided to all patients. Expanding the use of HTA in the Irish healthcare system would ensure that this decision-making process was independent, rigorous, transparent and based on high-quality information.

He said HIQA recognised the role that eHealth could play in significantly reducing clinical errors, improving patient safety, creating efficiencies, and, if properly implemented, reaping economic benefits.