Delivering better outcomes and savings

The system of funding the Irish health services needs a seismic overhaul, Mr. Brian Fitzgerald, CEO, St. James’s Hospital, Dublin, told the 9th National Health Summit in Dublin.

The system of funding the Irish health services needs a seismic overhaul, Mr. Brian Fitzgerald, CEO, St. James’s Hospital, Dublin, said. The health services would have significant problems until we had transparency in the allocation and use of resources.

Speaking on a panel discussion on “The Opportunities & Challenges to Delivering Better Outcomes & Cost Savings,” he said “Our cost system in this country is too rigid, with too much emphasis on a fixed cost base.  We need significant engineering of financial management across the country. We are very outdated in the structures, processes and procedures we bring to managing our finances in the health services.”

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Mr. Fitzgerald, who was previously Director of Finance at St. James’s said that you could not manage financial issues if you were changing strategy or if you had strategies which cut across or overlapped. We have tried to implement many strategies in recent times.

“We need better cost allocation models if we want to have a true partnership between clinicians and those who have been traditionally responsible for resources.”

Mr. Fitzgerald responded to a question on the feasibility of implementing Universal Health Insurance in the time frame and the economic situation.   “UHI is an enormous multi faceted project. We should definitely implement a new resource model and then look to the implementation of full UHI model if possible.

“While we build a resource model we should not be building a data model purely for funding. It needs to be built for quality and clinical audit at the same time. For example there may be a model being developed by HIQA for quality and a separate data model for funding. I would accelerate that programme but in the context of one data model for both.

The Irish health system requires significant investment in ICT to underpin quality and efficient patient services “For example, we should have had e-prescribing in this country a decade ago.  We also need to harness international collaboration.”

Dr. Una Geary, National Clinical Lead, HSE Emergency Medicine Programme, said her message was one of hope. “We have grounds in Ireland for cautious optimism.  We have been putting together building blocks for improving quality of service and while we have a long road ahead, we are making significant progress.

She said the HSE Clinical Programmes were making significant progress and the National Office for Clinical Audit was another important recent development, while great strides had been made in developing the role of clinical directors.

She said we needed investment in IT systems to get better feedback and true systems intelligence. “We need better cost allocation models if we want to have a true partnership between clinicians and those who have been traditionally responsible for resources.  Sometimes, the conversation is too much about the cost of staffing rather than the value being delivered.

“I am impressed by the work being done in the UK including introducing financial management at undergraduate level. We have a lot of work to do on patient partnership, discussing treatment outcomes with patients and encouraging them to give us feedback.”

Ms. Laura McGarrigle, Principal Officer, Department of Health, who now leads the UHI unit there, said the UHI design was a multifaceted complex piece of work. It was not just a case of transplanting the Dutch model.

She said that the money following the patient policy would provide both opportunities and challenges.

“It can bring very significant opportunities.  Firstly, it can bring transparency and much greater fairness, enabling meaningful dialogue between finance managers and clinicians. It also provides an opportunity to drive efficiency. Its true potential and value lies in delivering a value based model. We want a model that supports the excellent work of the clinical programmes and the Special Delivery Unit.  The challenge is to design a funding model that supports the delivery model.”

Mr. David Ferguson, Principal Consultant, SAS Ireland examined the opportunities now available turn data into knowledge. He said that, for example, the UK now had an automated process to identify what might trigger falls.