Poor quality care costs more

It was important that in looking at the health services, we should ground ourselves and recognise the central theme that although care costs, poor quality care costs more and patient safety was paramount in the health services, Mr. Tony O’Brien, Director General of the HSE told the Conference.

It was important that in looking at the health services, we should ground ourselves and recognise the central theme that although care costs, poor quality care costs more and patient safety was paramount in the health services, Mr. Tony O’Brien, Director General of the HSE told the Conference.

Mr. Tony O’Brien, Director General of the HSE
Mr. Tony O’Brien, Director General of the HSE

Speaking on “Reforming Leadership: Reforming the Health System,” he said it was equally important that we recognised that we were not alone in having to take action to control the spiralling cost of healthcare.

An international comparison of spending on healthcare between 1980 and 2008 showed that even before the disappearance of the good times, Ireland had a significant challenge on healthcare financing.

This year, the financial challenges included an overall budget reduction of €721 million, hospitals facing an incoming projected deficit of €271 million, while primary care schemes had a cost reduction challenge of €383 million.

On workforce, a gross reduction of almost 4,000 WTEs was required, following a reduction of over 12,000 or 11 per cent since September 2007.  Employment was at levels last seen in 2005.

The challenges were rising expectation and demand versus capacity, unaffordability with the spiralling cost of health care, the changes brought about by new health technologies, informatics and reform itself and the economic impact to budget and workforce of cost savings and cost extraction.

The critical questions were how could the health system accommodate an increase in demand with less financial and employment resources, while at the same time improving the quality of the health care services.

The critical questions were how could the health system accommodate an increase in demand with less financial and employment resources, while at the same time improving the quality of the health care services.

Mr. O’Brien said the continued implementation of the health reform programme was required to meet these challenges.  The overall vision was to create a single tier health system, supported by universal health insurance, where access was based on need, not income.

He cited successful systems reforms to date as the Cancer Control Programme, the National Clinical Care Programmes, the Special Delivery Unit and the National Treatment Purchase Fund.

Mr. O’Brien said there was a phased transition of the structural reforms.  Phase 1 involved the Health Service Executive (Governance) Act 2013, which provided for the new Directorate system, the establishment of a new leadership team and moving to the post HSE era. the Health Commissioning Agency in shadow form.

Hospital Groups were being established on an administrative basis as a transition to Independent Hospital Trusts, the ISAs were being reviewed to inform successor structures, executive management and governance, the Child and Family Support Agency was being established and Chairs, CEOs and management teams of the Groups were being recruited.

During this transition phase, the HSE retained responsibility and accountability and leadership was needed in the transition phase.

The key benefit of all this change was to bring about stronger governance and management structures, managed competition, more cost effective care and the removal of duplicated services. The aim was to achieve new models of care to ensure treatment was given by the appropriate professionals in the appropriate place and bring an end “the over centralisation of things which should never have been centralised.”

He said the new Directors had a crucial job of work.   Financial reform would provide real visibility on budgets, service reform would become a key catalyst for reform of the services and structural reform would oversee introduction of a purchaser provider split.

Transforming finance to deliver increased value at lower cost would contribute significantly to improved outcomes for patients.

The final report, which was due for consideration and decision in November, would look at the successor structure to the ISAs, integration between service providers at local level, alignment of boundaries between health services e.g. hospital groups and local government and management structures and governance arrangements.

The roll-out of hospital groups had commenced, overseen by the National Strategic Advisory Group and driven by the HSE. The key benefits of the hospital groups would be stronger governance and management structures, managed competition, which would result in more cost effective care and removal of duplicated services, the concentration of complex services at particular hospitals in order to ensure quality and efficiencies such as the avoidance of duplication in areas such as HR and finance.

They would lead to new models of care to ensure treatment was given by the appropriate professional in the appropriate place.

He said that the Haddington Road and Croke Park Agreements both highlighted the requirement to introduce individual performance management throughout the health services

Succession Management Strategy, would promote a sustainable approach to lead and manage people, aligned with the organisation’s goals and which allowed for local adjustment.  There was a Succession Management Programme for senior manager and the HSE had sponsored 40 people to do a Masters in Health Services Management 2013/2014.

“The HSE will do its bit to foster leadership and support people for the future health system.”