Sláintecare resigns leave HSE to drive healthcare reform


At the heart of the resignations of Laura Magahy and Professor Tom Keane – the two most senior people responsible for Sláintecare – is that they were supposed to be responsible for the implementation and advice on Sláintecare, but without real authority. to deliver it.

The 2017 Oireachtas Committee Report on the Future of Sláintecare Healthcare presented a 10-year healthcare reform plan, unique in that it was crafted through political consensus among parties. The objective of universal access to timely, quality and integrated care is at the heart of its concerns. Implementing a major health system transformation such as Sláintecare requires strong political leadership and a strong health system, sufficient resources (both human and financial) and sustained and sustained implementation at all levels. .

Dr Sara Burke is Assistant Professor at the Center for Health Policy and Management, Trinity College Dublin. His research team provided technical support to the Oireachtas committee on the future of healthcare that designed Sláintecare

The government was slow to adopt Sláintecare, taking 15 months to make it government policy. And when that was done, it was done on their own terms with a watered down implementation strategy and the creation of the Sláintecare implementation office at the Ministry of Health, not the Taoiseach ministry as planned in l ‘origin. Sláintecare survived last year’s change of government, featured in the government’s 2020 program. Yet the resources to fully implement Sláintecare were notoriously lacking in its first three years of implementation.

Carrying out large-scale reform like this is like changing the direction of a huge aircraft carrier. At the start of 2020, Irish healthcare policy was headed in the right direction, with many of the essential foundations for the implementation of the Sláintecare reform being put in place by the Magahy team. The core element of universal access is to provide much more care in the community, with seamless care pathways and to make access to the public hospital system a level playing field, gradually phasing out private care in the community. public hospitals. It’s about making sure patients get the care they need, when they need it, at no cost as a barrier.

Waiting lists for access to essential diagnosis and treatment in the community and in hospitals are the most problematic feature of the Irish public health system

Sláintecare’s progress has been hampered by the arrival of Covid-19 as all services except essentials have been closed, waiting lists in communities and hospitals have grown and many staff have been redeployed towards the pandemic . What also emerged was that many of the Covid-19 health system responses were inherent in Sláintecare – significant investment in e-health, new avenues of care, a strong push for more care outside the hospital, clear and strong public health messages, investment in more staff and services, with universal access to all Covid-19 tests, diagnostics and treatment, free at the point of delivery.

Implementation strategy

This year’s budget saw the largest investment ever in health, much of which is spent on managing the pandemic, as well as the largest Sláintecare allocation since its inception. In May of this year, the government approved the Sláintecare 2021-2023 Implementation Strategy and Action Plan, which chart the specific progress needed for system-wide change.

In his resignation letter in early September, Magahy spoke of his frustration with “slow progress” in three key areas – regional structures, e-health and waiting lists.

In the Sláintecare 2017 report, the rationale for the regions is clearly stated. Recognizing the disruption caused by the reorganization of the system, he recommends that “structural change be as simple as possible”. The objective of the regions is to facilitate the allocation of health resources according to the health needs of the population and to enable integrated care delivery, with clear management, clinical governance and accountability.

The Health Service Executive cyberattack is both a cause and a consequence of the slow transition to eHealth. Despite detailed plans in place, adequate financial and human resources still need to be allocated to the application of e-health, which is one of the most important mechanisms to enable major change in the health system.

Waiting lists for access to essential diagnosis and treatment in the community and in hospitals are the most problematic feature of the Irish public health system. Without eliminating our extraordinarily long wait times for care, universal access remains elusive. The fight against waiting lists requires a sustained and systemic multi-year budgetary approach. Plans to address the waiting lists have still not been released and no one is taking responsibility for tackling this specific problem.

HSE reorganization

The HSE has, against all expectations, proven itself in its response to Covid-19. Over the past few months, the HSE has quietly reorganized its own top level, indicating a reluctance to abandon its centralized command and control structure and an inability to carry out the long term which is a major change in the healthcare system.

If the government really supports Sláintecare, it must support it 100%

Magahy and Keane would not have resigned if they had had the political and institutional support to make Sláintecare. Most of the progress made to date can be attributed to their leadership. Yet there is no urgency about their resignations from our political bosses or the health system. The biggest risk now is that we are doing what we have always done in health – continuing with incremental, risk-negative changes. Leaving the responsibility for the implementation of Sláintecare to the Ministry of Health and the HSE will most likely result in a selection of the parts of the reform that are suitable or are easier to do, but critically ignoring the drastic and radical change in l whole system needed to provide a universal health system. Such inaction may well work for some people across the health care system who benefit from maintaining the status quo.

The 1989 Health Financing Commission observed that “the simple question ‘who is in charge’ of Irish health care cannot be answered”. Thirty-three years later, it’s more relevant than ever. If the government truly supports Sláintecare, it must support it 100%, clarify who is responsible for the conduct of Sláintecare, specify clear lines of clinical and managerial accountability and governance for the implementation of plans for the regions, e-health and waiting lists. .

Failure to do so means Ireland remains a European outlier without universal access to care based solely on medical need. Ultimately, the Irish would pay the price for Sláintecare’s demise. We certainly deserve better.

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