03/10/2018

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Sláintecare – ‘A Pathway to Better Care’

Dr Sara Burke, Dr Sarah Barry, Dr Bridget Johnston, Maebh Ní Fhallúin, Rikke Siersbaek, Prof Steve ThomasNational Acute Medicine Annual Conference, RCPI, Dublin 18 September 2018

Trinity College Dublin, The University of Dublin

SláinteCare – ‘A Pathway to Better Care’Overview of presentation

o Mapping the Pathways to Universal Healthcare

o Why Sláintecare

o The Sláintecare process

o What is in Sláintecare?

o What if Sláintecare?

o Where are we now?

o Some concluding thoughts…

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Trinity College Dublin, The University of Dublin

Mapping the Pathway to Universal Health Care in Ireland

To provide an excellent evidence base that will inform

strategic direction and implementation of universal

healthcare in Ireland

1. Assessing the gap between current Irish health

system performance and universal healthcare

2. Evaluating the strengths and weaknesses of

different models of universal healthcare and

assessing their feasibility of implementation

3. Assessing the organisational challenges of moving

to universal healthcare by reviewing the

experience of other countries & exploring the

current capacity & constraints facing decision

makers throughout the system

Health Research Award from Irish Health Research Board

(2014-2018)

Centre for Health Policy and Management, Trinity College Dublin

WHO Barcelona Office for Health Systems Strengthening,

European Observatory for Health Policy and Systems

https://www.tcd.ie/medicine/health_policy_management/research

/current/health_systems_research/news/

Six months work Oireachtas Committee on the Future of

Healthcare

Trinity College Dublin, The University of Dublin

Why Sláintecare

• Persistent problems: EDs, long waiting times, access & quality

• Lots of ‘reform’, with little real impact

• Changes in government & minister resulting in different & sometimes conflicting plans/reforms

• No universal healthcare, no legal entitlement to health and social care

• Extremely complex system of ‘eligibility’, which does not guarantee access

• Largely tax funded

• Out of pocket spending prevents access

• High private health insurance (45%)

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Trinity College Dublin, The University of Dublin

Why Sláintecare

– 2011 Programme for Government commitment to Universal Health Insurance, finally abandoned in 2015

– General election March 2016

– New minister, May 2016 – Simon Harris

– New Programme for Government

– request an Oireachtas All-Party committee to develop a single long term vision plan for healthcare over a 10 year period… Key to the long-term sustainability of our health service and Universal Healthcare…is the development of a new funding model for the health service

– Terms of Reference of the Oireachtas Committee on the Future of Healthcare

Trinity College Dublin, The University of Dublin

The Sláintecare processThe Terms of Reference

– The severe pressures on the Irish health service, the unacceptable waiting times that arise for public patients, and the poor outcomes relative to cost

– The need for consensus at political level on the health service funding model based on population health needs

– The need to establish a universal single tier service where patients are treated on the basis of health need rather than on ability to pay

– That to maintain health and wellbeing and build a better health service, we need to examine some of the operating assumptions on which health policy and health services are based

– That the best health outcomes and value for money can be achieved by re-orientating the model of care towards primary and community care where the majority of people’s health needs can be met locally and

– The Oireachtas intention to develop and adopt a 10 year plan for our health services, based on political consensus, that can deliver these changes

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Trinity College Dublin, The University of Dublin

The Sláintecare process

Trinity College Dublin, The University of Dublin

Entitlements Integrated Care

Funding Implementation

Political D

esign

Technical Designvision

goals/outcomes

What’s in Sláintecare: whole of system/process approach

Population health

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Trinity College Dublin, The University of Dublin

What’s in Sláintecare

1. Entitlement

‒ Legislate for an entitlement for all residents to health and social care & wait times guarantee

‒ Eliminate or reduce charges (low or no cost)

2. Integrated care

‒ At lowest level of complexity, in primary & community care (access to diagnostics), empowered patient, strong public health, eHealth, expanded integrated workforce

3. Funding

‒ A national ring-fenced health fund & transition fund

‒ Funded through Regional Integrated Care Structures

‒ Ending private care in public hospitals

4. Implementation

‒ Office to drive reform

‒ Better governance, accountability & leadership

A ten year plan for health reform devised through political consensus

Trinity College Dublin, The University of Dublin

What if Sláintecare 1. Culture Change

Status quo no longer an option

Entitlements and not eligibility

• Universal

• No or low cost care

• Waiting time guarantees

Legislation

Accountability

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Trinity College Dublin, The University of Dublin

What if Sláintecare 2. Changed Financing

Share of Funding from different sources

Trinity College Dublin, The University of Dublin

Changed Financing – an International Comparison

International Comparisons

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Government schemes Compulsory health insurance Out-of-pocket Voluntary health insurance Other

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Trinity College Dublin, The University of Dublin

What if Sláintecare 3. Changed Human Resources

GPs12%

Consultants9%

Nurses30%

OTs, Physios and Social workers

20%

Healthcare assistants

29%

• Expansion – 6,600 staff

• Most in primary and community care

• Investment in Additional Training - €665m over six years

Trinity College Dublin, The University of Dublin

Human resource – Austerity and recovery

HSE 2017

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Trinity College Dublin, The University of Dublin

What if Sláintecare 4. Changed Resource Allocation for Integrated Care

1. Expanding Activity based Funding to cover all elements of acute care

2. Establish population based resource allocation formula for primary and community care

3. Coterminous - Hospital Groups and Community Health Organisations

4. Pooled Funding

5. Local System governance for using pooled funding to resource integrated care based on health need

Local Health System Geographies with integrated funding and delivery of Hospital, Primary AND Community Care

Trinity College Dublin, The University of Dublin

What if Sláintecare 5. Changed Information & Communication

For Integrated Care, for patients, for healthcare staff

• Massive Investment in eHealth (€875m)

• Unique Patient Identifier

• New comprehensive data systems across the health system

• Better waiting time data better communicated

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Trinity College Dublin, The University of Dublin

And so we would have a different system…

New pathways to care

New workforce, new financing

New resourced allocation models

New ways of working and collaboration

New IT systems

With different needs…

Trinity College Dublin, The University of Dublin

Where are we now?

– July 2018: announcement of Laura Magahy as Executive Director of Sláintecare Programme Office and Tom Keane as Chair of Sláintecare Advisory Council

– August 2018: publication of Sláintecare Implementation Strategy

– No news of transition fund or Sláintecare funding

– Awaiting…o De Buitleir report

o Report on CHOs & Hospital Groups

o New HSE Board

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Trinity College Dublin, The University of Dublin

Yet, there are reasons to be hopeful…

• First time ever there is political consensus on a ten year plan for reform

• A new office to drive the reform

• A determined minister

• Driven by strong public health, much more care outside of hospital, care based on need not ability to pay, integrated, eHealth…

• Strong emphasis on clinical leadership

• Detail yet to be worked out allows your input into Sláintecare as a pathway to better care…

• Citizens care master plan

• May need another election to get the financing and political support required for delivering Sláintecare reform

Thank you

burkes17@tcd.iehttps://www.tcd.ie/medicine/health_policy_management/research/current/health_systems_research/@sburx