HSE to introduce new models of primary and hospital care

The HSE National Service Plan 2021 lays the foundations for new models of integrated and scheduled care, which will radically change how primary and hospital services are delivered in this country, writes Maureen Browne

The HSE sees more care, particularly for older people and those with chronic diseases, moving from hospitals to the community, where it will be delivered by community specialist teams, with bespoke pathways into and out of acute hospitals.

It also plans what it describes as “radical change to the delivery of scheduled care.”

HSE CEO, Paul Reid said, “The National Service Plan 2021 is the most ambitious plan we have ever submitted, reflecting the fact that we have received the largest year-on-year budget increase ever voted by Government to the Department of Health (DoH), and in turn to the HSE.

“The financial resources now available to the health service present us with a once-in-a-generation opportunity to really change how we deliver healthcare in Ireland. For years we have spoken about shifting care away from hospitals and towards the community, but progress has been slow. In the past 12 months, however, our staff and indeed the whole healthcare system have proven just how adaptive we can be in the delivery of health and personal social services.

“What we envisage for the year ahead for our health services, if we succeed, will indeed have a transformative effect.”

Paul Reid, CEO, HSE.
Pic: Brian MacCormaic

Health Minister, Stephen Donnelly said, “The budget for 2021 includes some very significant additional investments which will be applied to restart services in a Covid-19 environment, enhance or expand existing services, including enhancing service resilience and responding to demographic and other pressures, and to commence new approved service developments.”

The HSE will spend €20.6bn on health and personal social services in 2021, a record increase of 21 per cent on the 2020 health allocation.

From this, €426m has been allocated to fund the opening of the additional 488 acute beds, 74 sub-acute beds and 66 critical care beds already announced by Minister Donnelly. This will increase the total number of critical care beds to 321 at the end of 2021.

The HSE will develop 57 networks and 18 community specialist teams for older persons and chronic disease management. These will support 11 acute hospitals, mainly Model 4 hospitals. A further 39 networks and 14 community specialist teams will be rolled out in winter 2021-2022.

The HSE says general practitioners (GPs) will have access to a single source of up to date information on patient pathways and referrals and will have direct access to consultants’ advice and diagnostic services. It also says it will develop the first disease registries in Ireland.

The National Service Plan says more vulnerable people will be cared for in their own homes and communities, with fewer being cared for in acute hospitals and nursing homes.

It says we must reduce the number of older people in long-term residential settings. It has earmarked €30m this year to reform public residential care for older people. It will develop high risk preventative programmes, reducing hospital admissions and the proportion of older people requiring long stay care, and increasing the number of people receiving home support.

It plans to support 22,500 people in nursing homes, increase home support and pilot the regulation of home support services in 2021.

On the hospital side, it plans to progress the implementation of elective-only care centres, purchase additional capacity from the private and public sectors, fund more hospital beds and use resources more effectively.

It says additional consultants and other senior decision makers will support the delivery of shorter waiting times, the reduction of inappropriate hospital admissions, improved patient flow, and earlier discharge of patients to the community.

The National Service Plan says it will appoint additional consultants and implement a range of alternative pathways to provide for the delivery of care and seek to lay the foundations for radical change to the delivery of scheduled care.

However, it recognises that the recruitment of certain medical consultants will be challenging and to this end a small multi stakeholder working group including the HSE and the Public Appointments Service has been established to identify specific recruitment and resourcing strategies.

It wants to make progress towards achieving waiting times of 10 weeks for a new outpatient appointment, 12 weeks for an appointment for a procedure, and 10 days for diagnostics.

It promises a new patient-centred booking system nationally to reduce DNAs (Did Not Attends).

The HSE will continue moving people with disabilities from congregated settings to transition homes in the community and will pilot a service to support people with an intellectual disability and dementia to transition to community living. Funding has been provided to the HSE to develop and open an additional nine dedicated centre-based respite services across all Community Healthcare Areas.

The NSP promises health and wellbeing priorities, programmes and interventions, focusing on disease prevention, aiming to improve health and reduce morbidity, especially focusing on communities at risk (people who are homeless, refugees, international protection applicants, Traveller, Roma, members of the LGBTI+ community and people with enduring mental health problems).

It will recruit 123 new mental health staff, including 29 new posts in child and adolescent mental health services.

It says the recommendations within Sharing the Vision – A Mental Health Policy for Everyone will provide a new and enhanced focus on the provision of recovery-focused integrated mental health services in Ireland in the future, and continue to inform mental health service delivery.

This will be achieved through a person-centred approach that focuses on enabling recovery through an emphasis on personal decision-making supported by clinical best practice and lived mental health experience.

The transition to the new national forensic mental health service, increasing capacity on a phased basis, is listed as a priority for 2021.

There will be €12m invested in the National Maternity Strategy and improving gynaecology and fertility services and €10m in screening services including BreastCheck and CervicalCheck.

The HSE says it will also implement the remaining recommendations contained in the Scoping Inquiry into the CervicalCheck Screening Programme (Scally Report) as well as those contained in the Independent Rapid Review of Specific Issues in the CervicalCheck Screening Programme.

A total of €450m has been allocated for PPE, an initial provision sum of €200m for the Covid-19 vaccination programme, €445m for the testing and tracing programme, and €10m for the GP Covid-19 contract.

A total of €50m has been allocated for new drugs. The NSP notes that its capacity to respond to new drugs and new indications for existing drugs is finite and needs to be looked at in the context of circa €2.4bn the HSE is already paying each year to drug companies.

“This equates to 12 per cent or nearly one in every eight euros invested in running the health and social care services. Where companies are willing to reduce the cost of existing drugs, it enables headroom within that €2.4bn which the HSE can use to make additional new drugs available to patients earlier. Some encouraging progress in this regard was made in the latter half of 2020 and the HSE will look to continue this in 2021.”

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