Ireland's Sláintecare health reform risks mission creep, needs clearer vision

Euractiv

6 days ago

'Sláintecare can mean almost whatever we want it to mean,' said Professor Steve Thomas of Trinity College Dublin. 'There's a danger of mission creep,' he warned. Thomas, who helped draft the original Sláintecare report, said the reform risks losing coherence.
At a healthcare policy conference on 25 June, Prof. Thomas called for a clearer vision of universal healthcare. 'We're still debating eligibility and entitlement eight years on,' he said. 'We need to pin down as quickly as possible our vision.'
Sláintecare, Ireland's national healthcare reform programme, was launched in 2017 in response to long-standing issues in the country's health system. It aims to create a universal, single-tier health service where access to care is based on medical need rather than ability to pay.
While digital health transformation is gathering pace, policymakers, clinicians and economists think the reforms must be more ambitious.
They agree that digital advances must deliver better patient outcomes and improved value for money through a more robustly connected, data-driven healthcare system, but the system remains slow to change and fundamentally dysfunctional.
Prof. Thomas urged policymakers to leverage crises as catalysts for reform. 'COVID was quite helpful in getting extra resources into the health system,' he said. 'But we must protect our workforce. We're expecting a lot from them.'
Sláintecare, the country's flagship universal healthcare reform programme, still lacks a unifying vision in a shifting economic and digital landscape. The path forward is fraught with challenges, including fragmented systems, workforce shortages and demoralisation, and a lack of public engagement.
From analogue to AI
Ricardo Sampaio Paco, Service Improvement Lead at St James's Hospital, offered a compelling case study of how digital tools can transform hospital operations. 'At St James's Hospital, 80% of the discharges in the past were occurring after three in the afternoon,' he said. This bottleneck created a 'ripple effect' that delayed admissions and strained emergency departments.
To address this, the hospital implemented a visual management system that digitised patient flow data and enabled real-time decision-making.
'It's now possible to see … for every patient what their estimated discharge is, the clinical criteria for discharge, the discharge destination and required onward care,' Paco explained. 'You can have this within five seconds after you get in contact with the screen.'
The results were striking: a sharp reduction in late discharges, increased surgical throughput, and improved frailty assessments. 'We're now the best hospital for hip fracture care in Ireland,' Paco said, citing a leap from 7% to 70% compliance with national standards.
General practice, the digital bedrock
While hospitals are making strides, Dr Mike O'Callaghan, Clinical Lead at the Irish College of GPs, stressed that general practice remains the 'foundational' layer of Ireland's digital health ecosystem.
'General practice is where a lot of the volume happens,' he said, noting that GPs handle over 21.5 million consultations annually. 'Continuity of care is continuity of records and vice versa.'
O'Callaghan warned against creating new digital silos. 'If everybody's in charge and there's patient information everywhere, then no one is in charge,' he said. 'We need to have a central repository of all this stuff so that we're all on the same page - including the patients.'
He also highlighted the importance of maintaining and curating electronic medical records. 'It's not good enough to build a big, shiny system. You need to make sure that it's being maintained, because that's how patients are kept safe.'
Telemedicine 2.0
Dr Victor Vicens, Chief Medical Officer at Abi Global Health, argued that traditional telemedicine has failed to deliver on its promise. 'Basically, what it did was put a camera in front of a doctor,' he said. 'The basic unit, which was doctor time, was not changed.'
Abi Global Health is using AI to triage cases, allocate healthcare professionals, and monitor consultation quality. 'Next-generation telemedicine is omnichannel, on-demand and up to three times less costly,' Vicens said. 'This leads to better financial results and better health outcomes.'
The economist's view
Dr Jonathan Briody, a health economist at the Royal College of Surgeons in Ireland, framed digital health as a fiscal imperative. 'Digital health is not an optional thing anymore,' he said. 'It's integral to modern service delivery and group patient outcomes.'
He pointed to the success of virtual wards, such as the one at St Vincent's Hospital, which has treated over 500 patients and saved nearly 4,000 bed days. 'Each hospital bed that we free by a safe virtual consultation provides another bed for someone who needs it,' he said.
With the Health Service Executive's 2025 budget reaching €27 billion, Briody emphasised the shift toward value-based healthcare. 'We're measuring success not by the euro spent or services provided, but by the outcomes achieved per euro.'
Trust, data and the public
Despite the momentum, speakers acknowledged that public trust and digital literacy remain significant barriers.
'Patients are shocked when I can't see their medicines,' said O'Callaghan, referring to the lack of interoperability between GP and out-of-hours systems. 'Patients actually think our digital infrastructure is more cooked than it is.'
Briody added that many patients are unaware they own their health data. 'They're shocked to learn that their data belongs to them. We're just mining it for them.'
Vicens argued that public confidence hinges on transparency and evidence. 'Getting more confidence from the systems relies on doing what science has always done – publishing, providing reliable results, and reliable sources of evidence.'
Inclusion and equity
Digital exclusion was another recurring theme, particularly for older people and refugees.
'Six in ten older people in Ireland are not comfortable online,' said Vicky Harris, Head of Programmes at Age Action. 'Digital First, not Digital Only. Ensure quality services are maintained offline as well as online.'
Dr Hanna Balytska, a Ukrainian doctor now working in Limerick, described how language barriers and outdated communication methods - such as postal letters - led to missed appointments among refugees. 'They always keep their telephone number. They always keep their email,' she said. 'So that's why even in English, if we send something in English, they can translate it.'
Community care, the next frontier
Margaret Curran, General Manager at Caredoc, showcased the SMILE programme, which uses wearable devices and remote monitoring to manage chronic conditions. 'It showed a 41% reduction in ED attendances, 44% reduction in bed night stays, and 87% reduction in unscheduled urgent GP visits,' she said.
Curran emphasised the programme's cost-effectiveness. 'To manage 600 high-need patients, we have 4.5 whole-time equivalent triage nurses,' she said. 'It really pays for itself very early on.'
Michelle O'Hagan, a community pharmacist in Tallaght, called for greater integration of pharmacy services. 'We are the cornerstone of healthcare,' she said. 'We can offer more clinical skills and reduce hospital admissions.'
Ireland's digital health transformation is at a critical juncture. The tools, talent and political will are increasingly in place. But to deliver on the promise of Sláintecare, better care, better access, and better value, policymakers must ensure that digital innovation is inclusive, coherent, and grounded in the lived realities of patients and providers alike.
The foundation of the new health era in Ireland has to be a highly effective, data-driven system. Without it, an ageing population and chronic disease will drain and break Ireland's capacity to care for its citizens, damaging the economy and democracy.
By Brian Maguire