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Euractiv
27-06-2025
- Health
- Euractiv
Ireland's Sláintecare health reform risks mission creep, needs clearer vision
'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
Irish Times
16-06-2025
- Health
- Irish Times
GPs who take part in chronic disease management programme will not be surprised by latest findings
While a brilliant group of researchers in Limerick might not have broken the law , they have certainly upended one, and their important findings may be as compelling as those that led to the smoking ban. The law in question is 'The Inverse Care Law' which states roughly that those who need medical care the most are the least likely to get it, and when they do it is of poorer quality. It is also known as the Tudor Hart Law, after the brilliant and caring British GP (Dr Julian Tudor Hart, 1927-2018) who first proposed it. This law has been around for decades. The exception, it seems, is the Irish GP-led chronic disease management programme, known as CDM. READ MORE Prof Ray O'Connor and teams from the University of Limerick medical school and The Irish College of GPs mid-western training scheme have just published a paper in Family Practice, comparing the care received by patients who had GMS (General Medical Services) medical cards or Doctor Visit cards, and private patients with the same chronic condition who were ineligible to join the CDM programme. I don't think any GP who partakes in CDM, and we nearly all do, will be surprised at the findings. Some of my patients are on the sixth or seventh round, and the CDM review is now one of my favourite parts of general practice. We identify those with a chronic condition – cardiac, respiratory, stroke or two type 2 diabetes – and invite them in for review every six months. We measure their health through a number of tests and then go through medication and findings. The discussion could take in lipids, lifestyle, exercise, inhaler technique, weight or blood-pressure management. We look at immunisations and education programmes, and a lot more. There is room to ask about what else bothers people, such as loneliness and anxiety. I have lost count of the number of times something came up that I could help to sort out. The consultations take time, but it is time well spent. It is not only better for patient care and more human, but also saves money. You don't want your patient to end up on dialysis or have a myocardial infarction which could have been avoided by regular check-ups and tweaks of their medication. [ From 20 cigarettes a day for 55 years to finally quitting: 'I took it up thinking I was the big man' ] The analogy would be that it is better to get the car serviced than wait for it to break down. We now know that CDM has been a resounding success, and another HSE report found that the programme has had a high impact on 400,0000 patients, reducing hospital visits and emergencies, and 91 per cent of these now receive routine chronic disease care within the community. The chronic care programme also has an application in identifying those at risk of developing a chronic illness or those who already have one and did not know about it. Since 2020, 51 per cent of new chronic disease diagnosis had been made through GPs in the programme. This prevents the need for more intensive hospital-based treatments, which transforms people's health journeys and promotes sustainable healthcare practice. There are a frightening number of people who don't know that they have chronic illnesses which need proper management. The aim of Prof O'Connor's Limerick area study was to compare the CDM programme on the management of matched GMS patients with those without GMS cards. The first important and novel finding was that it found healthcare process inequities between the GMS patients who are eligible for the programme and private patients who are not. The standard disease monitoring is superior among participating GMS patients. Statistically significant differences emerged in vaccination rates and the monitoring of health parameters including blood pressure, smoking status, renal function, HbA1c, and lipids, with GMS patients consistently receiving more comprehensive care than fee-paying patients. Also, supplementary data collected from fee-payers' records showed little evidence of chronic disease care being provided outside of the GP setting. So what are the implications? It seems that if the CDM programme was extended to patients without medical cards it would make medical and financial sense. It would also be in the spirit of Sláintecare , which aims to create a universal healthcare system based on need, not ability to pay. The iniquity in the present system is that against the private patient. At the very least, there should be a feasibility study to see if we can extend the scheme to all. Dr Tudor Hart would be delighted.
Irish Times
17-05-2025
- Health
- Irish Times
Irish College of GPs conference hears 75% of members not taking new medical card patients
Three-quarters of GPs were not accepting new medical card patients, while just over two-thirds were not taking private patients in 2023, according to research conducted by the sector's training body. On Saturday, the Irish College of GPs held their annual conference in Cork city, discussing accessibility of services and meeting the needs of patients. Dr Mike O'Callaghan, clinical research lead with the Irish College of GPs, said the research indicates capacity problems in the sector. 'My own practice, our list has been closed for two years. If you can't look after patients safely then you shouldn't look after them,' he said. READ MORE 'And it's a very hard thing to tell a patient or their family that 'sorry we're just full. We can't take on new patients'.' According to the college, rural practices tend to be run by older doctors, who are men and are more likely to be solo practitioners. Its research also found urban areas have 100 GPs per 100,000 population, while some rural areas only have 60 per 100,000. Some 96 per cent of GPs keep appointments available so urgent cases can be seen on that day, while seven in 10 non-urgent or routine care appointments are seen within the week. 'It does vary a bit. In rural practices, people wait the least time. These are smaller practices and are often solo-run, so patients find it easier to get in there,' he added. Prof Suzanne Crowe, president of the Irish Medical Council , presented data on the demographics of GPs, which showed one-third are aged 55 and older. The medical council's data also highlighted how more women are becoming general practitioners in recent years. In 2024 there were slightly more women working as GPs than men. 'You can see as we shift towards more women in general practice, you can see with population mapping that within the next five to 10 years general practice will be wholly dominated by women doctors,' she said. 'It means our system or training, and also practice, will have to change as well. We do know that women shoulder a large proportion of caring duties within the home.' Former taoiseach and doctor Leo Varadkar also addressed the conference, during which he spoke about advancing technology and artificial intelligence (AI), which he said would bring positives and negatives. Mr Varadkar had recently been in the US, where there were 'exciting' trials on the use of AI in healthcare, he said. 'There was an AI-guided triage in the emergency department coming up with different decisions and different prioritisation of patients than a nurse or doctor would,' he said. 'It is probably likely that most physicians will have an avatar, so will be able to make a virtual version of you. And when a patient rings up, it'll be virtual you. It's like a telephone conversation but on a whole new level.'
