Future of Healthcare Committee publishes Sláintecare 
Today, the Oireachtas Committee on the Future of Healthcare published Sláintecare, its proposals for a ten year strategy for health care and health policy in Ireland.

It is the first time that cross-party consensus has been reached on a new model of healthcare to serve the Irish people over the next ten years. The report contains specific timelines for its various proposals to be implemented.

The Committee’s agreed vision is for a universal single-tier health and social care system where everyone has equitable access to services based on need and not ability to pay. Over time, everyone will have entitlement to a comprehensive range of primary, acute and social care services at no cost or reduced cost. The vast majority of care will be provided in the primary and community settings.

Shifting care out of hospitals and into the primary and community setting will in turn help address the challenge of access to our hospital system, but other measures are also needed including waiting time guarantees for hospital care, expanded hospital capacity and the phased elimination of private care in public hospitals.

Development of integrated workforce planning capacity is essential, and a strong focus is needed on addressing recruitment and retention issues.

Key recommendations include:

• The introduction of a Cárta Sláinte, which will entitle all residents to access a comprehensive range of services based on need, at no or reduced cost
• Expansion of capacity in primary care and social care – this includes, among other areas, investment in community diagnostics, primary care teams and mental health teams, services for people with disabilities, homecare services and free GP care
• Waiting time guarantees of 12 weeks for an inpatient procedure, 10 weeks for an outpatient appointment and ten days for a diagnostic test. Enhanced capacity, A range of measures to deliver on this are set out in the report including enhanced capacity and staffing.
• The phased elimination of private care from public hospitals. Everyone will have entitlement to access public care in public hospitals – those who have private health insurance will still be able to purchase care from private healthcare providers. The Committee also recommends an independent impact analysis of the separation of private practice from the public system in order to identify any adverse and unintended consequences on the public system
• Significant and ongoing investment, in the region of €2.8bn over a ten year period, to build up the necessary capacity, expand entitlements and reduce the relatively high out-of-pocket costs experienced by Irish people.
• A transitional fund of €3bn to support investment across the health system in areas such as infrastructure, e-health and expansion of training capacity. The HSE and the Department of Health must develop their integrated workforce planning capacity to guarantee sufficient numbers of well-trained and well-motivated staff are deployed in a targeted way to deliver care in the most appropriate care setting
• The HSE in future will become a more strategic “national centre” carrying out national level functions and regional bodies will be established to ensure timely access to integrated care, with regional health resource allocation.
• The e-health strategy should be strongly supported, with provision of the necessary funding for timely roll-out of the EHR system
• Having considered different funding models, the Committee recommends that the system should continue to be funded primarily by general taxation, with some ear-marked funding, all flowing into a National Health Fund.
• A Sláinte Implementation Office should be set up under the auspices of An Taoiseach by July 2017, with the remit to oversee and enable the implementation of this plan and develop a detailed implementation plan for the reform programme.

Chair of the Committee, Roisin Shortall, says: “The formation of the Oireachtas Committee on the Future of Healthcare provided a unique and historic opportunity for TDs from across the political spectrum to come together to develop consensus on a long-term policy direction for Ireland’s healthcare system. Our task has been to consider how best to ensure that, in future, everyone has access to an affordable, universal, single-tier healthcare system, in which patients are treated promptly on the basis of need, rather than ability to pay. “This report represents a new vision for the future of healthcare in Ireland. The Committee considers it imperative that its recommendations are implemented without delay.”

Diabetes Ireland welcomed the proposed shift to a care system that will provide equity of services regardless of where people reside or ability to pay. Diabetes Ireland submitted detailed submissions with recommendations on future diabetes care for both adult and paediatric diabetes services, many of which are in line with the proposed care system outlined in the report. Adult Diabetes Care service recommendations were:

Encourage the HSE to publish the strategy (models of care for Adult Type 1 diabetes, Type 2 diabetes and Diabetes in Pregnancy).

National Management Guidelines for Care in Type 1 diabetes, Type 2 diabetes and Diabetes in Pregnancy are an essential component for visualising care, planning the implementation of a quality service and identifying outcomes as a basis for audit. The diabetes community has come together and developed strategies, in the form of models of care. Some aspects of these strategies have been implemented by the HSE but a long term strategy and funding commitment is required.

Extend the current Type 2 Diabetes Cycle of Care initiative deliverable at community level to all people with uncomplicated Type 2 diabetes.

The Type 2 Diabetes Cycle of Care initiative launched in 2015 is a very positive commitment by the HSE to manage uncomplicated Type 2 diabetes in the community. However, it should not  discriminate towards people with the condition who do not have a GMS or GP Visit card and should be extended under the auspices of universal single tier health system to the estimated 120,000 people with uncomplicated Type 2 diabetes.

Extending this service to this cohort will move these patients from secondary to community care and also improve access to secondary care diabetes outpatient services for those with complicated diabetes and those most in need.

Adequately resource Adult Type 1 diabetes, complicated Type 2 diabetes and antenatal care (including Gestational Diabetes) at secondary care level.

Current secondary care diabetes services are under resourced. These cohorts of patients need regular access to consultant led care in order to maximise their daily management. These patients require review (3 appointments per annum) and ongoing assessment for acute and chronic complications and rapid access to vascular, nephrology, orthopedic, psychological specialist services must be available for these patients. The models of care proposed for these cohorts require a long term funding commitment.

Develop an appropriate national information and communication technology infrastructure and support for planning requirements.

Ireland does not have a diabetes patient register. The National Retina Screening programme, hosted by the NSS, register is the closest register available. Access to this register will enable highly effective planning, audit and evaluation to be undertaken by the HSE.

Mandate annual training and structured education for all professionals delivering diabetes care – primary and secondary.

Diabetes Educational programmes are available but without mandate are only undertaken on an ad-hoc basis. Delivery of best practice requires ongoing commitment to professional education in all aspects of care.

Promote ongoing patient and professional engagement to maintain links with Diabetes Ireland

Ongoing patient engagement with Diabetes Ireland or alternative support structures is required to enable individuals to effectively manage their condition. Links with Diabetes Ireland, who provides a range of education and support services is an integral element of this.

Secure a dedicated finance structure based on standard patient cost per individual with diabetes.

Currently there is an ad-hoc reactive funding system primarily focussed on dealing with chronic diabetes related complications. We need a preventative structure based on outcomes and efficient use of services that encourage patients to more proactively manage their condition and prevent the onset of complications, thus making financial savings for the exchequer.

Stem the rising incidence of Type 2 diabetes fuelled by increasing obesity levels by implementation of the Obesity Report Recommendations.  

Both rising obesity levels and an aging population will add future demographic pressures and further impact on diabetes incidence.  It is essential that policies are implemented to address both these issues to encourage those with pre-diabetes to make the necessary lifestyle changes and avoid/delay onset of diabetes.

From a paediatric diabetes care service perspective, Diabetes Ireland recommended full implementation of the HSE Model of Care for All Children and Young People with Type 1 Diabetes developed by the Paediatric Diabetes Working Group. Additional funding of just €5.5m is required to fully resource a high quality paediatric diabetes service that meets the needs of children with diabetes and their families and will make very significant exchequer savings in future years.

The service will be based in hospital settings and provide the medical, nursing and psychosocial support to deal with all children with diabetes, regardless of where they reside, in a care system with specific quantitative and qualitative outcomes. These measured outcomes, in other countries where investment has been made, have shown a reduction in HbA1c over 5 and 10 years. The paediatric diabetes community has come together to produce this model of care but a long term funded strategy is required to provide, audit and evaluate a quality system. Diabetes Ireland is seeking the support of the Oireachtas Committee on the Future of Healthcare to support this service.

Access the full report here, see pdf of the report beside the graphic on the following link: http://beta.oireachtas.ie/en/committees/32/future-of-healthcare/