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Move to outcomes-based funding — RCPI report

09 Feb 2017

Outcomes-based funding should underpin Ireland’s future health service, according to a blueprint to be presented by former cancer Tsar Dr Tom Keane within the next fortnight.

The system would see payments made on the basis of clinical outcomes, not just activity, IMT understands.

Rather than a hospital department simply recording, for example, the number of scopes carried out, the quality of work, resulting findings and whether treatment was commenced would in future be taken into account, with money following outcomes. Where a hospital had poor outcomes and there was consequent declining income, hospital CEOs might then elect to downgrade certain activities, thus effectively driving reconfiguration.

The RCPI’s ‘Towards 2026’ report is understood to urge more acute and emergency care for very ill patients in hospitals, while stressing that chronic diseases should be managed in general practice. However, any switch away from hospitals needed to be properly resourced, according to the report, and greater integration between primary and secondary care must be achieved.

Towards 2026 is a policy forum established by the RCPI, which is working on a collective vision for what acute hospital care should look like in 2026. The report is expected to be submitted to Minister for Health Simon Harris within two weeks, and will also be presented to the two Oireachtas Health Committees.

None of the proposed changes would be achievable, however, without a unique health identifier, according to the strategy, and Dr Keane has laid particular emphasis on an electronic health record whereby lab results, for example, would be readily available to GPs.

Irish doctor numbers are low by international standards and the document has stressed how serious efforts must be made to improve working conditions to order to address recruitment and retention issues.

NCHDs’ work that is not purely medical should be transferred to other grades, the report will urge, with more senior nurses also a requirement for multidisciplinary teams.

Proper doctor training and better assessment and improved work-life balance are also addressed in the report.

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