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Solution lies in more ‘focus on CDM’

21 Nov 2016

There had to be a rethink regarding where healthcare was delivered — particularly when the objective was to prevent acute disease, the Chief Executive of RCSI Hospitals Group has said.

By the time patients presented in EDs, they had an exacerbation of their condition and the aim should be to deliver care earlier and to locate more care in the community, Ian Carter told the Policy Forum for Ireland ‘Priorities for Healthcare Seminar’. Hospitals would then be accessed when a type of expertise or a sub-specialisation was required, he said.

The magnitude of the problem was such that a continued focus on “belt and braces reactive solutions” was doomed to fail. “We need to rethink. There is a need to avoid quick fixes: year-end waiting list initiatives do not achieve anything sustainable.

“Building back-up capacity takes time. The winter plan set a maximum target of 236 patients on trolleys. This misses the point if you cannot at the same time move patients out into community services. Plans must be achievable,” said Carter.

Ireland had, in his view, created a totally hospital-centric model. Acute medical assessment units were useful but a model that meant there were 500,000 people waiting for outpatient appointments needed to be reconsidered. That total was staggering given Ireland’s population, he said.

There are 80,000 patients waiting for inpatient care or day care. “There are good outcomes if a patient sees a consultant,” said Carter. “But if 85 to 90 per cent of what comes to the hospital is chronic disease, the solution lies in better management of chronic disease. Simply creating a faster or an alternative conveyor belt to a different part of the hospital has some cosmetic benefits. But the current supply of service does not meet service demand.”

The system did not run efficiently or effectively and a top-down approach had not proved effective, the hospital group CEO stressed. “There is a need to invest in and grow community services.”

“The focus should be on preventative maintenance — rather than having a consistently revolving door for acute exacerbations,” added Carter.

gary.culliton@imt.ie

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