“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.” -Roisin Shorthall, Future of Irish Healthcare Committee Chair
The healthcare system in Ireland has been explicitly identified as a pressure area for our government, for our healthcare providers, and for Irish citizens accessing their services.
Sláintecare: A New Vision
Sláintecare is a vision for a new health service in Ireland, detailed and discussed in the report by the Oireachtas Committee on the Future of Healthcare published on 30 May 2017. With an investment of €2.86bn over the next decade, and a phased expansion of service provision, this strategy document outlines a wholly new model of healthcare for Ireland.
The aim or ethos of the plan? To provide a single-tier equitable healthcare system. The goal is to reach a stage where everyone will have entitlement to a comprehensive range of high-quality primary, acute and social care services, either at no cost or reduced cost. This ‘Stay Left, Shift Left’ style strategy will see the majority of services pushed out to community-based and home settings.
Some of the key action points include the introduction of Cárta Sláinte (which will entitle all Irish residents to access an ample range of services based on need, at zero or reduced cost), increased investment in community diagnostics, mental health teams, primary care and homecare services, greater assistance for people with disabilities and free GP care. This strategy seeks in the main to address the issue of access to our healthcare system, backing preventative medicine and reducing hospital admissions by facilitating care in primary or community settings.
Global Healthcare Goals
As we discussed previously, these fundamental changes are also being mimicked across the global health care sector. What lies behind this seismic shift in thinking? We are now presented with changing demographics, increased consumerism, and the realisation that healthcare has lagged behind other service industries who have embedded powerful information-based systems for decades. Our aging and growing populations, the proliferation of chronic diseases and a heightened focus on care quality and value have desperately demanded of us as clinicians and innovators to evolve new structures, treatments and technologies, to a find new way to care.
Across the board, the shared goals of healthcare strategies (Sláintecare included), encompass:
- Improving digital connectivity between consumers and healthcare providers
- Facilitating self-managed care, with the help of technology-enabled solutions, in a secure and safe environment
- Delivering care outside the traditional clinical setting, ideally providing better access to care at a lower cost
- Seeking to improve population health outcomes
One such innovation in the area of preventative medicine is not only the adoption but the technological advancement of ‘wearables’. A term stolen from the fashion industry & coined for use by Pulsar’s first calculator watch (1975), the meaning is so much more expansive in relation to modern medicine. Many health-related wearable innovations leverage the power of biosensors, which can be placed in a watch, a patch on the skin, implanted under the skin, or swallowed like a pill. In addition to the widely used activity tracker, or wearables that measure light, pressure, temperature, moisture, and gas, biosensors soon may be able to monitor chemicals and biomarkers. For example, doctors may be able to use biosensors to determine how well a drug is metabolized and adjust the dosage and frequency accordingly.
Corporate Healthcare Programs or Employee Assistance Programmes have also been a much welcome addition to models of preventative care (often in conjunction with wearables). Driven by key stake-holders such as health insurance firms, whose aim is to reduce the probability and impact of chronic disease in their patient population, some of us now have access to Irish Life Health’s Workplace Fitness Challenge, Laya’s Thrive Health & Wellbeing or VHI’s Corporate Solutions programmes. Paired with increased competition for forward-thinking, innovative, and engaging workplaces for the working population and the employers desire to reduce absenteeism, corporate healthcare programs now play a huge part in workplace culture and subsequently the preventative methodology. Many businesses in Ireland and abroad have been seen to incorporate health checks, onsite services and wellness programs, to give their staff more control over their personal health, all in the comfort of the modern workplace.
The question is where do wearables and employee assistance programmes fit in the public healthcare space? How can we draw on what works in the private sector and implement it in an accessible and affordable manner in the mammoth machine that is our public healthcare system?
The goal of free GP care does not come easily in real-world terms; the proposal is not practical unless it’s properly costed. “We certainly don’t have the capacity for it. In a utopian society there would be free point-of-care access. In reality, we don’t have the capacity to handle the increased consultations. The NAGP signalled this before it was rolled out for under 6s” – NAGP President Dr Emmet Kerin. Kerin says the fact more parents are bringing their children to their GP is “displacing other patients, particularly the elderly and frail”, many of whom go to their local emergency department when they can’t get a same-day appointment at their GP, further exacerbating overcrowding there. All societies that have universal free point-of-care access, such as the NHS are struggling with capacity.
Alongside GP services, community-based multidisciplinary care is also at the heart of stay-left thinking. For example, the John Hopkins Hospital at Home® program, an innovative care model for adoption by health care organizations provides hospital-level care in a patient’s home as a full substitute for the acute hospital setting. This model is improving care outcomes whilst also showing, in some cases, cost savings up to 30% compared to traditional inpatient care. The program is being implemented at numerous sites around the United States by many hospitals, home care providers, and managed care programs as a tool to cost-effectively treat acutely ill older adults, while improving patient safety, quality, and satisfaction.
On a local level, the closest we have to this is community-based public Primary Care Centres whereby multidisciplinary are based in local clinics and, where required, can attend to patients in their homes. One can of course, pay for their own allied healthcare provider to treat them at home, or avail of health insurance firms’ expanding gamut of community based services such as Affidea’s Expresscare walk-in clinics or VHI’s Hospital@Home service.
So how do we move care from acute hospitals to the community and home when the system is also struggle from a financial and resource perspective?
As healthcare practitioners, telehealth is a tool that allows us to provide high-quality healthcare services to consumers, from the comfort of their homes. From preventative care to satisfying increased consumerism in healthcare, telehealth provides an important opportunity for healthcare practitioners to support the ‘Shift Left’ strategy (high quality, accessible care at a reduced cost). The success of once local, now global, providers VideoDoc, and UK-based Babylon Healthcare is weighty testimony that, from the patient’s perspective, a huge demand exists for online consultations with primary care physicians.
There are already some amazing products available in the Irish market that allow for home-based monitoring. Kinesis’s QTUG™ (Quantitative Timed Up and Go) is based on the Timed Up and Go test and is instrumented with wireless sensors placed on each leg. This technology provides a method for objective assessment of mobility, frailty and falls risk. Bluedrop Medical’s device enables diabetic foot ulcers to be detected early; the home-based device performs a daily scan of the patient’s feet and sends the data to the cloud for analysis through advanced algorithms capable of detecting abnormalities. By detecting falls risks and diabetic ulcers early, these technologies can meant treatment can be offered sooner, where outcomes and costs are greatly improved.
Day to day, what can healthcare providers do to join the journey? With clinic software solutions, such as Wellola, now available, allied healthcare providers also have the tools to bring their care further into the community and directly into their patients’ homes. There now remains minimal barriers for all allied healthcare professional to drive the new vision for healthcare even further left.
The Future Looks Bright
eHealth Ireland and the European Connected Health Alliance recently hosted an “Ecosystem Innovating for Sláintecare” event at Maynooth College. It was attended by patients, practitioners, entrepreneurs and key stakeholders in the Irish healthcare space. The atmosphere was one of optimism and motivation; there seems to be an urgency among this community to assist in the positive evolution of our healthcare system. Placing the patient at the core of this evolution is key, as noted by patient advocate and 22q11 representative, Anne Lawlor “The end user needs to be present at the beginning….for integrated, connected care”. One couldn’t concur more with the closing statement of Professor Philip Nolan “If we could liberate the innovative potential within the people who work in the HSE we will have done something really significant for Irish society”. Watch this space; the future looks bright.