Ireland delivering better, safer health outcomes

When people criticised the Irish health services they should be told that we were delivering better and safer outcomes than 10 years ago, to an increased population, a significantly increased elderly population, with more complex cases and less capacity, Dr. Colm Henry, National Clinical Advisor, Acute Hospitals told a meeting of the HMI South in the Erinville Hospital, Cork, last week.

Colm Henry

Dr. Colm Henry

Speaking on” Challenges and solutions: patient safety in Irish hospitals,” he said that while nothing appeared to have changed, there had been significant changes in the last decade.

Overall mortality had been reduced by 16.7%, mortality from IHD, stroke and cancer was also down, there had been a 55% increase in hospital discharges and ALOS was reduced, while the number of acute beds had been reduced 13.5%.

Dr. Henry said the number of people in Ireland over the age of 65 – who could be expected to suffer more chronic diseases – had increased from 536,700 in 2011 to 648,600 in 2016 and was set to reach 1.434 million by 2041.

“Public health measures have a far greater effect on health outcomes than hospitals. About 10% of measurable health outcomes depend on hospitals.”

At present, it was estimated that in Ireland that 1 million people suffered from one of the 4 chronic diseases – cardiovascular disease, diabetes, cancer and chronic respiratory disease.

The chronic disease burden was increasing by 4% each year and at present accounted for 40% of admissions to hospital, 75% of bed days used, 55% of hospital expenditure in Ireland and 80% of GP consultations.

Dr. Henry said that one of the challenges was that people in this country was that Emergency Departments were too popular. People felt that if they were ill, the ED was the best place to go, despite the fact that they were not the most appropriate place for people with chronic diseases. A survey had shown that if people had the option of having their problem addressed that day by a GP, 60% would still opt to go to an ED.

He said that hospitals often confused what they did with healthcare/ There was a wealth of international research that showed the determinants of how long you lived and how well you lived were firstly where you were born and secondly to whom you were born.

“Public health measures have a far greater effect on health outcomes than hospitals. About 10% of measurable health outcomes depend on hospitals.”

Dr. Henry emphasised that the future of healthcare in Ireland lay in public health measures and encouraging patients to have their conditions treated at the most appropriate level – either at home, by their GP, or at outpatients, at day case or as inpatients in the correct Level hospital.

This would mean patients would be treated faster, more appropriately and major hospitals freed up to treat complex cases.

Dr, Henry said that the medical workforce should be aligned to the needs of the healthcare system, with skill mix correlated with the needs of the system, in Model II, III and IV hospitals

Training provided to doctors should also be appropriate, adaptive and capable of responding to the changing needs of the patient and the health service.

We needed an increase in training posts at the expense of non training posts and it was important to ensure the geographical spread of trainees.

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