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Towards 2026 – A future Direction for Irish Healthcare, launched today 28 March 2017, presents a vision for patient-centred healthcare in Ireland.
The report calls for a radical change that requires building health services around patients, including locally and at a community level. It outlines a future direction for hospital care and the role of the doctor in Ireland.
It is the culmination of the Towards 2026 policy forum, which was established in 2016 and chaired by the former Director of the National Cancer Control Programme, Dr Tom Keane.
The report was developed through a series of consultations with more than 100 participants from across the spectrum of the Irish health service including patients, carers, doctors, nurses, health and social care professionals, GPs, healthcare policymakers and managers.
Towards 2026 is about understanding the future needs of patients, highlighting the gaps in current healthcare services and clarifying the new role of the doctor in a more responsive and dynamic healthcare system
Dr Tom Keane, who chaired the Towards 2026 Policy Forum, said, "Putting the patient at the centre of how services are designed, organised and delivered is what the Irish public want and deserve. This is the resounding message from the patients and carers, health professionals, policy specialists and hospital managers who have shaped this vision for the delivery of future healthcare.
"Fixing the health service to meet the needs of those who require care is an enormous task but it is not impossible. In my conversations with patients, carers and health professional over the past year I have been impressed by their inherent goodwill and lack of recrimination at the failings of the system. But I also sensed that tipping point of total system failure cannot be far off.
"The way healthcare is delivered to patients must change before that point is reached to prevent the inevitable consequences - a profoundly negative impact on the health and wellbeing of those dependant on publicly-funded healthcare."
Towards 2026 - A future direction for Irish healthcare contains 12 recommendations for moving towards patient-centred healthcare in Ireland:
The future health system must put people and patients at its centre in a meaningful way.
This means listening to the patient voice in the planning, design and implementation of services
Unless action is taken to keep people well, our health system will be overwhelmed by the rise in long-term diseases, such as diabetes
Clarity is needed on what can reasonably be expected from the health service, what funding is to be allocated to meet those expectations, and how decisions are made to benefit the greatest number of people in a fair and transparent way.
Healthcare policies, strategies and plans should use research evidence and relevant data to make clear connections between population needs assessment and frontline planning decisions.
Care pathways should be built around the needs of the patient, not the system.
We need to provide care that is joined up from the patient perspective, through the design and implementation of patient-centred, clinically led, evidence-informed integrated models of care.
Service delivery should be oriented around the service itself rather than buildings and institutions or legacy arrangements.
This includes the concept of a ‘hospital without walls’, where many services delivered in hospitals can and should be delivered in the community, with greater collaboration across hospital, primary care and community care settings.
We need a governance system that applies at every level, from service delivery upwards, and is grounded in the principle that the healthcare system is owned by and accountable to the people.
Major, sustained emphasis is needed on strengthening and supporting the people who deliver care, and on rebuilding trust and confidence among the workforce.
Successful organisations recognise the importance of the people who work for them; they try to recruit the best; ensure they are enabled to perform to their best; are involved appropriately in decision-making; are trusted; and are provided with development opportunities.
This is what we should aspire to for our health service.
The individual health identifier and electronic health record must be implemented.
The advent of the eHealth Strategy provides an opportunity to adopt a long-term strategy to underpin joined-up care across community, primary care, acute hospitals, and mental health, and to simultaneously enable effective population needs analysis, planning, outcome measurement, and performance accountability at local and national levels.
Only strong leadership at local, regional, national and institutional levels can overcome the lack of trust in the system and bring about the kind of change needed to return the health system to its core purpose.
A shared vision and long-term strategic plan with crossparty political support is essential.
Frequent changes in direction are fundamentally destabilising and undermining for the health service.
Failure to successfully implement change has been a recurrent and debilitating feature of the health service for many years. There must be significant, targeted and sustained investment into making these changes happen.
There have been many expert reports over the years that pointed to a direction that would ensure that the health system worked more efficiently for patients but none have been implemented. This failure to implement radical reforms is sustaining the current crisis-ridden system that is struggling to meet the demands of those requiring healthcare and frustrating and potentially harming patients in a way that is utterly unacceptable.
Dr Tom KeaneFormer Director of the National Cancer Control Programme
Dr Keane has said, "Today the Royal College of Physicians of Ireland is calling for the Towards 2026 recommendations to be adopted as an essential element of a new 10-year plan for the health services currently being developed by the Oireachtas Committee on the Future of Healthcare. But a vision has to be implemented and today we are calling on the Oireachtas to hold the health system to account for making the changes required to centre the health services around patients’ needs in national, local and community settings.
"My own experience in working to implement a radical redesign of cancer services in Ireland a decade ago is instructive. Cancer outcomes and quality have improved significantly. The reasons are many, but those most prominent are a well-designed evidence-based plan, strong clinical leadership, excellent communication and perhaps most important of all strong and sustained political support."
I am particularly pleased that this report represents the views of patients and carers, health professionals from all disciplines, hospital management and policy makers. This, I believe, has resulted in a highly representative report that demonstrates the level of consensus that exists within the health services for the change we advocate.
Professor Frank MurrayPresident, Royal College of Physicians of Ireland
Prof Frank Murray, President of the Royal College of Physicians of Ireland said, "RCPI represents doctors working right across the health services, and is fully committed to supporting the changes needed to create a patient-centred and effective health service.
"We hope this report will help to inform, and will be useful to the Oireachtas Committee on the Future of Healthcare as they continue their task to improve the Health service."
Leo Kearns, Chief Executive of the Royal College of Physicians of Ireland said, "Making these changes happen while continuing to operate a live health system is immensely challenging, but we can’t avoid this challenge because our health system is in deep crisis and this will only get worse. Change of this scale will require sustained political support for the next decade and beyond. With this level of political leadership, there will be support from patients, those working in the health services and from the wider community."
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