At the Oireachtas Health Committee on Wednesday we received an update on Slaintecare from the Implementation Team. We heard from Ms Laura Magahy, executive director, Sláintecare, Ms Ciara Mellett, Ms Caroline Pigott and Ms Grainne Healy, and from the HSE, Mr. Dean Sullivan, chief strategy officer. I raised a number of issues including Primary Care and GP services, the role of community and charity organisations and the impact of insufficient infrastructure such as Emergency Departments on Slaintecare.

Sean Kyne: I thank the witnesses for their presentations. They have provided us with a lot of information on what is a very important area.

We had a presentation last week from mental health groups, specifically Mental Health Ireland and Jigsaw. The representatives spoke about the percentage of the budget going to mental health and we also heard about the percentage going to GP and primary care services. Everybody’s percentage cannot increase because, otherwise, that for some area of the health sector would have to drop. Where are we out of step, comparatively, with our EU counterparts in the context of health spending and how can it be reprofiled?

There was mention of community healthcare networks. How do these compare with the primary care settings? I presume they would be part of that. We have seen the rolling out of many impressive buildings and there is always a question regarding buy-in from GPs. We have the infrastructure in many parts but not the buy-in from GPs.

There are areas in my county and close to Galway city, for example, that would not be covered by Westdoc. This can have an impact on recruitment of GPs. The system could break down if the recruitment is not there. If we are looking to invest, should we start by ensuring that there is adequate cover for Westdoc and other regional services?

I am interested in the issue of chronic illness. Heart failure in a community setting is very often overlooked, especially in comparison with cancer, but it is responsible for one in every two hospital admissions relating to people over 65. This is heart failure as opposed to heart attacks, although the difference may not be understood by everybody in the country. Do community voluntary charity organisations feature to the fullest extent in all of this? For example, Croí in the west of Ireland undertakes really excellent work with people on a holistic approach to health. Could more be done in this regard?

Mr. O’Sullivan mentioned the long waits for scheduled care services and accident and emergency departments. We will speak at some stage about capital plans. There are areas with new accident and emergency departments, such as Limerick and Kilkenny, while areas like Galway, based on the current timeline, could be four or five years waiting for a new accident and emergency department to open. Will these infrastructural deficits have an impact on the implementation of Sláintecare? Is the timeline too long and will this have an impact?

Ms Laura Magahy

I thank the Senator and will take his questions in order. The reprofiling of health spending is very interesting. The Economic and Social Research Institute, ESRI, has just finished a benchmarking exercise in respect of where Ireland sits in the international context. It was quite difficult to do because we include disabilities, mental health and other definitions in our spending, whereas other jurisdictions do not.

I take the Senator’s point on mental health and I am very happy to say we advanced significant funding to Jigsaw during the pandemic. Jigsaw is represented on our Sláintecare implementation advisory council. We are very aware of the work it is doing.

The Senator asked about community healthcare networks and how they link with primary care settings. The community healthcare networks are really interesting from a population planning perspective. They will be able to predict the needs of a population of an average of 50,000 people and adjust the services needed for the population. The primary care centre’s role is critical in that.

The Senator asked about GP buy-in. We have a very engaged working arrangement with GPs and we meet every three weeks. We have agreed a programme of work with them that also includes looking at future strategies for GPs, especially in the terms of the topics raised by the Senator, including recruitment in a rural setting. That is a major issue for GPs. We have also agreed to fund the benchmarking and monitoring of the chronic disease management that GPs will be doing. They have kindly agreed to work in close partnership with us in healthcare pathways, which is a very interesting system. I will ask Ms Mellett to elaborate on that if we have time.

The Senator asked about relief for GPs in the context of Westdoc. We have a very interesting initiative happening this year with advance triage and this is being funded by the National Ambulance Service. If people are anxious during the night they can phone up and be directed either to a service that is local or in a hospital, with the goal being to have this staffed by GPs. We look forward to working with the ambulance service in rolling that out, as it is a very exciting initiative.

The Senator mentioned Croí, which we have funded. The work it has done on heart failure is one of the projects we have been delighted to fund. The Senator is absolutely right that this is fantastic work. It is something we will look at in terms of scaling. The example I gave during the presentation was a remote heart failure clinic that is being run by Kilkenny and St. Vincent’s hospitals. There are slots available for GPs to phone in and get a senior consultant’s advice on whether a patient is doing well. It is a case of not bringing in people as an outpatient but having the expertise available on tap. The new ways of working we have been able to explore during the year are exactly what the Senator inquired about.

I will ask Dr. Healy to speak about community and voluntary organisations, which are a key part of our engagement. We have been very fortunate to have the support of the community and voluntary sector in the work we are advocating. Is it possible for my colleagues to speak about health pathways and the community and voluntary piece?

Ms Ciara Mellett

I can give some information on the integrated care pathways. These are a means of documenting the current approach to a particular condition, set of symptoms or patient cohort. They are agreed by relevant health professionals and adopted to local circumstances. The initial focus for implementation is around the interface across primary care, community care and social care with the acute sector.

With regard to benefits, this is really about building integration between primary care and secondary care. It allows clinicians to drive service improvements. In countries where a similar approach has been implemented, they have found that not only does it help to identify the current approach but it also helps to identify gaps where services could be improved so people can work together. It allows a greater level of standardised care. This is not a one-size-fits-all approach, it is quite the opposite. A minimum standard is agreed on the basis of the resources available in each region or area. That results in a reduced variability of care, providing a better patient experience through more timely and consistent care.

The key purpose is to support GPs and others providing care in the community in order to provide more care away from the hospital setting. It gives information to GPs in order to support them in making more decisions when the patient is sitting in front of them in the general practice. I will not go into too much detail but I should say GPs are very strongly in favour of this approach and we are working with a broad range of stakeholders to try to implement this approach with our colleagues in the HSE.

Dr. Gráinne Healy

The involvement of the community team in the voluntary sector is very significant for the delivery of Sláintecare right across the board. We have seen real evidence of this with the 122 integration fund projects that have been in the process of being rolled out for over a year.

That involves local community groups such as those mentioned by the Senator. Croí was a good example. We have also been working with local mental health services and vulnerable groups that have their own representation, such as LGBT Ireland which works with LGBT people and the needs they have. Such organisations may offer care for older people or those with particular vulnerabilities. Having partnerships between medical professionals and voluntary groups is very important. It is particularly important to move towards the delivery of care as close to home as possible and in the community in order to reduce the footfall into acute settings. We have found that many people prefer to be cared for at home or with their local community supporting them. It is an important delivery. Many of the 102 projects involve really interesting new pathways for care that are delivering the right care in the right place for those people.

Mr. Dean Sullivan

I do not have much time, so I will be brief. To build on what the previous speakers said around networks and so on, as well as to reassure members regarding general practitioner, GP, buy-in and so on, there were extensive discussions with GPs and other staff groups as part of the 2019 agreement to secure their buy-in through the relevant unions. The discussions involved taking that agreement forward and the development of the networks. As my colleagues have stated, voluntary groups are an integral part of the local network arrangement. The whole point of what we are trying to get towards with populations of 50,000 is that we can do things more locally and join things up in a much more straightforward manner than one can nationally or regionally. This initiative is very positive in that space.

The Senator asked about infrastructure and whether it is limiting step in this context. Obviously, there will always be more demands for capital and resources in general than there are resources available, but I assure members that we have robust prioritisation processes in place to ensure that all the capital resources we have are directed to maximum value, such as investing in additional equipment or new buildings or tidying up existing buildings and so on. There is a process to address issues that arise. The Senator mentioned the issue of front door capacity. For a combination of reasons, that issue would receive a high rating in any prioritisation process. It would be daft for us, given the budget outcome yesterday around some of the revenue funding and so on, to have everything lined up in terms of an ability to put additional capacity on the ground but then find that we did not have the kit for staff to use or a safe, modern and appropriate building for them to work in. We work very hard to ensure the revenue and capital sides of the house are very closely aligned. One of the reasons the service planning process we will conclude in the coming weeks is being taken forward in parallel with the capital planning process is to ensure the two join up.