The pandemic has been the greatest national challenge in any of our lifetimes. It has required unprecedented social, economic and justice measures. It has meant a collective reprioritisation and a multitude of sacrifices. In no other forum has this been more acute than healthcare.
While everyone on this island has their own unique experience of the pandemic, the coalface has been in the acute and primary care settings where Ireland’s healthcare professionals have been labouring to diagnose, treat and discharge the thousands of people who have been worst affected by the virus.
To cope with the never-before-seen pressures of the COVID threat, many health care professionals (HCPs) have been redeployed. In doing so, their attention has been drawn away from chronic conditions and illnesses which are prevalent in Irish society.
The prioritisation of COVID patients over other conditions has meant the suspension and cancellation of patient care and screening for all manner of illness including life threatening conditions, creating a huge backlog. In March, the Irish Hospital Consultants Association estimated the waiting list caused by COVID at approx 900,000 people. For a country and health service that has struggled for decades with waiting lists, it is hard to fathom how the system will cope when ‘normal’ service can be resumed.
While the Health Service Executive (HSE) and government have described the COVID crisis and the necessary increase in Health funding as an opportunity to reimagine how we deliver healthcare in Ireland, others have described funding as insufficient and reform measures unimplementable, like trying to service a moving vehicle.
Insufficient recruitment levels in key patient facing roles, postponed upskilling of existing staff, a lack of acute hospital beds and better diagnostic equipment are just some of the key issues at the heart of the problem.
The Sláintecare reform programme – the 10-year plan for long-term healthcare reform – is supposed to provide answers through increased staffing levels and a shift towards more community-based care delivery. This is aimed at creating efficiencies which should free up acute care facilities to tackle the waiting lists. However, the infrastructure and the resource levels are not in place to have any sort of significant impact in the short term.
These reforms may now be delayed even further because of COVID, which begs the question, what changes can we expect in Ireland’s health landscape in the aftermath of a global pandemic that has changed everything?
Home Care Reform: The majority of those in need of care due to age or illness have long expressed that they would prefer to stay at home rather than move to a care facility. 2020/21 has exposed many of the failings of grouping this cohort in care facilities. The only way to alleviate this pressure is to introduce a statutory scheme for home care. For nearly a decade, work has been ongoing to develop a home care regime (akin to the current Nursing Home Support Scheme) but is yet to materialise.
This is a substantial body of work as any regulatory framework for home-support services must ensure that all service-users are provided with a standard, high-quality level of care, which is safe, effective, and person-centred. It is intended that, subject to Government approval, this framework will comprise primary legislation, minimum standards, and national standards. The demand for home care will be significant and there will be opportunities for private companies who can meet the standards and attract quality carers as the public sector will not be capable of meeting demand.
Pharmaceutical Industry: In recent years, an impasse has existed whereby the pharma industry has expressed frustration with a decision-making process for drugs approvals which many view as opaque and inefficient, while the HSE contends its role is to scrutinise efficacy and deliver value for money for the tax payer. Since introducing the Health (Pricing & Supply of Medicines) Act 2013, the HSE has sought to minimise its exposure to expensive new medicines, questioning and rigorously testing the cost efficacy of new drug approvals and uses for new indications.
This has created tension but the COVID-19 context may be slowly improving that relationship. The vital importance of vaccines to Ireland’s ‘opening up’ strategy has meant a renewed recognition of the role that pharma companies play in society, paving the way for a possible thawing in the relationship and early signs of a spirit of renewed collaboration. With the pricing and supply agreement between industry and the Government due to be updated later in 2021, the negotiations will act as a litmus test for how the access environment is likely to look in the coming years.
Public Private Integration: Private hospitals must become “an integrated part” of the whole healthcare system. This is the opinion held by HSE CEO Paul Reid. While Sláintecare envisages a single universal, free-at-the-point-of-access health service, the route to this single system is complicated with many competing interests. While the pandemic experience has shown how private hospitals can be integrated into the public setting, the extent to which this can happen successfully will be vital to overcoming the challenges in healthcare, beyond COVID.
Telemedicine: People of all ages have become far more accustomed to virtual communications, meaning that telecare / virtual care could become commonplace. This has the benefit of avoiding bringing patients into hospital settings, decreasing the chances of illness or infection. Consultants could also conceivably increase their patient load provided that the technological infrastructure is in place to service this need. Telemedicine and remote clinics that otherwise would have been discussed, piloted and reviewed for years, just happened overnight. It is likely that many aspects of patient care including follow up appointments will happen remotely.
Brexit: The Northern Ireland Protocol creates a unique opportunity for Northern Ireland to establish itself as a logistics distribution centre for premium regulated goods requiring access to both the UK and EU. This is particularly advantageous for medical device, medicine and other pharmacology companies. With new supply routes being established between Ireland and mainland Europe this may become a new home for many companies involved in providing
If you would like to discuss how any of these reforms may affect your company or organisation, please get in touch.