Thread by @niallotuathail

*Thread* No ambition for reform of our health service from Fine Gael. Here's what their plan should say. 1. We cannot keep going as we are.

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Our population is ageing, there are large differences in how long people live for based on income inequality and access to health.

Hospital is not always the best place to give care. It contributes to infection and loss of independence. We need much more care locally...

... particularly for people who are frail and elderly and need many different types of care that is well co-ordinated.

When people do need hospital, there are large differences between hospitals in how likely you are to survive life-threatening illness.

This is because we do not have of each illness to provide every specialisation in every hospital safely. Doctors just don't have the #s of..

complex patients to build and maintain skills. For these types of care (including the critical A&E care) we must reduce the numbers of...

... hospitals that provide these services. It saves money - yes, and a lot of it - but more importantly it saves lives.

Continuing to pretend we can safely provide every speciality in every hospital and not having political courage to lead is killing people.

Technology has transformed almost every industry except health. We must invest in eHealth. Lots of great opps to improve care & save money

Our buildings are not fit for purpose. We need to use hospital sites better & we need better facilities out of hospital. Needs investment.

This isn't an annual funding issue. We spend one of the highest per capita in world on health. But we do need to spend money to save money.

All this combined is why we cannot keep going as we are. 2. What should we do about it?

Sláintecare, the plan for reforming our health service is the only show in town. It is a long-term plan but needs short-term implementation!

It would provide much more care in the community, taking pressure off hospitals and avoiding the need to build new ones.

I've been part of implementing similar plans in England and Scotland & this is what we do. 1/ We build a clear understanding of different...

... types of health and social care users (e.g., frail elderly, serious mental health, adults with long-term conditions) and we research...

... what they need rather than what we currently provide. Focuses the system on prevention, maintaining independence, reabling people...

... we also look at who can provide this care. Not just doctors, nurses and social workers but peer workers, physios, home help, carers...

... we aim to do as much care as we can preventatively and locally. Once we max that out, we design the hospital system around it. To have a

safe hospital service you need to have a big enough local population so that staff build skills, safe travel times for critical care, and...

enforced clinical standards twith HIQA being able to close services if people are dying unnecessarily (which does not happen right now)

For the vast majority of services that people need regularly, this means your local hospital will be safe. But for some complex and rare...

cases (a tiny % of all healthcare), this should mean you will need to go a specialist hospital for the safest possible care.

But politicians will not allow this to happen, not aware or (worse) aware and afraid of losing votes, meaning people die unnecessarily.

With the added insult to injury that we spend amongst the highest in the world on healthcare for a poor system.

We need to have a big and detailed conversation about A&E. Everyone who appears at an A&E is not the same. Most people who appear at an A&E

... need fairly basic care that can be provided by a minor injuries unit or urgent care centre in a local hospital or primary care centre..

"Closing an A&E" doesn't need to mean this goes from small hospitals. But for serious trauma (car accidents, knife wounds, etc.) we need...

... specialist A&E / Major Trauma centres. The amount of support services needed for this service goes way beyond the staff in A&E. Even if

we had more money, we couldn't hire enough staff to safely fill rotas. We need to concentrate the # of hospitals that provide A&E.

The same logic holds for stroke services, vascular, cancer, complex maternity, paediatrics, burns. We are killing people by not doing this.

Even after hospitals are completely redesigned you would still get most of your care locally. Services would improve & it would cost less

For the services that change, we need a better ambulance service (including helicopter) to get people in rural areas to care quickly.

That was we need to do. 3. How do we do it? Implementing a major reform programme like #Sláintecare is hard work.

A former NHS leader I work with said she used to be a foot taller before led a major reorganisation of services in London

It's also boring work & a grind. Not sexy work for politicians who prefer to cut ribbons on new hospitals & get headlines for right reasons

It starts with clinical engagement. Getting your clinical leaders and frontline staff having a common view on the reasons why things can't

stay the same. Everyone knows we can't but not everyone agrees why. It needs to be fact based and can't put a spin on it.

Once you have the case for change, you understand the population and design the care models (discussed above), with clinicians leading...

way on this work and engaging directly with public and politicians to give public confidence to the work.

Once you know what you want to do, and you have public and political backing, it gets messy. There are lots of organisations across health &

social care and you get into a complex web of who plans and delivers what at national, regional and local work. It needs people to overcome

decades of working in silos, not getting along with each other, being pulled in opposite directions. If you don't have good reasons for

doing this work, the process won't survive this part. But it is possible!

We also need to support the new ways of working with supports that every team will need (workforce planning, tech, buildings) and need to...

sort out how budgets and accountability will work in new system. Then you go live, inevitably with teething problems but you hold the line.

And vóila, a functioning public health system - something most developed countries have achieved. I wish I saw that in FG note *End Thread*