Minister's health service proposals for UK applicable to Ireland?

[patslatt]

Alan Milburn,UK Health Secretary 1999 to 2003,was highly respected by most UK politicians. His opinion on the current set of controversial health care reforms is in the Times February 8th article "I want reform but this health bill is a disaster" (subscription only) Key points paraphrased:
1.Chronic illnesses like diabetes and smoking and alcohol related illnesses require an emphasis on primary care and on prevention.
2.Budgets should increase the proportion spent on primary care and reduce it on hospitals.
3.Integration is needed between GPs,hospitals and community health and social services to prevent people being passed from pillar to post.
4.Decentralisation and autonomy to make the frontline take ownership and responsibility can only be done by devolving power locally.
5.Payment to health care providers should not be based largely on quantity of procedures but on quality,with an emphasis on keeping patients healthy and out of hospitals.
6.The NHS monopoly needs to be reduced,with increased emphasis on private and voluntary providers,though competition may be not be appropriate for every service.
7.Patients should have their own state-funded health care budget so that they can buy services efficiently across the system,which would require transparency across the system on those services and their costs.

Should these proposals be adopted in Ireland? As for the points above:
1.AFAIK,despite the emphasis by the former HSE CEO Dr Brendan Drumm on primary care group practice,little was done. Are Irish doctors so individualistic they can't work together or is it a reluctance to provide a 24 x 7 service? That suggests a change in incentives and fees in favour of primary care,with the funding to come out of the huge potential savings in hospital budgets in the shift to primary care as proposed in 2 above.
2. See latter.
3.Integration of Department of Social Welfare's services for people experiencing illness and for support in the community in old age could result in efficiency savings. It would be easier to integrate with group practices than individual GPs but the major challenge could be developing computerised records of patients. The reluctance of doctors to computerise should be penalised with admin charges to process paper records.
4.The experience with Irish health boards which became local political fiefdoms for councillors and sources of crony employmant do not favour this suggestion. Ireland may be small enough in population to consider the whole country as a single decentralised unit! That said,autonomy and operating flexibility in hospitals and group medical practices should be allowed within budgetary constraints. Incentives should be given to encourage efficiencies,instead of directing savings in efficient hospitals to inefficient ones. Instead of giving autonomy to full service hospitals serving small populations,they should be shut down and their staff transferred to hospitals experiencing heavy demands and overcrowding.
5.A continuous mass advertising campaign on healthy living could be more effective than preaching from doctors. Advertising people are good at motivating consumer behaviour. Ads knocking the fast food and soft drinks industry's role in the obesity epidemic are overdue,regardless of the industry's employment.
6.The proposal for private hospitals setting up on the grounds of public hospitals in Ireland would have increased competition but maybe there are enough private hospitals already to undertake the limited range of procedures they find financially viable in competition with state funded hospitals. Also,there was a risk that those private hospitals would have taken so much business from public hospitals as to undermine their finances.
7.This budget amounts to an imaginative form of rationing,which Mr Milburn believes is inevitable. Given the inefficiencies of the HSE compared to the parsimonious and cost conscious NHS,rationing will become extreme in Ireland,likely the typical rationing by queue for free government services (hopefully not a 100 yards long!).

[drzhivago]

Alan Milburn,UK Health Secretary 1999 to 2003,was highly respected by most UK politicians. His opinion on the current set of controversial health care reforms is in the Times February 8th article "I want reform but this health bill is a disaster" (subscription only) Key points paraphrased:
1.Chronic illnesses like diabetes and smoking and alcohol related illnesses require an emphasis on primary care and on prevention.
2.Budgets should increase the proportion spent on primary care and reduce it on hospitals.
3.Integration is needed between GPs,hospitals and community health and social services to prevent people being passed from pillar to post.
4.Decentralisation and autonomy to make the frontline take ownership and responsibility can only be done by devolving power locally.
5.Payment to health care providers should not be based largely on quantity of procedures but on quality,with an emphasis on keeping patients healthy and out of hospitals.
6.The NHS monopoly needs to be reduced,with increased emphasis on private and voluntary providers,though competition may be not be appropriate for every service.
7.Patients should have their own state-funded health care budget so that they can buy services efficiently across the system,which would require transparency across the system on those services and their costs.

Should these proposals be adopted in Ireland? As for the points above:
1.AFAIK,despite the emphasis by the former HSE CEO Dr Brendan Drumm on primary care group practice,little was done. Are Irish doctors so individualistic they can't work together or is it a reluctance to provide a 24 x 7 service? That suggests a change in incentives and fees in favour of primary care,with the funding to come out of the huge potential savings in hospital budgets in the shift to primary care as proposed in 2 above.
2. See latter.
3.Integration of Department of Social Welfare's services for people experiencing illness and for support in the community in old age could result in efficiency savings. It would be easier to integrate with group practices than individual GPs but the major challenge could be developing computerised records of patients. The reluctance of doctors to computerise should be penalised with admin charges to process paper records.
4.The experience with Irish health boards which became local political fiefdoms for councillors and sources of crony employmant do not favour this suggestion. Ireland may be small enough in population to consider the whole country as a single decentralised unit! That said,autonomy and operating flexibility in hospitals and group medical practices should be allowed within budgetary constraints. Incentives should be given to encourage efficiencies,instead of directing savings in efficient hospitals to inefficient ones. Instead of giving autonomy to full service hospitals serving small populations,they should be shut down and their staff transferred to hospitals experiencing heavy demands and overcrowding.
5.A continuous mass advertising campaign on healthy living could be more effective than preaching from doctors. Advertising people are good at motivating consumer behaviour. Ads knocking the fast food and soft drinks industry's role in the obesity epidemic are overdue,regardless of the industry's employment.
6.The proposal for private hospitals setting up on the grounds of public hospitals in Ireland would have increased competition but maybe there are enough private hospitals already to undertake the limited range of procedures they find financially viable in competition with state funded hospitals. Also,there was a risk that those private hospitals would have taken so much business from public hospitals as to undermine their finances.
7.This budget amounts to an imaginative form of rationing,which Mr Milburn believes is inevitable. Given the inefficiencies of the HSE compared to the parsimonious and cost conscious NHS,rationing will become extreme in Ireland,likely the typical rationing by queue for free government services (hopefully not a 100 yards long!).

Agree with a lot of above Pat BUT

• Difficult to compare Ireland and UK as each hospital here is its own fiefdom in comaprison to UK where Lage majority are NHS
• Primary CARE in UK is 90% + NHS - primary care in Ireland is 70% + private which means they pay for their own IT secretaries etc
• Health messages in school currciulum probably more useful than adverts or doctor preaching but it would be a long term payoff rather than short term political win so unfortunately less likely to happen

[patslatt]

Agree with a lot of above Pat BUT

• Difficult to compare Ireland and UK as each hospital here is its own fiefdom in comaprison to UK where Lage majority are NHS
• Primary CARE in UK is 90% + NHS - primary care in Ireland is 70% + private which means they pay for their own IT secretaries etc
• Health messages in school currciulum probably more useful than adverts or doctor preaching but it would be a long term payoff rather than short term political win so unfortunately less likely to happen
  

On the above points:
-Irish hospitals may be their own fiefdom but he who pays the piper can insist on reform and efficiencies.
-Are you suggesting Irish PCTs and hospitals need government funding for the IT systems necessary for integration of PCTs,hospitals and social welfare support systems for patients?
-Some effort is being made in schools on diet. Pupils in primary schools and maybe secondary are forbidden to bring junk food into schools and some nutritious meals are provided. Eating habits formed early tend to persist for life,as in the old saying "if it's gruel you were raised on,it's gruel you want".