An Assessment of the Public Policy Implementation of Integrated Care in Ireland

Abstract

This presentation argues that Integrated Care Policy has become well defined in Ireland in the past 5 years. The Health Services Executive (health administration body) working on the Department of Health's Primary Care Policy (Quality and Fairness 2001) have produced an array of policy documentation and an impressive Integrated Services Model from 2010 to date. Concomitantly, there has been an state commitment to: de-institutionalize most disabled people; provide Community Mental Health Teams across various population sub-groups in identified catchment areas; provide 570 Primary Care Teams nationwide to be delivered in approx 300 Primary Care Centres and the provision of falls prevention clinics, urgent day care centres and other clinics dealing with such acute problems as COPD, Diabetes and other conditions. The emphasis is on delivery of health and social care at the closest point to the client, at primary and community care levels. Also, information systems, discharge planning, disease prevention and health promotion at the primary care level, with strong communication and integrated working systems across all levels, are part of the vision. However, these exciting developments have been stalled by various factors: dramatic falls in government health spending since 2011; political interference in the designation of priority areas for Primary Care Centres; the laissez faire approach to wait for private consortia to build Primary Care Centres under more favourable economic circumstances; a lukewarm response by many doctors in the context of cutbacks to the Primary Care Reimbursement Scheme; the information gap in professional and educational mindsets and their failure to conceptualize how integrated care works, let alone, believe in the pressing need for its introduction and the failure of the term Integrated Care to be 'marketed' to the public or even to those in the established health and caring professions. At the level of practical delivery to high risk groups such as those with disabilities, mental illness, patients with acute diseases and older people, there are many enlightened medics and professionals who chart a practical course for the implementation of integrated care, most notably Prof Des O'Neill (Tallaght Hospital) and Eithne Fitzgerald (National Disability Authority), the Irish Medical Organisaiton, The Irish College of General Pracitioners, Alzheimers Ireland and John Saunders of the Mental Health Commission. International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-116966 – http://www.ijic.org/ 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 2 The presentation finishes with suggestions as to what might be done to convert the worked out plans for integrated care provision, and strong commitment to its introduction by the HSE and many enlightened professionals, in to a health and social care reality for patients and clients, working from the insights for action at a the policy and practice levels, arising from the above.