On his appointment as Director of Quality & Clinical Care for the HSE, Barry White (BW) introduced a number of clinical programmes and initiatives, with the aim of improving the quality and cost-effectiveness of patient care. His intention was to involve clinicians in decision-making in the HSE, as this was perceived to have been very successful with the Cancer Control Strategy. The programmes were initiated through engagement with the relevant training bodies and follow a structured approach determined by BW, with a clinical lead, a working group, regional representatives and an advisory group nominated by the relevant training body. Each programme must develop a workable plan which, when approved by BW, will be given to the Regional Directors of Operations of the HSE for implementation. The programmes are also intended to facilitate direct communication between front-line clinical staff and HSE senior management through BW.
Initially, the programmes related only to chronic disease management, as this accounts for most of current healthcare spending; examples included the COPD and Stroke/TIA programmes. BW then set up “overarching” programmes, the first of which was Acute Medicine. Critical care (CC) was also given a specialty-specific programme. BW asked for a representative from IAEM/ ACEMT for the AM programme and I was nominated on behalf of EM. There have been a number of meetings between the AM working group and IAEM/ACEMT/INBCEM since the AM group started in March this year. The plan for AM is still in draft format but is being circulated to the AM advisory group and will be subsequently shared with EM.
BW had initially intended to develop an EM programme as part of his second phase of change implementation but revised this decision and invited EM to participate in an overarching programme in the past couple of months. I believe that a number of factors and the recent crises in EM may have contributed to this. The key importance of EM became more apparent as the AM programme progressed and EM was also asked to support the CC programme. The NCHD recruitment catastrophe and the ongoing overcrowding problem have focussed attention on our specialty. BW accepts that expansion in Consultant numbers in Emergency Medicine is crucial to improving the quality of service patients receive in our departments. The programme’s objectives are yet to be finalised but are likely to include developing models for future Consultant staffing, driving the implementation of the six hour target, integrating service development with the AM and Critical Care programmes and implementing the recommendations from other programmes which are relevant to EM e.g. management of acute coronary syndrome.
BW met IAEM/ACEMT/INBCEM a couple of weeks ago and I was asked to lead the EM programme, in part because of my involvement in the AM and CC programmes. In line with other programmes, a working group will be set up with regional leads from our specialty, along with nursing and pre-hospital care representatives, and possibly other representatives, though this has not been finalised. An advisory group will be drawn largely from IAEM/ACEMT, with the intention of ensuring that every region in the country is represented. The programme groups are not intended to be exclusive, but given the amount of work to be done many other Consultants in EM may be called upon to contribute to particular work-streams. The programmes objectives have to be refined and I expect the working group will commence in early July, with a deadline for the first draft of a plan within a couple of months.
There are no guarantees as to the success of this programme. I can only share the assurances that I have been given. This is about developing an implementable plan, not writing another report. There is potential for expansion in consultant numbers and there is real commitment to improving the quality of care in our EDs. It is recognised too that although the programme is expected to make recommendations as to how overcrowding might be eliminated, it is not within the remit of the programme, nor is it the responsibility or within the power of Emergency Medicine to resolve this problem. Furthermore we will be expected to produce models consistent with the realities of reconfiguration.
This programme is going to be challenging, but I hope that everyone will be willing to help and I have no doubt that, as a team, we can realise significant achievements through participation in this programme. This is for our patients and our specialty.
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