LIFE IN THE ACUTE HOSPITAL SECTOR Prof.Orla Hardiman Dept.Neurology Beaumont Hospital

Population health triangle 5% 15% 80% Undiagnosed disease Healthy population with risk factors Disease Severity

THE PATIENT JOURNEY Inefficient Poorly Coordinated Bad geographic access Reactive funding

Use of hospitals

THE NEED FOR REFORM We tried everything, but it still wont work! IRISH We all the usual methods but it still wont work! We tried everything, but it still wont work!

CHALLENGES TO REFORM Power struggles Weak governance

Power Struggles Department and HSE Sections within HSE Managers and clinicians Who is in charge? Who should be in charge? Clinical judgement and standardized care Who is accountable?

Weak Governance Hospital management Clinical work practices HSE Structure Process v outcomes?

SOLUTIONS Good governance Accountability New debate over public and private

Good governance

Accountability

Public and private Co-location? Cui bono?

HOW TO GET THERE.. START THE DEBATE The time is now…