Enhanced community care –a worthy goal, but a lot more to do

At his appearance before the joint Oireachtas health committee meeting on 14 June, HSE CEO Mr Bernard Gloster discussed the benefits of the enhanced community care (ECC) programme. The purpose of the ECC programme is to increase community health services and reduce pressure on hospital services.

Mr Gloster said the investment in clinical frontline staff for the programme was “unprecedented”.

According to the HSE CEO, there are a total of 2,643 whole-time equivalents (WTEs) with the programme, which represents 76 per cent of the overall 3,500 posts approved.

He pointed out 94 of the 96 community healthcare networks (CHNs) and 47 of 60 community specialist teams (CSTs) for older people and chronic disease are operational. The remainder are expected to be in place by year-end. Also, 21 community intervention teams have been rolled-out.

Mr Gloster stressed the benefits of the programme are now being seen.

There were 22,266 patient contacts made by the integrated care programme for older persons CSTs in the first four months of 2023. Some 64 per cent of those people were discharged home, 6 per cent were admitted to acute hospital, and 1 per cent were admitted to long-term care. Mr Gloster added 29 per cent of these patients remain engaged with the teams. “Those are very significant indicators of success, given what was originally planned,” he said.

Some 91 per cent of patients with chronic disease are now fully managed routinely in primary care and are not attending hospital for ongoing management of their chronic condition. GPs are referring any patients who cannot be managed within general practice to the CSTs for chronic disease – 28,362 such patient contacts were made from January to April 2023. Community diagnostics were responsible for 136,852 radiology scans between January and May 2023 and just over 253,000 in 2022. The CEO said this resulted in “significant reductions” in referrals to hospital services.

Mr Gloster stated he has set “a specific requirement for this September to flex the ECC model to provide an interface with both public and private nursing homes to improve hospital avoidance and to support post-hospital discharge”.

“This will be a new departure for primary care services. This high-level view of the ECC programme demonstrates a significant opportunity for the future and we are focused on ensuring this valuable resource has both short-term and long-term benefit to the reform of healthcare delivery.”

While further care in the community is a worthy goal, and in line with Sláintecare principles, there continue to be significant obstacles. In this edition of the Medical Independent, the CEO of Tallaght University Hospital Ms Lucy Nugent highlights the continued deficit of step-down facilities and requisite staff within the community, which is contributing to delays in discharging patients from hospital.

GP capacity continues to be an issue. It is likely to remain so, even with the investment announced as part of the €130 million agreement between the IMO and the Government on the extension of GP visit card eligibility.  Our lead feature also outlines the concerns about transitions of care between hospital and the community, and the ‘inappropriate’ transfer of workload onto GPs. 

While the progress detailed by Mr Gloster is welcome, there should be no doubt that the journey to enhancing care in the community has only begun.