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Budget 2022 and health priorities
Health measures in Budget 2022
Budget 2022 identifies “immediate actions to address waiting lists” as the most urgent health priority for next year, before implementing a long-term multiannual plan for waiting lists in both hospitals and community health services.
While Budget 2022 provided more than €1.1 billion for the expansion and modernisation of the health service, delivery was impeded by the Covid-19 surge last winter and the subsequent HSE cyberattack in May 2021. Consequently, not all the measures planned for 2021 will be delivered by the end of the year.
Regardless, the additional funding provided during 2021 has been again made available for 2022. Indeed, an additional allocation of €1 billion, including over €300 million for new measures, has been added for 2022, increasing overall core funding allocation for current expenditure to over €20.4 billion.
Referencing the pandemic as “the greatest challenge that has ever faced our health system”, Minister Donnelly asserts that Budget 2022 is a demonstration of the Government’s commitment to deliver universal healthcare.
Identifying his most urgent priority in 2022 as “taking immediate action to address waiting lists which are unacceptably high at present”. As such, the Department of Health, the HSE, and the National Treatment Purchase Fund are collaborating on a multiannual waiting list plan which will seek to resolve the backlog associated with the Covid-19 pandemic and align waiting lists with Sláintecare objectives.
Another priority he emphasises is investment in women’s health, which will be boosted by an additional €31 million in 2022. This will fund the phased introduction of free contraception, beginning with women aged from 17 to 25, as well as measures to address period poverty and expand clinics for endometriosis and menopause.
Credit: Merrion Street
BUDGET 2022: Advancing Sláintecare
ACCESS AND CAPACITY
➤ €10.5 million for 19 additional critical care beds in 2022. ➤ €8 million to modernise and build capacity of the National
Ambulance Service. ➤ €22 million for additional Winter
Plan measures.
QUALITY
➤ €36.5 million for clinical governance system measures. ➤ Implementation of phases two and three of the Safe Staffing
Framework. ➤ Funding to expand the advanced nursing and midwifery workforce to a target of 2.3 per cent of the total nursing and midwifery workforce in 2022. ➤ Implementation of the Nursing
Home Expert Panel recommendations.
AFFORDABILITY
➤ €45 million provided into 2022 to advance the Sláintecare objective of health services moving to free at the point of delivery provision, based entirely on clinical need. ➤ Expansion of access to free GP care to children aged six and seven years. ➤ Expansion of dental access to medical card patients. ➤ Reducing the monthly threshold for the Drug Payment Scheme from €114 to €100. ➤ Moving on a phased basis to reducing hospital charges for those aged under 18 years.
Disability
Meanwhile, Minister of State with responsibility for Disability, Anne Rabbitte TD outlines that Budget 2022 allocated a further €65 million to the €2.2 billion disability budget, inclusive of €10 million for one-off Covid measures. This, the Minister of State noted, would enhance the delivery of supports and services for disabled people, including the recruitment of therapists and administrative staff in support of the 91 Children’s Disability Network Teams, alongside increases in digital health technologies, respite houses, personal assistant hours, and residential places for disabled people.
With a total allocation of €1.15 billion in Budget 2022, mental health will receive an additional €47 million (€24 million for new developments, €13 million for existing services and €10 million for once-off Covid funding) next year.
Mental health and older people
Minister of State with responsibility for Mental Health and Older People, Mary Butler TD remarks: “This investment will ensure significant developments in mental health services next year… New mental health services for older people will also be developed, in line with the model of care for specialist mental health services for older people and will be piloted next year.”
Detailing the Budget’s €2.33 billion allocation to older people services, which includes €30 million for new developments, Butler explains that this will specifically facilitate:
• funding totalling €150 million for five million additional hours of home support in 2022;
• an increase in the new home support hours that are ringfenced for people with dementia from 5 per cent into 2021 to 11 per cent in 2022; • further improvement in dementia services, as well as the implementation of the dementia registry and dementia audit within acute hospitals and the national intellectual disability memory service; and
• the implementation of the Covid-19 Nursing Homes Expert Panel
Report recommendations.
Sinn Féin spokesperson David Cullinane TD
Announcing a €16 million investment in new measures to in support of Healthy Ireland and the National Drugs Strategy and €13 million of Covid funding, Minister of State with responsibility for Public Health, Wellbeing and the National Drugs Strategy Frank Feighan TD outlines specific initiatives for 2022 which include “a healthy weight campaign, an innovative coordinated approach to encourage physical activity through Sport Ireland and the HSE, and funding for the expansion of the HSE’s pilot online STI testing programme”. 4
Reaction
Welcoming the health allocation in Budget 2022, the Irish Nurses and Midwives Organisation (INMO) praises proposed spending on women’s health, “including the long-underfunded National Maternity Strategy”, as well as Sexual Assault Treatment Units, and mental health, disability, and hospice services.
However, the INMO indicates that it would seek greater clarity on several areas including the number of nurses and midwives to be recruited by the end of 2022, the Safe Staffing Framework in Nursing, and the number of additional CAO places that will be allocated to nursing and midwifery.
Meanwhile, having acknowledged the additional funding for health in Budget 2022, the Irish Medical Organisation (IMO) asserts that it will not be
Resource allocation for the health vote group in 2022
CORE COVID NRRP TOTAL
sufficient given that around one million patients were on a waiting list at the end of 2021, one-in-five consultant posts are vacant, and there are only three hospital beds per 1,000 of the population.
Equally critical, Sinn Féin spokesperson on health, David Cullinane TD remarks: “It is clear that the Government does not realise the scale of the challenge in health, and this budget falls far short of what is needed to tackle waiting lists, invest in public hospitals, and bolster community healthcare.”
Likewise, Labour health spokesperson Duncan Smith TD suggests: “Budget 2022 will be a disappointment for many people in Ireland, particularly those with additional care needs. It’s clear that this government will do nothing to tackle the huge systems failures within the health service… There is no vision for community based primary care and moving treatment outside the acute hospital setting.”
Keeping track of the Covid-19 vaccine
GS1 standards are helping to ensure that Covid-19 vaccines get efficiently and safely to patients at Central Vaccination Clinics, writes Siobhain Duggan, Director of Innovation and Healthcare, GS1 Ireland.
Almost immediately after the world learned that Covid-19 vaccines existed, a question arose: what is the best way to ensure their efficient and safe distribution? This is the sort of challenge where GS1 standards can, and do, play a critical role. GS1 barcodes can be used globally to identify Covid-19 vaccines uniquely and securely as they move from manufacturing sites through complex distribution networks to points of administration. During the last year, the team at GS1 Ireland worked closely with the Health Service Executive (HSE) to help ensure the safety of Covid-19 vaccines.
It was important for the National Immunisation Office (NIO) that no dose was wasted and that batches of vaccine could be tracked to the point of vaccination. Following an intensive design phase with the HSE project team, two software applications were developed: ScanVax and TrackVax. ScanVax was installed on over 1,000 PCs across the country to allow for the receipt of vaccines. By scanning the barcode on each of the vaccine boxes, vaccine information is then uploaded to the national vaccine administration system. This means that vaccinators can select the correct batch when administering the vaccine. TrackVax has been installed in all CVCs across the country. This allows the CVC teams to identify, label, track, and report on the vaccines in their centres, allowing a much easier vaccine reconciliation process locally and nationally. Both solutions are provided by GS1 Ireland.
“The feedback on TrackVax from the Senior Management Teams and the High Level Taskforce has been really positive in terms of enabling visibility of vaccine usage and it has been recognised that TrackVax has made a significant contribution to the efficient rollout of the Covid-19 vaccinations across Ireland,” says Lucy Jessop, Director of Public Health, HSE National Immunisation Office. TrackVax is now running in nearly all 43 Centralised Vaccination Clinics. A barcode scan of each vaccine records the critical data, including its batch and the exact time a vial is to be discarded. Prior to the introduction of TrackVax, the discard time was handwritten on the vials, a time-consuming process that also posed a medication safety risk.
“Traceability is a key part of managing the vaccine process. The use of barcodes has been very beneficial, and it is evident that while it has saved time and resources, more importantly it is giving time back to clinicians while providing accurate information for decisions. Patient safety is key and TrackVax has been a real enabler in this case,” says John Swords, National Director of Procurement, HSE. The excellent data quality from TrackVax provides the NIO with oversight of vaccine usage, logs accurate stock level data, and keeps waste to a minimum. Looking forward TrackVax has been operational since 3 March 2021. The software has enabled the tracking and management of nearly four million vaccine doses, as of December 2021, or nearly 50 per cent of Ireland’s vaccination programme. TrackVax has been widely accepted across CVCs and has delivered value to the HSE through medicine safety, vaccine tracking, operational efficiency, and programme integrity. The next step is to provide ongoing traceability support for the rollout of the Covid-19 vaccine in Ireland and, in time, for other vaccines.
GS1 licences the most widely used system of supply chain standards, serving more than two million public and private sector organisations worldwide. T: 01 208 0660 E: healthcare@gs1ie.org W: www.gs1ie.org/healthcare Siobhain Duggan, Director of Innovation and Healthcare, GS1 Ireland
Time for a medical workforce strategy
A comprehensive and coordinated approach to the medical workforce is needed to secure the future of our health service writes Leo Kearns, Medical Council CEO.
For the past two years, healthcare providers and institutions in Ireland have had a tumultuous time, navigating the uncharted waters of the Covid-19 pandemic. While there have been many steep learning curves, the dedication of tens of thousands of healthcare staff to meet the challenge of delivering care to their patients and the wider community in such difficult circumstances has been truly outstanding.
This experience has once again reminded us that our health service is fundamentally dependent on the people who work in it. Quite simply, without high-quality healthcare staff, at all levels and in all disciplines, it is not possible to have a high-quality healthcare service. While the pandemic may have refocused attention on the challenges faced by healthcare staff, the reality is that issues relating to workforce and staffing long predate the arrival of Covid-19.
The primary role of the Medical Council, as the regulatory body for the medical profession, is to protect the public. While there is perhaps a general perception that this only refers to the Council’s responsibility to investigate complaints against doctors, the Council’s actual role is much broader and relates also to registration, education and training, maintenance of professional competence and ethical and professional guidance; all of which play a very significant role in protecting the public. In the context of this broader role, the Medical Workforce Intelligence Report, published by the Medical Council, provides essential information regarding the make-up of the Irish medical workforce. The 2019/2020 Report highlighted issues that affect Ireland’s doctors including excessive working hours, resourcing issues, workplace bullying, consultant vacancies, doctor training numbers and the need for a greater focus on doctor wellbeing.
24,720 doctors retained their place on the Medical Council’s register as of June 2020, while 1,135 doctors withdrew voluntarily from the register in 2019, of whom 382 doctors were graduates of Irish medical schools. The main reasons cited for voluntary
withdrawal were resourcing, excessive working hours, lack of respect, personal and family reasons, retirement, costs of professional indemnity and registration, inflexibility of the registration model and in 2020, reasons associated with the impact of the Covid-19 pandemic.
There has long been a positive history of Irish doctors moving to work abroad for a period and returning to work in the Irish healthcare system, which then benefits from that enhanced experience. However, it is concerning that despite having a relatively high number of medical school graduates by international standards, the Irish healthcare system is still significantly dependant on recruiting doctors from around the world to fill staffing gaps and who in the main are not in a training programme. Recent changes to legislation to remove the barrier to access training for non-EEA qualified doctors are very welcome, but more needs to be done in this regard.
The Medical Council’s annual Your Training Counts survey provides insights into the experiences of trainee doctors and interns in the Irish healthcare system and examines working conditions, experiences of bullying, retention and career plans, and the health and wellbeing of doctors on training schemes.
Overall, the results of the latest Your Training Counts survey have been broadly positive, and in some areas, we have seen improvements on recent years. The latest survey was carried out in 2019 and 2020, so although it captures the timeframe of the outbreak of the Covid-19 pandemic, interns and trainees largely reported feeling safe in their workplace, having good general and mental health, and their selfreported quality of life is similarly positive and improving year on year.
However, significant issues do remain, including bullying and harassment, and working excessive hours. While the percentage of trainees who reported experiencing bullying has decreased since the previous survey, it remains far too high. An environment where bullying or intimidation is tolerated creates conditions where an adverse event is more likely, with the consequent implications for patient safety.
Long working hours are associated with burnout and stress and increase the likelihood of involvement in adverse events, thereby negatively impacting patient safety. It is therefore necessary to ensure that the European Working Time Directive (EWTD) is followed in all clinical settings. Furthermore, compliance with EWTD is necessary in addressing retention and attrition rates and ensuring the wellbeing of doctors and high-quality, sustainable patientcentred care.
These are challenges that must be addressed as they impact directly on patient and professional safety. Patterns highlighted in previous reports are repeated in 2019 and 2020 and will continue to do so in the future unless there is a commitment to collective, coordinated and planned action across stakeholders.
There is no simple or single solution to the problems faced by the medical workforce. We must address the systemic issues impacting our doctors, so we can truly protect patients, and support our medical workforce.
What is clear is that we need a comprehensive medical workforce strategy for our country, one which addresses critical immediate issues and also plans for the next 10 to 20 years. This needs to be part of a broader healthcare staffing strategy to meet the needs of an integrated, multi-disciplinary model of care for patients. It is only by working collectively with all stakeholders that we as a country can make real positive changes in healthcare delivery in Ireland and ensure continued highquality care for our patients.
Leo Kearns is Chief Executive Officer of the Medical Council, appointed in May 2021.
Previously, Kearns was Chief Operating Officer of VHI Health and Wellbeing DAC from 2019 to 2021. He was Chief Executive of the Royal College of Physicians of Ireland (RCPI) from 2006 to 2018 and National Lead for Transformation and Change for the Health Service Executive (HSE) from 2013 to 2015. Kearns was heavily involved in the development of the National Clinical Programmes and played a key role in the development of Clinical Directors within the Irish health sector. He played a major part in the introduction of Professional Competence Schemes for doctors and was instrumental in founding the Forum of Irish Postgraduate Medical Training Bodies. Kearns holds a master’s degree in organisational behaviour from Trinity College, Dublin.
E: info@mcirl.ie W: www.medicalcouncil.ie
health report €77 million Winter Plan unveiled
The Health Service Executive’s Winter Preparedness Plan was belatedly published in early November 2021, pledging over €77 million to deliver on Winter Plan funded initiatives, as well as the implementation of 2021 Service Plan aims such as the delivery of 205 acute beds over the winter.
Of the €77 million dedicated to Winter Plan specific measures, the two initiatives receiving the most funding will be the increasing of acute services purchased from private capacity (€20.16 million) and the funding of transitional care for older persons (€20 million). Most notable among the supports to be implemented during the winter of 2021/2022 from the 2021 Service Plan are the addition of 205 acute beds, 1,100 private bed days per week, 275 community beds and 100 additional private community beds.
The full year 2022 cost of the Winter Plan will be €77,051,157 overall, with the costs broken down into four basic categories. In line with government priorities under continuing efforts to progress Sláintecare reforms, community services are the most wellfunded of these categories, receiving €41,654,978, 54.1 per cent of the total. Acute services will receive €29,345,777 (38.1 per cent); the National Ambulance Service will receive €5,700,402 (7.4 per cent); and €350,000 (0.45 per cent) will be pledged towards communications. Aside from the additional beds to implemented as part of the 2021 Service Plan, the winter of 2021/22 will also see the expansion of the ECC Programme, circa 4,000 GP diagnostics per week and the addition of 2.7 million home support hours available “in the context of pressures caused by unfunded price increases” as part of the Service Plan. The five priorities for the winter, as outlined in the plan, are: building capacity; pathways of care; testing and contact tracing; population health; and vaccinations.
New initiatives to be rolled out to ensure the meeting of these priorities include the implementation of new community based models of care; the introduction of new roles such as ED phlebotomists; the expansions of the Pathfinder Frailty model; additional emergency Placement, Respite and Complex Packages of Care; and the identification and targeting of those who have not yet been vaccinated with a communications campaign addressing hesitancy.
With the number of beds in both critical care and general acute care a major talking point and point of criticism of the Government’s recent Budget 2022 due to its addition of just 19 additional ICU beds, the plan includes Covid-19 demand and capacity modelling. Broken down into conservative and pessimistic scenarios, the modelling predicts the need for between 43 and 89 or between 152 and 164 critical care beds in conservative and pessimistic scenarios respectively. The 19 additional beds will bring the total to 340; in January 2021, when there was a capacity of 348 due to the leasing of private beds, occupancy peaked at 330.
Between 119 and 313 general acute care beds will be needed in the conservative scenario, with between 513 and 615 needed in the pessimistic scenario. Before the announcement of Budget 2022 and the recent uptick of Covid-19 cases, the Irish Medical Organisation (IMO) had stated that the number of critical care beds in hospitals would need to be doubled. “The fragility of our health services was exposed during the pandemic and had it not been for exceptional efforts of doctors, and other professionals across the country and huge temporary financial support, the services may have collapsed entirely,” IMO President Ina Kelly said in September 2021.
“As it is, the services have been severely weakened and patients are being forced on to ever-lengthening waiting lists which should shame a leading EU state.”
Upon publication of the plan, Minister for Health Stephen Donnelly TD said: “I particularly welcome the enhanced focus on service restoration in disability services, mental health, services for older people and social inclusion care groups. I fully support the HSE’s commitment to improve Patient Experience Times, particularly in terms of keeping everyone safe while we respond to Covid-19.”
However, the IMO has labelled the plan “inadequate”, pointing to the pressure that the healthcare system was under at the time of its launch in terms of both bed capacity and staffing. Kelly said: “This plan was launched at a time when we have only 21 ICU beds available in the country. Every doctor and healthcare worker is working beyond capacity right now and it is untenable that they are being asked to face into a winter with insufficient support.
“We have 700 vacant consultant posts meaning huge extra pressure on those consultants we do have. We have NCHDs working excessive and illegal hours putting them under enormous strain, and we have GP services facing unprecedented demand from patients. The capacity is simply not there to meet demand and it is not all Covid-related.”
An additional 16,000 hours whole-time equivalent was approved in the 2021 Service Plan “for a comprehensive range of new initiatives”, but just 10,716 were taken on, with an additional 3,200 staff recruited for vaccination and contact tracing. Further criticism has surrounded an apparent lack of clarity as to how the staffing increases still needed given the failure to meet this target will be met, with no details offered in the Winter Plan.
2021 SERVICE PLAN
• 1,152 acute beds (795 open) • 73 sub-acute beds (all open) • Circa 1,100 private bed days per week • 551 community beds planned (276 open) • Access to 572 private community beds (472 currently contracted) • 96 EEC networks planned (15 networks in place YTD) • 85,315 diagnostics accessed by GPs • 5 million additional home support hours (2 .3 milion used YTD) • Full population coverage for CIT services SERVICE PLAN SUPPORTS TO BE IMPLEMENTED DURING WINTER 2021 – 2022
• 205 acute beds
• 1,100 private bed days per week • 275 community beds • 100 additional private community beds • ECC programme expansion • Circa 4,000 GP diagnostics per week • 2.7 million additional home support hours available in the context of pressures caused by unfunded price increases
The future of the Irish Blood Transfusion Service
The Irish Blood Transfusion Service’s (IBTS) Chief Executive, Orla O’Brien talks to eolas about the ongoing challenges posed by the pandemic, the organisation’s strategy, Connections That Count, published in 2021, and Research and Development Lead Allison Waters outlines the key elements of the first ever R&D strategy devised by the IBTS.
As the pandemic rolls on, the IBTS has continued to provide blood and blood products to the Irish healthcare system. This has been incredibly challenging, and we have been in real difficulty meeting hospital demand on occasion. We imported RhD blood from the NHSBT in June as ongoing restrictions and social distancing requirements on donation clinics made it increasingly harder to meet our collection targets. Many venues previously used to run clinics were too small to allow for adequate social distancing and some venues were no longer available to us because the hospitality industry was effectively dormant. This meant we were relying on the same cohort of donors to keep the blood supply going. In October, we initiated a targeted appeal to replenish the blood supply as we were in very real danger of having to advise hospitals to start cancelling elective surgery that may require blood support.
“Despite the Covid-19 crisis I was keen that we finalise our strategic plan and Connections That Count was approved by the Department of Health in May 2021,” says O’Brien. “This Strategy is an exciting development with a vision for the IBTS in five years time that will transform the organisation. Work commenced on implementing strategic initiatives in early 2021 and we will continue to deliver on our strategic objectives over the coming years.
“It has a strong emphasis on initiatives that will strengthen innovation and people development. One of the services the IBTS is focusing on is the re-establishment of the Irish Eye Bank, the project plan for this complex project was developed in consultation with healthcare partners and approved in Q3 2021. Delivering a project of this scale will take some time, however it is expected within the lifetime of this strategy, the IBTS will be in a position to launch the national eye bank for Ireland, facilitating a safe and sustainable supply of corneas procured in Ireland for use in cornea transplants.”
The National Donor Screening Laboratory in the IBTS undertook a benchmarking exercise with My Green Lab, an organisation that aims to introduce sustainability to the communities responsible for the world's life-changing medical and technical innovations. The IBTS is committed to introducing sustainable best practice throughout the organisation and utilised the services of My Green Lab to commence work on this. On the basis of the benchmarking exercise, the NDSL introduced a pilot project to improve some of the practices in this area with the aim of rolling it out to other departments in 2022.
In developing Connections That Count, the majority of feedback from our donors
was that they would like to have an online appointment system. Our donors donate not just their blood but also their time and so it's important to us to make the donor experience as efficient as possible. We are tying this in with our sustainable objectives as we work towards a digitalised environment. We are aiming to remove the need for paper forms on our clinics by Q2 2022, donors will be able to use a tablet to complete the health and lifestyle questionnaire before progressing with their appointment. In addition, we aim to have an online appointment system available before the end of 2022, this will mean donors will be able to make appointments themselves either on their laptop or phone without the need to speak to one of our customer service agents. Of course, that option will still be available for those donors who prefer to use the telephone.
The IBTS is undergoing somewhat of a transformation, there is an emphasis on innovation, agility and improving the experience of our people and our customers. In 2021, an innovation working group was established in the IBTS and in 2022 it will be progressing an action plan with a series of initiatives aimed at embedding innovation in the organisation. The action plan is very much aligned to the Public Service Innovation Strategy, and we look forward to implementing innovation initiatives and building capacity for innovation, research, and development in the IBTS.
There is also a renewed focus on R&D so that the IBTS “can do its own research and development providing an Irish context on transfusion medicine,” according to Allison Waters.
“In April 2021, the IBTS published its first-ever dedicated research and development strategy outlining the role of research in maximising the ability of blood and tissue donation to improve the health of patients,” she explains. “The organisation is committed to providing the evidence-base from which to build future improvements to its blood and tissue services. Research engagement will be supported at all levels throughout the organisation, thereby capitalising on previously untapped expertise of personnel, and clinical and academic colleagues, and ultimately positioning the IBTS as a key research leader in the field of blood donation and transfusion.”
The research and development strategy is underpinned by three core objectives: “Research engagement will be supported at all levels throughout the organisation, thereby capitalising on previously untapped expertise of personnel, and clinical and academic colleagues, and ultimately positioning the IBTS as a key research leader in the field of blood donation and transfusion.”
1. To gain a deeper understanding into the dynamics of the donation process. Insights into the factors motivating and preventing people donating blood will drive improvements to blood collection policies, testing algorithms and clinical guidelines.
2. To future-proof the service in relation to changing technologies, blood demands and blood component usage, thereby optimally serving all transfusion and transplant recipients. Specifically, the development of novel cellular solutions to disease management requires translation from the research benches to large-scale production using good manufacturing processes.
3. To position the organisation as a key research leader in the field of transfusion medicine through participation in national and international networks, and through collaboration with clinical colleagues, international blood services and commercial partners for research endeavours and clinical trials.
The effective implementation of research best-practice, a clear research governance structure and a supportive research culture has begun the creation of a positive and innovative environment for all personnel engaging in research. Over the course of 2021, the IBTS have contributed to 10 peer-reviewed publications and presented their research findings at numerous international and national conferences. The newly formed R&D department also further developed its research profile through collaboration on six different international studies alongside international blood establishment partners.
In 2021, research investment was directed to supporting public health monitoring by investigating the progression of the SARS-CoV-2 epidemic in healthy donors. The SARSCoV-2 antibody profile was investigated through each infectious wave and following the rollout of the vaccination programme. Furthermore, European funding supported the production high titre Covid convalescent plasma, which successfully enabled the production of plasma from Irish donors for the firsttime in over two decades. Other research focused on profiling the red cell antigens in the Irish donor population providing baseline Irish blood group data. Investigations on blood components gained insights into the mechanisms impacting the function and activation of cold-stored platelets, as well as red blood cell oxygen saturation.
The focus for the immediate future is on effective research communication and building on the innovative research culture foundations laid throughout the past year. The team aims to design and launch a research, learning, and development website, targeted at clinical, scientific, and academic professionals. In addition, the IBTS will lead on a future-focused blood donation and haematology research symposium. Lastly, they will continue to build on their research publication strengths in epidemiology and component production.
W: www.giveblood.ie
Next decade care costs will require billions
The Government will need to substantially increase its expenditure on primary, community, and longterm care by 2035 to meet rising costs and population growth and ageing, an ESRI report has found.
Projected nominal expenditure growth by health and social care service, 2019–2035
General practice
Public health nursing*
Occupational therapy*
Physiotherapy*
Speechandlanguagetherapy*
GMS/DP/LTI
HT
LTRC 2019 2035
Homesupport
500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 Expenditure (€m)
Projected nominal expenditure growth under the central scenario. *Provided through HSE Primary Care services. Source: ESRI
The need for increased expenditure will be largely driven by the cost of delivering care, specifically pay-related costs, the report, which projects expenditure in health and social care from 2019 levels out to 2035, found.
Designed to help inform policymakers on which parts of the health and social care system should be prioritised for investment and where policies should be focused to contain cost pressures, the report suggests that up to €12 billion could be needed to fund primary, community, and long-term health services over the next 14 years. A range of factors and pressures including population changes, healthy ageing, government policy measures and pays costs will affect the scale of the increase needed, with overall projections ranging between a low of €4.4 billon to a potential high of €12 billion.
Analysing four services, it estimated the largest cost increases will be: public and private GP services and public health nursing and community care; high tech-medicines dispensed in the community; long-term residential care; and home support services. The report’s authors find that “continuing current trends will lead to expenditure growth on high-tech medicines and long-term residential care that far exceeds that of general practice and home support in the medium term”.
The increased cost of providing care is identified as the largest driver of projected expenditure growth of between €1.6 billion and €2 billion in public and private general practice by 2035. The report implies a 2.9 per cent to 4.5 per cent average expenditure increase.
A 6.1 per cent to 10.5 per cent average annual increase in high-tech medicines reflects a continuation of high recent growth in demand and comes at an estimated expenditure increase of between €2.3 billion and €4.4 billion in 2035.
Population ageing is the key driver of projected expenditure increase in public and private long-term residential care of between €3.8 billion and €5.7 billion in 2035. The costs imply a 4.3 to 6.9 per cent average annual expenditure increase.
Finally, the ESRI follows the Sláintecare recommendation that a statutory home support scheme be established and predicts a 4.4 per cent to 10.4 per cent average annual increase requirement to meet a projected public and private home support requirement of between €1.2 billion and €3 billion in 2035.
“Changes in the cost of delivering care, particularly pay-related costs, is the main driver of expenditure growth. In addition, population ageing, and additional modelled demand for hightech medicines and the assumed introduction of the statutory home support scheme, are key drivers of expenditure growth. Identifying approaches to address the projected increases in the unit cost of care delivery should be an important consideration of policymakers,” the report states.
A modern and dynamic nursing and midwifery regulator
Essene Cassidy, President of the Nursing and Midwifery Board of Ireland (NMBI) talks about the role of the regulator, modernisation and adapting during the global pandemic.
As the regulator for more than 80,000 nurses and midwives in Ireland, NMBI’s mission is to protect the public and the integrity of the professions through the promotion of high standards of education, training, and professional conduct. We maintain a Register of Nurses and Midwives and a Candidate Register for students.
As we enter the final year of our Statement of Strategy 2020-2022, we will continue to ensure we can adapt to the evolving global healthcare environment and regulate effectively, while upholding the highest standards. Our focus remains on professional development and competence, engaging more with registrants and stakeholders, and the continued digitisation of the organisation. We also remain committed to building trust and to ensuring our role as a regulator is understood.
Development of our new strategy will begin in 2022 and we are more aware now than ever of the need to provide leadership to registered nurses and registered midwives.
Modernisation at NMBI
NMBI is dedicated to the implementation of our digitisation agenda. Every nurse and midwife practising in Ireland must be registered with NMBI and the annual process of renewing registration is taking place online for the second year running.
As well as streamlining the process for registrants the new online portal MyNMBI also allows for the collection of data which assists us in our work to maintain standards and associated public safety and contribute to workforce planning. This is more relevant than ever with the rollout of Sláintecare in the years ahead.
Since the start of the pandemic NMBI has moved speedily and dynamically to embrace new technology. As a board we showed agility, as our meetings continued without disruption. Our complaint management process also moved online or to hybrid format to ensure hearings could continue. Witnesses can give testimony from anywhere in the world now without having to get on a plane or into a car.
Embracing change for all stakeholders
Engagement with stakeholders, and in particular our professions, has never been better. NMBI does a huge amount of work in collaboration with key stakeholders around setting standards, supporting practice initiatives, and promoting quality care provision by nurses and midwives. A key example I recall is the removal of the requirements for collaborative practice agreements (CPAs) for nurse prescribers. This change has allowed our nurse prescribers to become autonomous practitioners. We also worked with the Department of Health on the advanced practice policy and revised the Advanced Nurse Practitioner pathways.
Pride in my colleagues
On behalf of the board, I would like to acknowledge the challenges faced by nurses and midwives since the Covid19 pandemic began and express our appreciation for the valuable contribution they have made in treating patients and maintaining ongoing healthcare services. Nursing and midwifery professionals in all their roles have always been able to adapt to change. For generations, new ideas have been embraced and welcomed, all with the sole aim of improving outcomes for our patients. When the Covid-19 pandemic struck, once again we saw our nurses and midwives adapting to change in all care settings. It has been a difficult time for many, but the dedication and compassion of our professions shone through and continues to do so. It fills me with enormous pride to witness this incredible commitment to care.
T: 01 639 8500 W: www.nmbi.ie
Capital spending in health
Capital spending on health accounted for 10.4 per cent, or €1.084 billion, of the €75 billion allocated under the National Development Plan in 2021. Capital spending on health will amount to €5.7 billion in the first five years of the renewed NDP.
Of the 10 national strategic outcomes included in the renewed NDP, released in October 2021, number 10 pledges the Government’s commitment to “access to quality childcare, education and health services”. Under this heading, the expansion of primary and community care in line with Sláintecare reform goals is the key health goal mentioned, a goal that will require sustained capital spending on health around the State in order to localise health infrastructure.
In its sectoral strategy section for health, the NDP states that the Sláintecare Implementation Strategy “identifies capital investment as a critical enabler of the reform proposed” and that “capital investment has a key role to play in enhancing service provision, ensuring the delivery of high quality and safe health and social care” such as the delivery of the recommendations of the Health Capacity Review, the eHealth Strategy for Ireland, the National Maternity Strategy 2016-2026 and a host of other government plans.
Over the full course of the NDP, 20212030, the plan says health capital investment will be “based on needs to enhance service provision, enable reform in the sector and the ongoing need to address patient safety and regulatory requirements”; from 20212025, the investment will be focused on “patient safety, regulatory requirements” and will “provide the foundations for reform in the sector”.
Projects outlined as priorities in health spending from 2021 to 2025 include: eHealth and ICT investment programmes (estimated between €50 million and €100 million); the new Children’s Hospital campus at St
Project
Cybersecurity enhancement
CHI, EHR and ICT improvements
Integrated Financial Management System
Children's Hospital and Tallaght Hospital
Oncology units in Galway
Dublin Beaumont Phase Two
St James's
Acute bed capacity projects
Status Estimated cost
Not given €250 million-€500 million
In progress €50 million-€100 million
In progress €50 million-€100 million
Construction stage with commissioning completion in 2024 Over €1 billion
Construction completion in 2024 €50 million-€100 million
Construction completion in 2025 €50 million-€100 million
Preliminary design
In progress €50 million-€100 million
€500 million-€1 billion
Primary care centre construction
Enhanced Community Care Programme In progress
In progress
Replacement and refurbishment of Community Nursing Units In progress
Equipment Replacement Programme
Infrastructural Risk Programme In progress
In progress
Ambulance Replacement Programme In progress
Ambulance Base investment
Mental Health Capital Programme In progress
In progress €100 million-€500 million
€100 million-€500 million
€500 million-€1 billion
€100 million-€500 million
€100 million-€500 million
€50 million-€100 million
€50 million-€100 million
€100 million-€500 million
James’s and the second outpatient department and urgent care centre at Tallaght Hospital (over €1 billion); radiation oncology units in Galway, phase two of Dublin Beaumont construction and St James’s redevelopment (all €50 million-€100 million); acute bed capacity projects (estimated €500 million-€1 billion); and the construction of primary care centres (estimated €100 million-€500 million).
Health service capacity will, given the context of the Covid-19 pandemic, be the most high profile of the reforms funded through the NDP, but it is an area of the plan where details are light. The plan states that the building of dedicated elective centres in Dublin, Cork and Galway is currently being progressed for consideration through the Public Spending Code and that “these facilities will provide high volume, low complexity procedures on a day and outpatient basis, together with a range of ambulatory diagnostic services”.
The plan also states that additional capacity has been delivered since the publication of the Health Service Capacity Review in 2018, but that “further beds in line with overall requirements and informed by regional requirements will be required to be provided in the period to 2030”. In 2018, before the pressures of the pandemic, the Health Service Capacity Review stated that an additional 2,590 hospital beds would be required between 2018 and 2031; the plans within the NDP do not seem to address this need.
Indeed, amongst the most costly and common of the health priorities for the period 2021-2025, many appear to be refurbishment and replacement schemes that while providing necessary updates to Irish health and its technologies, will not increase capacity. It has been well documented that the National Children’s Hospital will not add significant capacity to the health system, but other projects such as the replacement and refurbishment of 88 community nursing units to regulatory compliance are estimated to cost €500 million-€1 billion. Continued maintenance of the current ambulance fleet is set to cost €50 million-€100 million with no added capacity. Both the Equipment Replacement Programme, which will update diagnostic equipment, and the Infrastructural Risk Programme, which focuses on fire and electrical safety as well as emergency supply, carry estimated costs of €100 million to €250 million. The National Maternity Hospital project, which will add capacity to the health system, is estimated under the plan as costing €20 million-€50 million, which indicates that its construction will likely not commence until after 2030, with the majority of the capital spending related to the project happening then.
While the capital spending on modernisation efforts within the health system are no doubt worthwhile and necessary, aside from the Children’s Hospital, the plan shows a bias towards replacement buildings, equipment, ambulances and investments in eHealth, which raises the question of the amount being spent. The €5.7 billion of capital spending allocated to health from 2021-2025 account for approximately 5 per cent of the total health spend in that period. When the capacity issues facing the health system are taken into account, the lack of projects similar to the Children’s Hospital in scale, but with the key provision of enhancing capacity, seems a glaring omission.
A modern hospital with medieval foundations
There’s a remarkable yet reassuring dichotomy story writ large in the annals of St John’s Hospital in the heart of Limerick city today. It is of an old hospital, Limerick’s oldest, that dates to darker days of even more deathly epidemics, such as cholera, typhus, and typhoid.
A creaking and capacity strained 99 bed hospital of narrow corridors and constricted rooms, its 20th century constructs mixing with old limestone remnants of the original 15th century Walls of Limerick. Yet, for all its reminders and challenges of past, it’s a hospital very much of the present and with a definite focus on the future, and it’s a hospital that still puts the patient at the centre of everything. walls, but the remarkable thing is that, in contrast with those ancient surrounds, it’s a hospital of innovation. A hospital breaking new boundaries, meeting new needs with new approaches and practices and all with a ‘patient first’ approach.
Then again, St John’s has always been about meeting the greatest medical demands of the day, right from its very foundations in 1780 when Lady Hartstonge responded to the needs of the destitute in Limerick by creating the first ‘fever hospital’ in Ireland (or Great Britain for that matter), fitting out the old ‘guard house’ with beds and whatever essentials she could get to help the helpless.
As epidemics evolved, so too did the hospital; the take-over of it by the Little Company of Mary sisters in 1888 enhancing care and operational standards. The raison d’être of the order, physically caring for the poor, sick, suffering and dying people in our midst, was an imperative for the time.
Through the decades it met, struggled with, and saw off pretty much everything that was thrown at it, not without pain and loss but always with courage and resilience. Much of the 500-year-old city defence walls may have gone but St John’s remains at the frontline of health responses, finding new ways for innovation.
It was such last year when Covid hit, turning the clock back to origins of the ‘fever hospital’. The words of its CEO Emer Martin in a short video documentary titled House of Courage synopsises this latest heroic frontline siege of the Limerick hospital: “There's a lot of history behind these walls, but so much of it is about the courage of St John’s and the people who come to work here every day. It was that way in 1780 and it's still that way today.”
It’s a hospital, the only acute voluntary hospital still standing in the city centre, that’s always served the people of Limerick well, has always put them first in return, St John’s has a special place in the heart of Limerick people, as borne out by patient feedback to this day. As is often said locally, “everyone has a St John’s story”.
It’s the proverbial underdog that never gives in, using whatever resources it can
In fact, it’s flourishing in a classroom in the Old Medical School, otherwise the ground-breaking Rapid Innovation Unit (RIU). The Science Foundation Ireland sponsored unit uses 3D printing and other engineering pathways to find live patient-centric solutions, as explained by the unit’s Director, Leonard O’Sullivan, who works on the project with Kevin O’Sullivan, Research Lead and Aidan O’Sullivan, Technical Lead.
“We just saw potential benefit from having a natural innovation unit between a hospital and university, working with clinical stakeholders in University of Limerick Hospital’s Group to identify unmet needs from patient quality of life perspective,” he says. “It was really important to move out of the university and embed this into the hospital setting and St John’s has been a great partner in this. We are using 3D printing to be able to innovate and create the novel medical devices of the future and get them onto patients as quick as possible.”
One of the many examples of this ‘living lab’ at work is resolving catheter issues for a teenager who had cystic fibrosis. “The child had a feeding tube into the stomach that had a problem. It resulted in the child being unable to feed successfully. It just took 24 hours to design a solution, get it made on-site and put it on the patient. The child would not have been a good candidate for surgery because of the medical condition so that was a really good outcome.”
He adds: “We’re throwing away shackles of old-fashioned manufacturing methods. What we have in St John’s is a pilot to demonstrate this. It’s a ‘factory in a box’. The digital element is important. We identify the opportunity with front line staff and then digital manufacturing kicks in.”
The old hospital’s ability to meet today’s needs is also reflected in how it is dealing with one of the biggest threats to patient care everywhere today: infection control. The appointment last year of a new Director of Nursing, Michelle Burke, to also take on the role of Director of Infection Control, the only hospital in the country to twin these roles, reflects just how seriously St John’s is taking on the threat.
“The first day I walked on the ward I thought the beds are so close, the rooms are so tight but what it does is it makes us sharper. It’s managed so well by our staff that infection rates here are very, very good. For example, CPE bug rates are high in the Mid-West, yet our infection rates are so low. We work hard at it. That’s the way it is here. When things are hard, people get on with it. No matter what we do, patient care is at the centre of it.”
Andrew Scott’s contribution in setting up a regional service in respiratory care is another example of how St John’s is a patient-first hospital. “My goals since I have started in July 2020 are to develop a Respiratory and General Internal Medicine centre of excellence. I have from the beginning had excellent support from the senior management in St John’s Hospital. Everyone here is enthusiastic to develop St John’s into something we can all be proud of,” he says.
“Recently we have initiated a lung function lab in St John’s which will provide basic respiratory tests to the patients of the region which is something that was greatly missing over the years for patients in St John’s. We’ve also introduced the indwelling pleural catheter (IPC) service for managing malignant pleural effusions, which is another first for patients in the region. “Internationally this is now recognised as a first line option for the management of malignant pleural effusions. The patient can normally go home the next day. We train family members to look after patients at home following this very simple procedure, allowing patients to have more control over the management of their own care in the later stages of their diagnosis and to have more time with their loved ones.”
Some 240 years after Lady Hartstonge’s intervention, St John’s is still putting patients first and finding innovative new ways to care for them.
Emer Martin, CEO, St John’s Hospital
St John’s Hospital St John’s Square, Limerick, V94H272 T: (061) 462 222 W: www.stjohnshospital.ie
DASSL: A technical infrastructure to support access, sharing, storage and linkage of health data
Simon Wong Orna Fennelly
Covid-19 has highlighted the importance of and accelerated the demand for high-quality health data for policymaking, practice, and research. Ireland has a poor track record in this regard and in a recent OECD report1 ranked last for secondary use and availability of health datasets. Ireland is also one of only two countries not regularly linking datasets for research, statistics, and monitoring.
Across the Irish health services, barriers to data sharing and linking datasets have included siloed datasets, inconsistent application of existing legislation, the need for new enabling legislation, concerns, and different interpretations over data protection. Added to these barriers, minimal use of unique identifiers and the lack of a formal and secure infrastructure to integrate, link and support remote access to data for secondary purposes, including for research, has led to valuable projects being inordinately delayed or in some cases abandoned.
Internationally, similar barriers have been overcome. To protect individuals’ privacy while driving benefits from routinely collected, statistical and survey data, national Health Data Platforms have been developed, most notably in the UK, Australia, Canada, and Finland. A similar model has been proposed for Ireland by the Health Research Board (HRB2); DASSL, or, data access, storage, sharing, linkage. The DASSL model aims to provide a single point-of-access to researchers and data controllers to facilitate linking of health data in a safe and trusted manner, with patient anonymity secured at all times.
The Irish Centre for High-End Computing (ICHEC), along with collaborators from the RCSI, HSE, and TCD, was awarded funding from the HRB to develop the proof-of-concept (PoC) technical infrastructure for DASSL. Hosted by NUI Galway and supported by DFHERIS, ICHEC is Ireland’s national centre for high-performance computing (HPC), providing e-infrastructure, services and expertise to higher education institutions, industry, and the public sector.
Objectives
A key objective of the work ICHEC is undertaking with the PoC is to develop a prototype technical infrastructure for DASSL and test it using synthetic health data. The final report will provide recommendations gathered during the PoC and from key stakeholders which will inform the development, technical infrastructure requirements, operations, and governance of Ireland’s future Health Information Systems. The overall objective of which is to improve healthcare and public health and wellbeing.
The proposed model
Overall, the DASSL model includes several components to facilitate safe and secure access, sharing, storage and linkage of health and related datasets as outlined in Figure 1.
Governance
Access, sharing, storage and linkage of national health data requires a lawful basis, clear security and data protection policies and procedures, and governance boards. While this PoC will only use synthetic data, the national roll out of a solution that processes real health and related datasets will necessitate legislation, significant investment, public consultation, appropriate governance structures and various project approval boards (e.g., Research Ethics Committee
Figure 1: DASSL Model
approval, declarations from the Health Research Consent Declaration Committee, access requests via a Research Data Governance Board). These processes are under review by the Department of Health as part of a reform of Ireland’s Health Information System.
Stakeholder involvement and engagement
In addition to close engagement with the HRB (the commissioners of this project), other key stakeholders have contributed to the planning and development of the DASSL PoC, including the formulation of use cases. This includes representatives from the Department of Health, the HSE, public and patient representatives, HIQA, researchers, and data controllers. It is clear that ongoing public consultation including a Public Advisory Board will be critical to the success of any model taken forward. Openly sharing of the results of research projects using national data will also be crucial to promoting use of these findings for public trust and enhancing public benefit.
SAIL Databank (Wales) Use Case2
By linking GP care data, emergency hospital admissions, prescriptions and asthma deaths together with geographical and socioeconomic deprivation areas from 2013 to 2017, an asthma study found that people from deprived areas in Wales have worse outcomes and increased risk of death. This was then used to inform new policies to combat inequity.
Research Support Unit
The Research Support Unit (RSU) plays a pivotal role in facilitating researchers from the conception of a project idea, support in conducting the research and managing any research output. As the point-of-contact for researchers, the RSU staff require in-depth knowledge of the datasets to assess whether a research project is feasible, prepare linked pseudonymised datasets for researchers (with the data minimisation GDPR principle in mind) and assess any research outputs to ensure privacy is preserved prior to export. The RSU role also includes managing a catalogue of datasets.
Technical operation
A key principle that underpins the operation of the DASSL model is that only the data custodians store (a) personally identifiable information such as names, addresses and (b) the 4
1. https://www.oecd-ilibrary.org/docserver/55d24b5d-en.pdf?expires=1632828042&id=id&accname=guest&checksum=17313F06FC4DAB502633A51CBDF16130 2. https://saildatabank.com/wp-content/uploads/Annual_Report_2020_21.pdf 3. https://www.hrb.ie/fileadmin/publications_files/Proposals_for_an_Enabling_Data_Environment_for_Health_and_Related_Research_in_Ireland.pdf
Loretto Grogan, Office of the Nursing and Midwifery Services Director, HSE.
corresponding medical/clinical/health data. They are split at source into Dataset A and Dataset B and sent to the Trusted Third Party (TTP) and the Health Research Data Hub, respectively. Datasets can then be linked, prepared, analysed and any research output vetted by the following components of the system.
Trusted Third Party: where records are linked
The TTP is a trusted team of people or an organisational unit who conduct record linkage using personal data (Dataset A) received from data custodians. Linking individual records between datasets is critical for reassociating a person across their healthcare pathway to produce useful insights, and the establishment of a TTP for this purpose is common practice internationally. Again, the explicit separation of personally identifiable information from corresponding health data ensures that only the data controllers have both sets of information and thus helps ensure privacy. The TTP then shares encrypted linkage keys with the Data Hub.
Health Research Data Hub: where data is prepared
This is a tightly controlled data storage and processing platform to prepare datasets for researchers. It receives the variables of interest to the researcher (Dataset B) that are already pseudonymised (i.e., personally identifiable information is stripped and replaced with a random identifier). Using linkage keys from the TTP, the same individual can be linked across the different pseudonymised datasets. These datasets never store any personally identifiable information and are stored for only as long as required in line with GDPR. Access is highly restricted to operations staff (e.g., the RSU) who need to prepare datasets for researchers.
Safe Haven: where data is analysed
A locked down, secure research environment supports virtual access to the pseudonymised project data by approved researchers. Once a researcher is securely connected to this environment (following a stringent access request and approval process), data is prevented from being imported/exported and outgoing internet access is disabled. The researcher is provided with the required analytical software to process the requested datasets. Once the researchers have completed their analyses, any output that needs to be exported (e.g., for publication) is placed in a folder for output checking before being released.
Output checking
The research findings that the researchers want to export from the Safe Haven are assessed for statistical disclosure control by the RSU. This ensures that the data released does not contain any information that could reidentify individuals.
Outlook
There is a huge demand for a national technical infrastructure to support safe and secure analysis of linked datasets both in Ireland and internationally. Increased momentum of initiatives such as the European Health Data Space and associated EU legislation to support the coordination of international data sharing will also require Ireland to be able to facilitate secondary use of data for public benefit. The DASSL PoC, commissioned by the HRB and delivered by ICHEC will report its findings at a critical time to inform actions to shape a fit-for-purpose Irish health information ecosystem, with a clear policy intent to optimise the use of health and social care data for secondary purposes, and informing the associated governance, legislation and investments required. The ultimate aim is to enable a better, evidence-informed health system and stimulate research and innovation to improve healthcare outcomes and the wellbeing of the population.
T: 01 529 1042 E: info@ichec.ie W: www.ichec.ie
IACP celebrates 40th anniversary
In 2021, the Irish Association for Counselling and Psychotherapy (IACP) celebrated its 40th anniversary. For 40 years, the IACP has been promoting safe and effective counselling and psychotherapy in Ireland.
Fromauspiciousbeginnings, when the inaugural meeting was held in a basement in Dún Laoghaire in 1981, the IACP has become themost prominent and leading body of counsellors and psychotherapists in Ireland. We now have over 4,700 members,andour membershipcontinuesto grow.The years 2020/2021 werechallenging; our organisation, no different to any other, was significantlyaffected by the pandemicand had to moveitsoperations online.Like countless others,wehad torapidlyadapt to this shiftingparadigm,and we took advantage of theavailable technology.
To celebrate this momentous year, we hostedour40thanniversary campaign. This consisted of a public awareness campaign andan onlinepublic event. The awareness-raising campaign aimed to promote our excellent Find a Therapist function on iacp.ie. This tool facilitates potential clientstoconnectwith accredited IACP members.Our first online public event,Essential Conversations with IACP, was aresounding success. Essential Conversations featured host Blindboy Boatclub, and moderated discussions in featured panels on body positivity, parenting, sports and mental wellbeing, and inclusion and diversity. Each forum featured panellists such as Colman Noctor, Dublin football’s Shane Carthy, and Síle Seoige. The IACPand our PR company,Fuzion Communications, werenominated for Best Technology Innovation for this event at therecentDigital Media Awards 2021.
Continuing with our publicawareness raising and lobbyingwork to increase accessibility to counselling and psychotherapy,welaunchedourPreBudget Submission (PBS). This is a vital tool for an organisation to communicate their wants to government ahead of the publication of the following year’s budget and we publish one yearly. This year, in keeping with ourmove to embrace technological advances, we also called on our members to engage via adigital advocacy platform where they could send emailsdirectlyto their Oireachtas representatives.
In our 40 years, we have witnessed the expansion and evolution of our professionand the increased discourse around mental health, particularly during this pandemic period. These are very positive developments and our requests to the government in our PBSarereflective of this trend. We aresimply seeking parity of esteemwith other health professionals. The implementation of our requests would have multiple benefits. Tax relief, if fully extended to counselling and psychotherapy, would not only make therapy more affordable,itwould also further endorse the profession and solidify the view thatgoodmental health isof the utmost importance to us all. Further details of our submission are available on our website.
From our modest beginnings in Dún Laoghaire 40 years ago, we have seen a remarkable change in public attitudes towards counselling and psychotherapy. We have been instrumental in changing these views. Inevitably, there is more work to be done, and persistent campaigning is one such means of achieving our goal. Thefirm beliefthat all people should have access to regulated,high quality andprofessional counselling and psychotherapy servicescontinues to propel us forward.The IACPbelieves that counselling and psychotherapymust bean integral part of healthcare provision,and we will continue tolobby and advocatefor the realisation of this vision.
T: 01 230 3536 E: ceo@iacp.ie W: www.iacp.ie
Technology and innovation report
