Enhancing Resilience in the Irish Health System During Economic Contractions
The Resilience Project conducted at Trinity College Dublin focused on fortifying the Irish health system amidst economic challenges. The project aimed to identify strategies to protect health resources, manage scarcity, pursue reforms, and anticipate future crises. Three key pillars of health system resilience were outlined: financial resilience, adaptive resilience, and transformatory resilience. Findings highlighted failures in protecting vulnerable populations, the need for efficiency in resource allocation, and constraints on management capacity for change.
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Building Resilience into the Irish health system Steve Thomas Director and Associate Professor Centre for Health Policy and management
Recession Severity Index 2008-2009 120 100 80 60 40 20 0 Spain Turkey Malta Latvia Hungary Portugal Greece Netherlands Ireland Italy Finland Slovenia Denmark France Cyprus Norway Sweden Romania Bulgaria Austria Luxembourg Estonia Slovakia Belgium United Kingdom Lithuania Czech Republic Germany Trinity College Dublin, The University of Dublin
The Resilience Project Resilience of the Irish Health System: Surviving and utilising the economic contraction Duration: Oct 2011 March 2014 Initial Collaboration: Centre for Health Policy and Management, TCD Economic & Social Research Institute WHO, Health Systems Strengthening, Barcelona Broader Collaboration Countries in Crisis Group and European Observatory Trinity College Dublin, The University of Dublin
Project Aims Overall Aim: to identify best practice guidelines and strategies for how the Irish health system can withstand the current crisis (in terms of protecting resources for health and managing resource scarcity well) benefit from the opportunities that the recession brings to pursue reform and alleviate system bottlenecks. build the resilience of the Irish health system in anticipation of future crises Trinity College Dublin, The University of Dublin
Health System Resilience 1. Financial resilience: the protection of funds for health care, and particularly that of the vulnerable, in the face of economic contraction. 2. Adaptive resilience: the ability of government and providers to manage the system with fewer resources, through efficiencies, while not sacrificing key priorities, benefits, access or entitlements. 3. Transformatoryresilience: the ability or capacity of government to design and implement desirable and realistic reform when the current organisation, structures and strategies are no longer feasible. Trinity College Dublin, The University of Dublin
Key Findings 1. Financial Resilience Failure to protect the sick and the old Increased financial burden on households 2. Adaptive Resilience Efficiency to rationing From more with less to less with less 3. Transformatory Resilience Captured voice Management capacity for change constrained Trinity College Dublin, The University of Dublin
Change in budget, staff & hospital activity 2005 2014 1.4 1.3 1.2 Index (=2008) 1.1 1 0.9 0.8 0.7 2014* 2005 2006 2007 2008 2009 2010 2011 2012 2013 Public health budget Staffing Inpatient discharges Day cases ED admissions Trinity College Dublin, The University of Dublin
Numbers waiting for inpatient & day case hospital treatment 2008 to 2014 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 2008 2009 2010 2011 Nov-12 Nov-13 24+ Nov-14 0 to 3 3 to 6 6 to 12 12 + Trinity College Dublin, The University of Dublin
Cost shifting on to households 2008-13 Trinity College Dublin, The University of Dublin
Managers Priorities vs Time 140 120 100 80 Govt Ind Time 60 40 20 0 ED Waiting MFP Hospital Groups Free GP care Healthy Ireland UHI Trinity College Dublin, The University of Dublin
What ties up managers time? 180 160 140 120 Govt Ind Time 100 80 60 40 20 0 Living within budget Managing change HSE Other reorganisation Trinity College Dublin, The University of Dublin
Resilience project website Trinity College Dublin, The University of Dublin
With access to indicators for all Trinity College Dublin, The University of Dublin
Key Outputs 7 international peer-reviewed publications + 2 case studies 13 International presentations at conferences and to international bodies (WHO, World Bank, OECD, European Observatory) 3 national workshops/conferences 1 National Policy roundtable 1 International Policy consultation Numerous national presentations (>25) HSE Master class, 05/14, Convention Centre Dublin President Higgins ethical initiative on health, Galway, 2/15 Trinity College Dublin, The University of Dublin
Informing international research Trinity College Dublin, The University of Dublin
Informed 2015 Budget negotiations Trinity College Dublin, The University of Dublin
Informed HSE 2015 Service planning Trinity College Dublin, The University of Dublin
Good media coverage Trinity College Dublin, The University of Dublin
Text from senior health service leader after Budget 2015 The resilience findings were a big help in making the case for more money From more with less to les with less Trinity College Dublin, The University of Dublin
Response from senior political figure to Resilience journal article sent From more with less to les with less armoury Thank you! One for my Trinity College Dublin, The University of Dublin
Why the impact? 1. Zeitgeist and Barndoor 2. International networks/friends 3. Convenient and Inconvenient Truths 4. Media links 5. Patience and help early on 6. Team Trinity College Dublin, The University of Dublin
Next upPathways to UHC HRB HRA: October 2014 3 years Aim: To provide an excellent evidence base that will inform strategic direction and implementation of universal health care in Ireland. Components: 1. Assessing the gap between where we are and UHC 2. Evaluating the options or pathways to get to UHC 3. Assessing the organisational challenges of moving to UHC Watch this space Trinity College Dublin, The University of Dublin
