Presentations will come after the politics of responses to members
questions have been teased out to insure that councillors receive
satisfactory responses to queries which must not be clinical details of
individual cases.

Can the HSE give an overview of where it currently stands with regard to
its planning for a disease management programme in the area of diabetes?
Cllr. Robbie Gallagher

Response:
Prof Richard Firth has just been appointed as Clinical Lead of the National Diabetes Programme in the National Directorate of Quality & Clinical Care under Dr. Barry White. The National Diabetes Programme is beginning its work under the following prioritised headings:

1. National Diabetes Retinopathy Screening Programme.
2. National Diabetes Register.
3. Implementation of Foot Care Initiatives to reduce A&E and hospital admissions with foot problems.
4. Implementation of an Integrated Care System for Diabetes in HSE Areas to achieve better outcomes for people with diabetes.
5. Strategies to improve diabetes control and risk reductions to prevent diabetic complications (e.g. to rationalise Insulin Pump Therapy particularly in young children).

This work will be implemented in each of the HSE Areas by the Diabetes Service Implementation Group (DSIGs). Currently there is a DSAG Diabetes
Service Advisory Group in the HSE Dublin North East, however this is being
currently reconstituted to be more geographically representative and its role will be implementing rather than advising as was heretofore.

The rollout of a National Retinopathy screening service as set out in the
National framework for diabetic retinopathy screening will be one of the
immediate priorities. The Retinopathy Sub group is a Dublin North East Sub
Group and is being lead out by Dr. Fatima Hamroush, who has met with all
the Ophthalmologists in North Dublin and are in the process of preparing a
Business case with them for a Dublin North East Retinopathy Screening service.

Question:

Does the HSE have any plans to improve or streamline prescription protocols and the communication between hospital consultants, GPs and pharmacists with regard to prescriptions as there is strong anecdotal evidence that people discharged from hospital with prescriptions often have these prescriptions filled in addition to their previous prescriptions resulting in people having large stashes of medication which can be confusing for them and their carers and which in some cases may possibly be contra-indicated and what are the likely cost savings or implications of same?

Response:

This is a multifaceted issue that challenges most healthcare systems. In August 2009, the HSE appointed Dr B. White as its first National Director of Clinical Care. This new Directorate is designed to drive clinical governance, quality and risk, national standards and protocols and to provide clinical leadership within the healthcare system. Clinical leads are being appointed within various chronic disease programmes.

These programmes will describe optimum clinical care pathways and protocols. It is anticipated that this work will address some of the issues
raised in this query.

The multi-agency, multi-stakeholder Medication Safety Forum has been
designated by the Department of Health and Children as the Implementation
Body for the medication safety recommendations of the Commission on Patient Safety and Quality Assurance report ‘Building a Culture of Patient Safety’. It is also considering a number of issues identified.

Dear Dr Conroy,

I would like the Forum Chairman’s Meeting to be presented with a table of
the number of staff at grade 4 and above at this date with the comparison
data representing the staff rank numbers at the end of the first year of
the HSE and the final head count under the same criteria in the final year
of the Health Boards.

The numbers of professional staff including medical, nursing, radiographers, Medical scientists, biochemists, physiotherapists, occupational therapists, psychologists, social workers whould be provided for the same time lines.

This could form an objective foundation for a discussion which I would like
to have on the employment of independent external agencies to carry out
lean studies on the HSE central organisation and on the administration of each of the hospitals in the state at grade 4 level and above.

I have personal evidence of excessive layers of management in hospitals.

My purpose is to put the patient first. The patient is placed at the centre of our institutions patients’ charter and on the published core values of hospitals but the reality is often different.

Prior to taking the chair at Kells, some officials told me that for them, the impact of the forum had approximated to zero.

Given the needs and degree of angxt among the public concerning the health
services, that had to change. I hope I can make a constructive difference.

I propose that the Chairs take this idea back to each Forum and have a
country wide demand by Councillors to employ an independent external Lean Study to streamline operations and get objective value for money in
publicly funded health agencies. The HSE objective of reducing staff by natural wastage or financial incentive is very inefficient and not in the public interest. Implementation of a Lean Process is the way to go.

It is claimed that the Croke Park Agreement facilitates this objective. However, turkeys and christmas comes to my mind. So carrying this out is
likely to be met with resistance.

Best Regards

Dr Bill Tormey
Dublin City Councillor
167 Glasnevin Avenue
Dublin 11