OPINION:What's the alternative to demand-led schemes? Schemes for which there is no demand?, asks Marie Hogan.
AT THE IRISH Pharmacy Union's recent agm, I put forward a motion calling for the HSE to stop seeing the demand-led schemes, such as the medical card or drugs payment schemes, as the problem for the health service, and rather seek to utilise the enormous potential of primary care to improve efficiency in the service.
I had been amazed recently to hear the term "demand-led" being used again. I first heard the term being used at meetings of the Mid-Western Health Board.
The words annoy me. What's the alternative? To have schemes for which there is no demand? Or maybe to fail to meet the demand, which is what happens in most other parts of the health service.
"Demand-led schemes" are dirty words, like "drunk drivers" or "litter louts". They are seen as a black hole that swallows up vast amounts of money, over which there is no control.
This comes from the old perception that patients go to the doctor with lists of non-essential medicines and go home with bags full of stuff, which they farm out to neighbours and friends. In this model, the only form of quality healthcare happens in hospitals.
Everyone forgets that if you develop a community-based service, be it home care of the elderly, palliative care, new oral chemotherapy, home IVs for patients with cystic fibrosis, you free up hospital beds and save significant monies. However, you add to the cost of the medical card, the drugs payments, long-term illness and high-tech schemes.
For example, someone on Glivec, for myeloid leukaemia, is a fully functioning, active member of society, but the cost of the medicine is coming out of the high-tech scheme rather than having multiple admissions to a hospital for IV therapy.
Furthermore, they may need antibiotics, antifungals, creams for skin eruptions, etc, all of which will create costs under the medical card scheme or drugs payments scheme.
At the national health consultative forum they stood and applauded a home-based IV system for adult cystic fibrosis patients. This costs €4,000 for the week compared with €23,000 if the patient was in hospital. But everyone ignored the fact that this would result in an extra €4,000 per treatment per cystic fibrosis patient on the long-term illness or medical card schemes.
Some of the HSE's spare management capacity ought to be asked to analyse the data which they have on file to see whether the growth in "demand-led schemes" is really caused by patients with shopping lists or whether it is due to extended use of community-based services.
As community-based services grow, so will the demand-led schemes and therefore they are going to have to get to grips with them somehow.
For a start, the HSE needs to publish reports on prescribing patterns more quickly. Here we are in May 2008 and the only data relates to 2006. How can you learn lessons and apply change, if you are working with data that is two years old?
The HSE also needs to improve the analysis of information. The re-appointment of a chief pharmacist in the Department of Health and Children would be a big help in this regard.
Government policy has led to the rising cost of the community drugs schemes. It was Government policy to provide a medical card to every person over 70, to introduce the drugs payment scheme and free blood pressure and cholesterol medication for patients with diabetes. It was also Government policy to use newly developed, but more expensive, medicines to provide treatments for the prevention of osteoporosis. These are all positive developments but have added to the costs of the demand-led schemes.
When heart attacks and stroke were the biggest killers in the Republic, the Government devised the cardiovascular strategy. Patients at risk of heart disease are now often encouraged, along with lifestyle changes, to take medication to reduce their blood pressure and lower their cholesterol.
This will push up the amount spent on community drugs schemes, but fewer people are dying from heart attacks and stroke and that's the aim.
Pharmacists have offered to help the State contain the costs of the community drugs schemes by using greater amounts of generic medicines and reducing the amounts of medicines wasted every year. However, the HSE has not engaged with us on this.
Primary care needs to be developed. The Department of Health and Children and the HSE are committed to doing so. It has enormous potential to provide convenient, cost-effective treatment for a variety of conditions.
It enables patients to be treated in their own environments. But as primary care develops and extends the range of services provided, the cost will go up.
The HSE needs to work with its partners, the service providers - be they doctors, dentists, pharmacists or nurses - to plan and co-ordinate future services, so patients can access better healthcare in the community.
• Marie Hogan is a pharmacist in Limerick and past president of the Irish Pharmacy Union