Could communities take control of their healthcare?


PRESSURE VALVEBy keeping the majority of healthcare as local as possible, the strain on the overcrowded hospital system could be considerably lessened.


Andrew O'Brien

I had a chuckle to myself last week when an email appeared looking for input from the community and voluntary sectors on the HSE’s Corporate Plan. Has someone in the HSE or Department of Health figured that for better or worse we’re probably going to have a new minister shortly, so now might be a good time to produce something shiny and exciting to show off to the new boss and the public?
You’d like to think that nobody could be that opportunistic and cynical, but elections can do funny things to people.
I hope that the survey is truly genuine and that the replies are taken into account and, more importantly, acted upon when the HSE’s new corporate plan in formulated. That said, I wonder whether it could have been better written.
Like most surveys, respondents are asked to rank a series of statements on a scale of importance from ‘not a priority’ to ‘essential priority’. So far, so good. It’s just that in this one, every single statement really should be considered an essential priority.
Take the first page as an example, the question is as follows: Thinking about improving the performance of the health service to deliver better patient care, please let us know what priority you would give to each of these goals.
I could list all eight options and wonder at the point of each, but we’d be here until the next election, so here’s two of them. Firstly: ‘Make sure high-quality services are in place for people who are marginalised or socially excluded’. If you need to ask that whether that is a priority, you probably aren’t suited to any job in a health service.
What about ‘Deliver better value and improve financial control’? The health service has an annual budget somewhere over €16 billion, interminable waiting lists, people constantly lying on trolleys and nobody seems to have a clue as to how much the new children’s hospital is going to cost. If improving at least some of that isn’t a priority, then any new health minister will soon be an ex-minister.
I could go through each page, but I fear some of what I said when answering the survey might be written verbatim and the innocent folks of Mayo might learn some impolite Australian phrases. I admit that I’m no policy expert and that I couldn’t possibly comprehend how to run one hospital, much less the whole health service, but seeing as this is my soapbox, I might share a few of my own suggestions.
I would like to see each town or area set up their own community health service, with guidance and funding from the HSE. These groups could then look at their population profile, and see whether the resources that are available match the needs of residents. From there, they could see what is working well and also what resources are either missing or need improving and set about doing so.
Included in those resources should be everything from GPs to gyms to knitting groups. We can’t continually look at health as something to be dealt with by doctors and hospitals. Community groups like Men’s Shed, Active Retirement and ParkRun have been shown to improve physical and mental health, in part by increasing social engagement, and their involvement is crucial.
By keeping the majority of healthcare as local as possible, the strain on the hospital system can be considerably lessened. Such a system would take time and work to set up, but it has been done – I have written before about the Compassionate Communities programme in the UK – and been shown to work.
I’d also like to see referrals by GPs to exercise classes, healthy-eating groups and the like become national policy and at least partly government funded. I know GPs are under enormous pressure and don’t have time to give patients in-depth dietary or exercise advice, but if under a community-based system a patient could be referred to an exercise or healthy-eating resource as their first port of call, we could improve health, medication dependence and social engagement all at once. Prevention is, after all, better than cure.
There they are, my health policies, all of which I shared with the HSE and may now be passed off as the idea of a new health minister in the coming weeks. Good luck to them, they’ll need it.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at