Progressing Sláintecare delivery from proposal to implementation: Insights from palliative care in Ireland
Sláintecare, Universal Health and Social Care, Palliative Care, Implementation, General and Specialist Palliative Care
“Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care”
World Health Organization, 2021
Sláintecare*, is the Republic of Ireland’s national ten-year programme to transform existing health and social care services to a universal single-tier health and social care system where everyone has equitable access to services based on need and not ability to pay. The Sláintecare Report, devised through political consensus, maps out the reforms necessary to transition towards universal healthcare in Ireland (Houses of Oireachtas, 2017). A key recommendation is universal entitlement to a health benefits package, including palliative care. Ireland would be the first country to introduce universal entitlement to palliative care.
Evidence is needed to inform strategic planning for the implementation of universal palliative care within an Irish context. The primary research questions addressed by this study are: 1) What are the Irish population palliative care needs; and 2) how can the existing health and social care system adapt to provide responsive and integrated care?
One objective of palliative care strengthening is ensuring better integration with the wide range of service delivery needs of people living with life-limiting conditions and their loved ones. Given that palliative care strengthening has within it all the key requirements for wider health system strengthening, it provides a valuable model for learning about how to plan and implement universal health care across other areas of care. This study will inevitably provide a probe into wider health systems strengthening.
*Sláinte is the Irish language word for “health”.
Ireland has a proud history in the field of palliative care, and this provides a strong basis for co-operation and engagement with this study. The collaborators include the most senior national palliative and health reform leaders within the Irish health system as well as experienced palliative care, health systems and policy researchers.
This research project will analyse the implementation of palliative care in other countries with universal healthcare systems and apply these learnings to the Republic of Ireland. The project will explore from 2023 to 2040 what are the projected palliative care needs and what levels of service capacity and workforce requirements or would be required to meet universal palliative care in Ireland.
The project will use a multi-methods design including: 1) a comparative analyses of palliative care policy and implementation in six countries (including the Republic of Ireland) and applying the learnings to the Irish context; 2) modelling regional palliative care needs between 2023 and 2040; 3) estimate service capacity and workforce requirements required to meet these needs; and 4) determine the applicability and acceptability of expanding the role of generalist palliative care in Ireland through stakeholder engagement.
The project will include the following workstreams:
1. Reviewing palliative care policy in other countries and the learnings for Ireland
The focus of this workstream is to identify the policy options for delivering universal palliative care in Ireland. It will draw on the learnings from other countries’ experiences, successes and failures on introducing palliative care at a policy and system level. This type of cross-country comparison will provide important evidence for policymakers. Guided content analysis will be used to describe and contrast the content of national palliative care policy, strategic planning and/or implementation documents. The analysis will draw on the WHO’s Health System Framework ‘building blocks’: service delivery, health workforce, health information systems, medicines and technology, financing, and leadership and governance.
To assess the potential for implementing examples from other countries here in Ireland, qualitative methods will be used undertake a critical analysis of palliative care policy and implementation in Ireland since 2011. The aim is to map out potential interests and interactions of relevant stakeholders and organisations.
Questions will include: What services are provided? What do they cost? Who can access services? Who are the stakeholders in Ireland? How do they interact with each other? What are the key developments and gaps in Irish policy?
Countries to be included in the analysis: Australia, Canada Norway, Sweden, United Kingdom and Ireland
2. Palliative care needs across the Irish population
An important development in the Sláintecare reforms is the establishment of six regional health bodies, Regional Health Areas, to deliver people-centred health and social care. These regional health bodies will have their own budget based on local population needs and will facilitate improved accountability and transparency. The aim of this workstream is to understand regional population needs and appropriate responses to these needs.
We will identify groups of people with similar types of needs or patterns in the healthcare services they use. These analyses will allow us to estimate current and future palliative care needs across Regional Health Areas. This information will be used to design, deliver and evaluate services that meet those needs, within the resources available.
3. Planning for future palliative care needs
The aim of this workstream is to collate and combine available data to provide a more detailed picture of palliative care capacity across the Regional Health Areas. Additionally, it will estimate future service capacity and workforce requirements to provide universal palliative care access between 2023-2040.
Components will include:
Create a profile of palliative care supply across the Regional Health Areas and assess the adequacy of current service capacity
Complete a rapid review to identify examples of best practice in workforce planning and modelling for palliative care provision
Estimate workforce and system requirements to meet population need between 2022 and 2040
4. Understanding viewpoints on meeting future palliative care needs
The aim is to systematically explore and describe the range of viewpoints expressed by stakeholders about the role of generalist palliative care in supporting people with life-limiting conditions in the community and the barriers and facilitators to implementation.
This will be achieved through qualitative interviews and a Q methodology study. Q methodology is exploratory and combines qualitative and quantitative methods to provide a framework for eliciting viewpoints about a specific topic. The aim of Q methodology studies is to identify the viewpoints people hold rather than comparing proportions of the population who hold similar or different views.
The findings from this research will provide detailed evidence and guidance for the Sláintecare Implementation Office and Health Service Executive in delivering universal palliative care in the Republic of Ireland specifically and offer wider learnings for of universal healthcare implementation nationally and internationally.
Findings and research outputs will be made available through this research project webpage once available.
A peer reviewed paper produced from this research (May et al. 2020) was used by the Department of Health to inform palliative care expenditure profiles within the ‘Spending review 2021: Impact of demographic change on health expenditure 2022-2025’, July 2021 paper.
January 2021 – January 2024
Dr Bridget Johnston, Research Assistant Professor in Health Economics and Policy Centre for Health Policy and Management, Trinity College Dublin
Prof Steve Thomas, Edward Kennedy Chair of Health Policy and Management, Trinity College Dublin
Sheilagh Reaper- Strategy and Planning Lead for Palliative Care,
Reynolds Health Service Executive
This study is funded by the Health Research Board under the Applying Research into Policy and Practice Fellowships scheme [ARPP-2020-016].
Research outputs will be available from 2022.
(2021) Sláintecare implementation status in 2020: Limited progress with entitlement expansion
(2020) Evidence on the effectiveness and cost-effectiveness of out-of-hours palliative care
(2020) Health system foundations for Sláintecare implementation in 2020 and beyond – co-producing a Sláintecare Living Implementation Framework with Evaluation: Learning from the Irish health system’s response to COVID-19. A mixed-methods study protocol
(2020) Effectiveness and cost-effectiveness of out-of-hours palliative care: a systematic review
(2020) Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States
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