Oireachtas Joint and Select Committees

Wednesday, 7 March 2018

Joint Oireachtas Committee on Health

Chronic Disease Management: Discussion

9:00 am

Dr. Rónán Collins:

It can be done in primary care. To return to Professor McDonald's point about telemedicine virtual consultation, it is something of which I am a huge fan. I was involved in a telemedicine pilot for strokes back in 2009 and have seen the value in bringing expertise to the table there and in heart failure also. It is very simple. Telemedicine does not have to be high-tech, it can be merely a secure screening showing an ECG in practice, and asking others what they think and then establishing a care pathway based on that. We are currently piloting one in Tallaght.

Returning to the point about nursing homes, there are an increasing number of nursing home admissions in my hospital but the number of nursing homes built in our area has also increased. One problem I have looked at is how the planning and co-ordination of this does not appear to be thought out. If I built a brewery in Tallaght, I would probably have to ask the local council if I could use 20% of its water, yet we can build many nursing homes in one area. It is not unique to Tallaght but we need to refer to how it might impact an acute care area if one introduces a population of people with complex care needs. I am a geriatrician myself as well as specialising in strokes. Of course frail older people should not be bussed around unnecessarily into hospitals but there are several factors at play. First, returning to my opening statement, we need to get primary care resourced again to look after these populations and second, we need effective communications between GPs on the ground, through nurse specialists, geriatricians and the integrated care programmes that Dr. O'Shea spoke about. This can happen through community teams and also through effective telemedicine consultation. Nursing homes are an are in which I am very interested. Often it is not the case that the general practitioner lacks the skill mix to sort this out but they are complex cases that need two sets of eyes, two opinions and reassurance that the treatment and the care pathway are right. Much can be done to improve how we model our care of our most vulnerable people. We always look back on history, but in 20 years we might ask if we did a good job for our frailer persons in nursing homes. Dr. O'Shea referred to this. There is great hope in integrated care. We in geriatric medicine are very committed to looking after what is occasionally referred to as the lost tribe, the people who live their life in residential care, and remember that 15% of stroke patients also end up requiring nursing home care. They need support too.

On the Act FAST campaign, there are numerous health advertisements about everything on television, some from private industry and some from our own public health initiatives. Strokes are our third leading cause of death and our leading cause of acquired adult disability and we have taken off what was probably the most important advertisement explaining what the symptoms of stroke are and most important, what one must do when one sees them, that one does go to hospital as soon as possible. I would encourage all support for initiatives. The Irish Heart Foundation has asked for that advertisement to be put back on televisions.

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