Dr. Diarmuid O'Shea:

We are very grateful for the invitation and to have the opportunity to attend.

I am the national clinical lead for the clinical programme for older people. I am joined by my colleagues, Professor Ken McDonald, national clinical lead for the heart failure programme, and Professor Rónán Collins, national clinical lead for the stroke programme. We are honoured to be here to represent the clinical care programmes. All of the programme managers and health care professionals are working together to develop different models of care and care pathways to help to improve health care services.

As the population ages, we very much welcome the opportunity to share with the committee the progress made to date and the plans for the future in the older persons programme and chronic disease management under the national clinical and integrated care programmes. In the course of the opening statement we will update the committee on the three national clinical programmes and cover some information from the integrated care programme for the prevention and management of chronic disease, ICPCD.

The objective of the integrated care programmes is to design an integrated model of care to treat patients at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. The ICPCD programme focuses on a number of chronic diseases that impact on a large number of patients. Approximately 1 million people suffer from a variety of chronic illnesses, including dementia, respiratory diseases, cardiovascular diseases and diabetes. The Irish longitudinal study of ageing reports that 65% of the over 65 age cohort live with comorbidities and multiple illnesses. The current and projected impact of chronic disease presents a major challenge not just for the health service but also for Irish society and the economy. We have more people living longer and the numbers with chronic disease and multiple comorbidities will increase. While it is very welcome that the range of investigations, tests and treatments available is increasing and improving, it comes at a cost. We must continue to implement change to meet present and future challenges and the projected demand on services in the next decade.

The ICPCD programme aims to provide better care for people with chronic diseases. This will be achieved by providing for a continuum of preventive, management and support services for patients with these conditions. It is built on an approach which helps people to understand and care for their own condition, with education playing a key role, in collaboration with their general practitioner and the primary care team. It includes easy access to diagnostics and specialist supports in the community and close co-ordination with hospital services in order that people can receive the care they need when they need it and in the most appropriate way to meet their circumstances, be it at home, in the community or hospital. This will require a significant reorientation of service delivery and associated resources and will be challenging, but we believe it is the best and most sustainable approach for the health service.

Through the patient narrative project, patients have clearly articulated their expectations of the health care they wish to receive. They want person-centred, co-ordinated care services that provide them with the services they need. They want care based on a full understanding of their lives and their world, combined with the information and support they need. They want care that respects their choices in building care services around them and those involved in their care. The proposed model of care for people with chronic diseases honours this and will be co-designed in partnership with patients, clinicians and managers who, together, are the stewards of health care.

Having given the committee a brief overview of the ICPCD programme, I will take members through the work of the national clinical programme for older people. The population of those aged 65 years and over is projected to increase by between 58% and 63% between 2015 and 2030. The so-called "older old" population, that is, those aged 80 years and over, is set to rise even more dramatically, as outlined in the recent 2017 ESRI publication entitled, Projections of Demand for Healthcare in Ireland 2015-2030. As older people have complex health care requirements, the health care system needs to adapt to meet the demands associated with this demographic change.

For this to truly happen, we need a culture change to drive the shift in how we think and provide care, especially for the ageing populations. If we get it right for this group of patients, we will get it right for everyone. In line with the recommendations outlined in the national clinical and integrated care programme for older people, NCPOP, the core principles, otherwise known as the ten-step framework, which we have included in our briefing document will support and drive better outcomes for older people at risk or living with frailty and are being implemented throughout the country. Examples of achievements are frailty education programmes, with 22 established, with more than 130 trained facilitators and 550 health care professionals trained in the programmes. Twelve integrated care pilot sites have been developed in the past 18 months and there are numerous other sites throughout the country where local managers, clinicians and health care professional are delivering innovative change, providing evidence that these approaches work.

Growing up and growing old, something we all hope to do, is not easy. Prevention is always a challenge in ageing; therefore, emphasis is placed on wellness. As a result. the NCPOP is collaborating synergistically with other projects to work towards the joint goal of healthy ageing. A few examples include the Irish longitudinal study on ageing, TILDA, and how it will inform policy and give us an evidence base to further improve and target resources and innovation; the Healthy Ireland initiatives to promote wellness and maintain independence that speak to the real importance of the public health message; and collaboration with the acute and emergency medicine programmes and the new dementia clinical lead and national dementia strategy in addressing education needs such as frailty education and managing people with dementia and delirium in the community and hospital.

With regard to future plans, as described in our briefing document, the evolution of the local governance group structure around the theme of "ageing well in the community" will champion the pockets of excellence emerging from the learning in those areas that are redesigning and implementing pathway stages of the specialist geriatric services MOC and the ten-step framework. The delivery of this type of care needs to be built on. Every older person should have access to the right care and support, with personalised, co-ordinated care, integrated between services and putting the older person at the centre of the care pathway. Collaborative working with the integrated care programme for older persons indicates that co-ordinating care for older persons is better, but while some of the costs involved could be met through identifying inefficiencies within the system, there is little doubt that significant investment both in staffing and infrastructure is needed to ensure health and social services will be resourced to effectively manage and respond to the health care needs of the rapidly increasing older population. The ageing population is testament in part to improved health care in Ireland and to be welcomed, but we need to rise to the challenges it presents. Care for the older person is everybody’s business. It is imperative that as these new ways of working are designed and developed under the clinical programmes of the RCPI and the HSE that there be continued ongoing support and investment in implementation as we continue to work with local and regional areas.

I will hand over to my national clinical lead colleague, Professor Ken McDonald, to describe the national clinical programme for heart failure, NCPHF.