Professor Ken McDonald:

I thank Senator Colm Burke for his questions. Before getting onto the virtual consultation issue, I would like to add a couple of thoughts on the need to change. As the Senator pointed out, is critical that any of these programmes contain measures that we can examine to see whether they are being effective. This is the State's money we are spending so we need to be able to match it up against key performance indicators and all of the programmes provide that data. For example, we know length of stay in cases heart failure has reduced since the development of heart failure care programmes and that saves bed days. Reporting these improvements back to the people involved in these change processes encourages them to continue with the process. Even though we have gone through a very difficult time economically, if we continue to show that the process is bringing improvement, albeit sometimes at quite a slow pace, it still acts as an encouragement.

The Senator's second question was about staffing. He mentioned nurse involvement in chronic disease management. For my area, heart failure, it is a very important development. The national clinical programmes are very conscious of the role that people in allied health care can play in the management of chronic disease. However, we also need to protect the nurse so that he or she is not out on his or her own. I always see the nurse role in the community as being under the guidance of the general practitioner, to try to co-ordinate the overall care of the patient.

When we are talking about allied health care, one group that we have not yet mentioned today that is also an underused resource in the community is that comprising pharmacists. They have a very strong role to play in chronic disease management when one considers an issue such as adherence to medical therapy, such a bugbear for us in the system.

Coming back to virtual consultation, this crosses a couple of the questions from Senator Colm Burke and Deputy Kelleher. On the value of virtual consultation, I think it breaks down this divide that we have between the consultant led specialist services and the general practitioner led community services. That is a real Achilles heel for us at present. Virtual consultation is a very strong way of breaking down this divide because it removes the reliance on the goodwill of a couple of GPs who might know a couple of consultants, as Deputy Kelleher said, for them to interact on a specific case. It formalises the process in the same way as happened with our outpatient clinics in hospital and our formal clinics. Virtual consultation needs to develop and, to use Senator Colm Burke's term, it needs to be fast-tracked to provide an alternative mode of interaction between primary and secondary care. Even if its impact is not as dramatic as the first 400 cases would indicate from the pilot projects to date, and if outpatient referral is reduced by 50% rather than by 80%, that would still be a dramatic impact.

We need to take a strong look at this process, and not only cultivate it in heart failure as much of what we are talking about is generic across chronic disease. We need to look at developing it as a strategy for chronic illness and to learn from the experience.