Professor Ken McDonald:

The Sláintecare report has provided a very good routeway for chronic disease in general. If we can work on implementing its recommendations that certainly would be going in the right direction. The barriers are the need to break down the silos of historical health care, which the Chairman knows about from working in the area. I think we need to go on the route of making sure that we stop the divide between primary and secondary care and that we realise that chronic disease management requires not just the physician, be it the general practitioner or the specialist in the hospital, but also requires a very strong input of allied health care professionals. Moreover, none of these chronic illnesses about which we are speaking will be managed properly unless the patient and his or her family are actively involved in care. That is clearly demonstrated for example in heart failure care where, prior to admission to hospital or to an emergency room, there is a signal available for the patient to act on - if the patient or his or her family is aware of it - that could result in that deterioration being aborted before it got to the stage that it would need emergency care. Breaking down the historical way that we deliver health care is critical, whether we do that through the rolling out of the Sláintecare recommendations or medics trying to reshape the way we deliver care in their own individual areas.