Ireland's Sláintecare health reform risks mission creep, needs clearer vision
At a healthcare policy conference on 25 June, Prof. Thomas called for a clearer vision of universal healthcare. 'We're still debating eligibility and entitlement eight years on,' he said. 'We need to pin down as quickly as possible our vision.'
Sláintecare, Ireland's national healthcare reform programme, was launched in 2017 in response to long-standing issues in the country's health system. It aims to create a universal, single-tier health service where access to care is based on medical need rather than ability to pay.
While digital health transformation is gathering pace, policymakers, clinicians and economists think the reforms must be more ambitious.
They agree that digital advances must deliver better patient outcomes and improved value for money through a more robustly connected, data-driven healthcare system, but the system remains slow to change and fundamentally dysfunctional.
Prof. Thomas urged policymakers to leverage crises as catalysts for reform. 'COVID was quite helpful in getting extra resources into the health system,' he said. 'But we must protect our workforce. We're expecting a lot from them.'
Sláintecare, the country's flagship universal healthcare reform programme, still lacks a unifying vision in a shifting economic and digital landscape. The path forward is fraught with challenges, including fragmented systems, workforce shortages and demoralisation, and a lack of public engagement.
From analogue to AI
Ricardo Sampaio Paco, Service Improvement Lead at St James's Hospital, offered a compelling case study of how digital tools can transform hospital operations. 'At St James's Hospital, 80% of the discharges in the past were occurring after three in the afternoon,' he said. This bottleneck created a 'ripple effect' that delayed admissions and strained emergency departments.
To address this, the hospital implemented a visual management system that digitised patient flow data and enabled real-time decision-making.
'It's now possible to see … for every patient what their estimated discharge is, the clinical criteria for discharge, the discharge destination and required onward care,' Paco explained. 'You can have this within five seconds after you get in contact with the screen.'
The results were striking: a sharp reduction in late discharges, increased surgical throughput, and improved frailty assessments. 'We're now the best hospital for hip fracture care in Ireland,' Paco said, citing a leap from 7% to 70% compliance with national standards.
General practice, the digital bedrock
While hospitals are making strides, Dr Mike O'Callaghan, Clinical Lead at the Irish College of GPs, stressed that general practice remains the 'foundational' layer of Ireland's digital health ecosystem.
'General practice is where a lot of the volume happens,' he said, noting that GPs handle over 21.5 million consultations annually. 'Continuity of care is continuity of records and vice versa.'
O'Callaghan warned against creating new digital silos. 'If everybody's in charge and there's patient information everywhere, then no one is in charge,' he said. 'We need to have a central repository of all this stuff so that we're all on the same page - including the patients.'
He also highlighted the importance of maintaining and curating electronic medical records. 'It's not good enough to build a big, shiny system. You need to make sure that it's being maintained, because that's how patients are kept safe.'
Telemedicine 2.0
Dr Victor Vicens, Chief Medical Officer at Abi Global Health, argued that traditional telemedicine has failed to deliver on its promise. 'Basically, what it did was put a camera in front of a doctor,' he said. 'The basic unit, which was doctor time, was not changed.'
Abi Global Health is using AI to triage cases, allocate healthcare professionals, and monitor consultation quality. 'Next-generation telemedicine is omnichannel, on-demand and up to three times less costly,' Vicens said. 'This leads to better financial results and better health outcomes.'
The economist's view
Dr Jonathan Briody, a health economist at the Royal College of Surgeons in Ireland, framed digital health as a fiscal imperative. 'Digital health is not an optional thing anymore,' he said. 'It's integral to modern service delivery and group patient outcomes.'
He pointed to the success of virtual wards, such as the one at St Vincent's Hospital, which has treated over 500 patients and saved nearly 4,000 bed days. 'Each hospital bed that we free by a safe virtual consultation provides another bed for someone who needs it,' he said.
With the Health Service Executive's 2025 budget reaching €27 billion, Briody emphasised the shift toward value-based healthcare. 'We're measuring success not by the euro spent or services provided, but by the outcomes achieved per euro.'
Trust, data and the public
Despite the momentum, speakers acknowledged that public trust and digital literacy remain significant barriers.
'Patients are shocked when I can't see their medicines,' said O'Callaghan, referring to the lack of interoperability between GP and out-of-hours systems. 'Patients actually think our digital infrastructure is more cooked than it is.'
Briody added that many patients are unaware they own their health data. 'They're shocked to learn that their data belongs to them. We're just mining it for them.'
Vicens argued that public confidence hinges on transparency and evidence. 'Getting more confidence from the systems relies on doing what science has always done – publishing, providing reliable results, and reliable sources of evidence.'
Inclusion and equity
Digital exclusion was another recurring theme, particularly for older people and refugees.
'Six in ten older people in Ireland are not comfortable online,' said Vicky Harris, Head of Programmes at Age Action. 'Digital First, not Digital Only. Ensure quality services are maintained offline as well as online.'
Dr Hanna Balytska, a Ukrainian doctor now working in Limerick, described how language barriers and outdated communication methods - such as postal letters - led to missed appointments among refugees. 'They always keep their telephone number. They always keep their email,' she said. 'So that's why even in English, if we send something in English, they can translate it.'
Community care, the next frontier
Margaret Curran, General Manager at Caredoc, showcased the SMILE programme, which uses wearable devices and remote monitoring to manage chronic conditions. 'It showed a 41% reduction in ED attendances, 44% reduction in bed night stays, and 87% reduction in unscheduled urgent GP visits,' she said.
Curran emphasised the programme's cost-effectiveness. 'To manage 600 high-need patients, we have 4.5 whole-time equivalent triage nurses,' she said. 'It really pays for itself very early on.'
Michelle O'Hagan, a community pharmacist in Tallaght, called for greater integration of pharmacy services. 'We are the cornerstone of healthcare,' she said. 'We can offer more clinical skills and reduce hospital admissions.'
Ireland's digital health transformation is at a critical juncture. The tools, talent and political will are increasingly in place. But to deliver on the promise of Sláintecare, better care, better access, and better value, policymakers must ensure that digital innovation is inclusive, coherent, and grounded in the lived realities of patients and providers alike.
The foundation of the new health era in Ireland has to be a highly effective, data-driven system. Without it, an ageing population and chronic disease will drain and break Ireland's capacity to care for its citizens, damaging the economy and democracy.
By Brian Maguire
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Euractiv
17-07-2025
- Euractiv
EU must take lead role on pharma, and patient access, says Czech minister
Czech Deputy Health Minister Michaela Matoušková (STAN, EPP) is calling for stronger EU action on pharmaceutical policy, better coordination on digital health, and a more unified approach to patient access to innovative medicines across the bloc. In an interview with Euractiv, Matoušková urged the EU to move from passive coordination to proactive support, particularly when it comes to ensuring equitable access to innovative medicines and building the Union's strategic autonomy in healthcare. Matoušková, who took office in February this year, believes the COVID-19 pandemic and the EU's fragmented response exposed structural weaknesses that Brussels now has an opportunity to address. 'We have the brains, but we lack coordination – and that is the role of the European Union,' she said. She argues that the EU level is the only viable arena to tackle the uneven and delayed access to new medicines that persists across member states. 'Some smaller states do not introduce medicines, even though the European Medicines Agency (EMA) has approved them, as quickly as others. If we really want a patient-focused approach, this has to change,' she said. The Czech deputy minister voiced strong support for the pharmaceutical package currently negotiated by EU institutions in the trilogues. However, she underlined that success will depend on finding the right balance between patient access, price and industry incentives. 'The compromise is crucial,' she said. She noted that the Commission's proposal rightly aims to increase access to medicines in all member states, but that this will require cooperation from industry. 'They need to understand what we are trying to achieve: speed of rollout and availability,' Matoušková said. Innovation vouchers One of her concerns is the growing trend of pharmaceutical companies threatening to pull out of Europe in response to proposed changes in market exclusivity rules. 'The USA invests significantly more – three times more than the EU, I believe. But it's not just about money. It's about how fast we bring medicines to market and how long the data and market protection lasts,' she said. Matoušková acknowledged the financial pressures innovators face and expressed support for maintaining incentives that allow for returns on investment. To bridge the interests of both patients and industry, she supported 'a system of innovation vouchers' as a complementary tool to support faster development and approval of new drugs, while maintaining investment appeal. She also addressed the broader relationship between innovation and generics, noting, 'I think generics will always be here. But we need to push for innovation, that is what we need to protect.' Matoušková also sees digital health as an area where EU leadership is urgently needed. While the European Health Data Space regulation has opened a promising debate, the deputy minister warns that implementation is lagging in some areas. 'We would like to have shared medical documentation, but we are missing regional data networks. We do not have enough infrastructure to make it work,' said Matoušková. She believes the EU should step in with funding and coordination. 'The EU should provide the legal framework, the conditions, and the funding. The EU should be the roof over the whole structure,' she said. Cross-border cooperation Her ambition is also to see greater EU involvement in cross-border emergency services. 'Why do we need bilateral treaties for cross-border emergency care? We could define it at the EU level,' she said. In the longer term, Matoušková urges Brussels to invest in services that reflect demographic changes and make a difference on the ground, such as palliative care and home-based support for older people. 'Personally, I am not a fan of building more facilities. Care should move closer to patients, into the field, into their homes,' she said. She would also welcome more EU guidance on workforce reform, including a broader debate on prescription rights for qualified non-physician personnel, adding that, 'We have very erudite non-physician professionals in Czechia, but they haven't been granted the appropriate competences.' Her message to EU policymakers is clear: health policy must be treated as a strategic investment. 'We should see the EU not as a repressive body, but as a source of change – an institution that supports innovation. Not as a dictator, but as a partner that helps address our needs,' she said. [Edited by Vasiliki Angouridi, Brian Maguire]
Euractiv
15-07-2025
- Euractiv
Irish AI start-up targets chemotherapy bottlenecks with remote assessment platform
Dublin - Irish health-tech start-up eAltra is poised to transform chemotherapy care delivery with an AI-powered remote assessment platform that promises to cut costs, reduce patient wait times, and ease pressure on overstretched oncology departments. The company, a spin-out from Trinity College Dublin's ADAPT Centre and backed by Enterprise Ireland as a High Potential Start-Up (HPSU), has demonstrated the efficacy of its conversational AI tool in a six-month pilot study conducted in partnership with Health Innovation Hub Ireland (HIHI) and Tallaght University Hospital (TUH). The platform enables patients to complete chemotherapy toxicity assessments remotely in under six minutes, a process that traditionally requires in-person consultations. According to the study, the tool not only improves patient experience but also delivers measurable gains in clinical efficiency and cost savings. The study found that, 'For patients, eAltra's pre-appointment remote assessment, completed in under six minutes, reduces unnecessary travel and optimises appointment scheduling – timed chemo production ensures treatment is ready when a patient arrives, eliminating wait times by up to two hours.' Patients reported high satisfaction with the tool's usability and clarity. Clinical teams also stand to benefit. The study reported a minimum productivity gain of 3.5 hours per treatment day, equating to 20 minutes saved per patient. Importantly, the AI chatbot achieved a 98 per cent agreement rate with nurse-led assessments, the current gold standard. Scalable cost-savings From a financial perspective, the implications are significant. In a hospital treating 200 patients annually, the tool could generate savings of €27,300 per nurse, rising to €55,000 with two clinical nurse specialists. Additional savings are anticipated from reduced paper usage. The platform is designed for seamless integration with existing health IT infrastructure. It complies with HL7 standards and is interoperable with national systems including the National Cancer Information System, Cerner/Oracle Health, and EPIC. Sustainability is another key advantage. By enabling remote care, eAltra reduces patient travel and associated emissions. With healthcare accounting for five per cent of global travel, the shift to digital engagement offers a meaningful reduction in carbon footprint. Denis Roche, founder and CEO of eAltra explained that, 'eAltra is a spin out company of Trinity College Dublin and was awarded High Potential Startup status by Enterprise Ireland.' Roche explained how, 'Health Innovation Hub Ireland has been supporting our development throughout these milestones. The clinical access, study design support and pilot management they have provided has contributed to our product development and market positioning. We are hugely ambitious for eAltra both at home and abroad and the HIHI pilot result provide significant evidence of efficacy, useability, impact and patient satisfaction.' AI reshaping healthcare Eimear Galvin, HIHI Dublin Manager, highlighted how AI is reshaping healthcare She said: 'These study results show that eAltra improves patient care, provides cost savings and increases productivity by streamlining processes and minimising delays in systemic anti-cancer therapy, in this case chemotherapy.' Galvin added that by enabling remote assessments just 24 hours pre-appointment, unnecessary travel and associated costs are eliminated, ensuring timely rescheduling when required. She explained that, 'Timed chemotherapy production aligns drug preparation with patient arrival, reducing wait times by up to two hours and optimising pharmacy workflows.' The announcement comes as HIHI launches a national competition, ' to identify and pilot AI-driven healthcare innovations. The call is open to companies, researchers, and clinicians until 28 August, with selected projects to be trialled in clinical settings across Ireland. More information is available at Digital care policy advances eAltra's innovation aligns closely with Ireland's national AI strategy. As the Department of Enterprise, Trade and Employment stated in its 2024 strategy refresh: 'AI presents opportunities completely unlike those we have experienced before with previous technological advancements, in terms of their potentially transformative impact for our collective good.' Ireland's 'Digital for Care' framework also underpins eAltra's approach. The framework sets out a roadmap to digitally transform health services in Ireland and improve access for patients, and at the European level, the European Commission has noted that, 'AI is emerging not just as a tool but as a transformative force reshaping healthcare delivery.' The Commission has said that 'AI-driven personalised treatment plans can complement traditional approaches by offering more targeted and effective care, improving patient outcomes while also helping to reduce the financial burden on healthcare systems.' By Brian Maguire
Euractiv
09-07-2025
- Euractiv
Hardwire One Health into EU law before ‘Disease X' strikes
The next pandemic will likely emerge where humans, animals, and ecosystems intersect, yet veterinary systems remain Europe's blind spot. That warning dominated the 'Preventing Disease X' conference in Brussels on 3 July, where experts called for EU policy to match the scale of the risk. Their message was clear: if One Health is to be more than a buzzword, it must be hardwired into legislation, now, before Disease X strikes. Most pandemics, including COVID-19, began with zoonotic pathogens, and the next one, dubbed Disease X, likely will too. Preventing it starts with animal health. From concept to capability Dr. Emmanuelle Soubeyran, Director-General of the World Organisation for Animal Health (WOAH), delivered a blunt assessment: 'One Health is not only a concept, but it is becoming a binding principle of global health programmes. But principles are not enough, and they need to be translated into actions, especially when the first signs of disease emerge. That's why veterinary services must be at the frontlines of pandemic prevention.' She called the COVID-19 pandemic 'a governance stress test that exposed painful gaps in surveillance in the veterinary system and in public health systems and in multi-sectoral coordination.' Those gaps, she warned, still exist. The problem isn't just technical. It's political. Soubeyran said: 'We need to raise the profile of animal health and convince both political and private decision-makers that investment in animal health is very important. Animal health is not only an issue of animal health. It has an impact on trade, food security and public health and antimicrobial resistance and also impacts on biodiversity and environmental impact.' Yet the conversation too often stops at ministries of health. 'Most of the time I speak about One Health in front of ministers of health, but not in front of ministers of agriculture or ministers of economy,' she said. 'I should speak with Ministers of Agriculture, Ministers of Economy, and Ministers of Finance as well.' Without that broader engagement, she warned, the One Health agenda risks narrowing into 'One Human Health.' Governance meets the laboratory Jean-Baptiste Perrin of the European Commission's DG Health Emergency Preparedness and Response Authority (HERA) acknowledged the governance gap, and outlined efforts to fix it. 'We have the preparedness strategy published in March, but additional strategies are coming,' he said. Chief among them is a new EU stockpiling strategy, due on 8 July. While focused on medical countermeasures (MCMs), it has clear implications for zoonotic outbreaks. 'One is the stockpiling strategy, so explaining how the European stockpile can articulate with national, sometimes regional, or local stockpile for meaningful countermeasures,' Perrin explained. Also in the pipeline is a strategy for novel countermeasures (NCMs), mapping the full value chain from innovation to deployment. 'One very important point in this strategy … [is] the governance and the coordination, the chain of command that needs to be clear in time of crisis.' HERA is also working on threat-specific technical roadmaps. 'We're working on threat-specific roadmaps tailored to each pathogen and its most effective countermeasures.' To support this, HERA is building links between human and veterinary institutes, a concrete expression of the One Health vision. However, Perrin stressed that none of this will work unless member states collaborate. 'It's a complex task, especially given the differing competencies of Member States.' Legislative levers remain limited Asked whether the Critical Medicines Act (CMA) could expand HERA's remit to cover veterinary tools, Perrin acknowledged structural limits. 'There is a specific difficulty at European level to properly and fully implement the One Health approach … we do not have the same competency in public health and animal health. That said, it's worth discussing, and I think we need to keep the discussion open and reflect further on the mandate. But as of today we need to concentrate on human health,' he said. The price of neglect If money was missing from the conversation, Professor Jonathan Rushton supplied the spreadsheet. 'Economics is not just for advocacy,' the agricultural economist from the University of Edinburgh warned. 'Economics can help with the drivers of human behaviour … and it can support the assessment of the incentives about how we get people involved in vaccination campaigns.' Rushton noted that animal health contributes to far more than farm productivity. 'We're providing animals that are healthy; they provide products that are safe to eat, in quantity, that actually provides important micronutrients and proteins … it's also an economic activity.' Yet global spending still fails to reflect this importance. In a livestock sector worth an estimated $3.3 trillion annually, animal health spending barely reaches 2 percent of that. 'In 2021, $10 trillion was spent on human health. $70 billion was spent on animal health. It's minuscule.' Prevention is not a luxury Roxane Feller, Secretary-General of Animal Health Europe, closed the meeting by reinforcing what others had said throughout the day: investment in animal health is strategic. 'Animal health is not a cost, it's an investment.' Political momentum is growing, she noted, citing a new Parliament report on livestock sustainability, and recent Council debates on vaccination and disease control. But the One Health gap remains. 'The missing elephant in the room is more on One Health. We still believe that there is a lack of understanding of this intrinsic correlation between human, animal and environmental health.' That disconnect is felt most acutely on the ground. Emily, a young dairy farmer from South Devon, shared the emotional and financial toll of losing over 130 cows to bovine tuberculosis (TB), wiping out decades of selective breeding and destabilising her entire business and family. 'TB's just not a disease when you're losing cows,' she said. 'It absolutely ruins your life.' Her story underscored what many experts argued throughout the day: that prevention must start with engagement, support, and investment, well before crisis hits. From silos to systems What emerged from the conference was not a lack of awareness, but a shared frustration at the fragmentation of the current system. Governance remains weak, investment lags, and political engagement is too narrow. Surveillance, veterinary services, and pandemic response must be connected through legislation, budgets, and cross-sector cooperation. As Soubeyran concluded, 'We cannot prevent every outbreak … but with sustained political will, coordinated investment, cross-sectoral action, we can stop the next pandemic, or at least we can get prepared to be more efficient.' Europe must act before Disease X makes preparation irrelevant. [Edited By Brian Maguire | Euractiv's Advocacy Lab ]
