CLOCK WATCHINGHEALTHY AGEING IN A MODERN IRELANDA Breakfast BriefingMerrion Hotel, Dublin, 14th June, 2013

Produced for AbbVie by Irish Medical Times

On June 14 2013, AbbVie held a breakfast briefing meeting on the topic of sustainable healthcare for an ageing population. The speaker pan-

el included Department of Health Secretary General Dr Ambrose McLoughlin; Dr Azita Saleki-Gerhardt, PhD, Senior Vice President Operations, AbbVie; Charles Handy, social philosopher and writer; Pascale Richetta, Vice President, Western Europe and Canada Operations, AbbVie; and Mr Tommy Byrne, Client Principal, Hewlett-Packard Ireland Limited.

The invitation-only event was attended by leading figures in Irish healthcare, includ-ing representatives from public and private

service delivery, clinicians, patient advocates, consultancy experts, academia, government representatives and policymakers all keen to address this challenging healthcare issue.

Presenters noted that life expectancy in Europe has risen by an average of 10 years since 1960,1 and that by 2050 it will average 82 years.2

While this is to be celebrated, it poses chal-lenges in ensuring older people live full, active and healthy lives. Chronic illness is a key issue in this respect, as 100 million Europeans have a chronic illness.3 This is a leading cause of mor-bidity and mortality, which is placing severe strain on healthcare systems across Europe, including Ireland.4

A number of the speakers maintained that the burden of chronic disease can be managed in a more cost-effective and patient-friendly way, through early diagnosis, intervention and treatment as part of preventive and primary healthcare. It is likely that this will be deliv-ered with the aid of new technology platforms. The meeting served as a call to action to open multi-stakeholder dialogue on planning to ex-tend healthy life years and create a system that addresses to the needs of Ireland’s ageing population.

Speakers noted that increased life expect-ancy should be seen as an opportunity, not a problem, for positive changes in how our healthcare system is structured.

ExEcutivE Summary

Mr Ryan Quigley, General Manager, AbbVie Ireland

What iS SuStainablE hEalthcarE?

Mr Quigley opened the meeting by posing the question: What is sus-tainable healthcare?

He said to fully realise the op-portunities offered by sustainable healthcare, synchronised strategies are crucial, whether the perspective is public, private or intersec-toral, adding that this is a core theme of the Government’s Healthy Ireland document.

He told the attendees that, in line with the focus of the meeting, as a new company AbbVie is committed to sustainability and innovation, and that the company is keen to share a number of initiatives and pilot projects that demonstrate its dedication to sustainability.

Mr Quigley said that Dr Azita Saleki-Gerhardt PhD, Senior Vice President Operations, AbbVie was present at the event to detail the company’s manufacturing foot-print in Ireland. AbbVie has two manufactur-ing plants in Sligo and a third operation in

Cork and the company is looking at options that may expand the range of products manu-factured in Ireland.

During his presentation, a short video

highlighting the challenges of healthy aging in Europe was played. It showed how life ex-pectancy continues to increase but chronic illnesses threaten the viability and sustain-ability of European healthcare systems: Approximately 86 percent of deaths 5 in the EU are caused by chronic conditions.

The video pointed out that our healthcare systems are designed to deal with acute, short-term illnesses and injuries rather than the pre-vention and management of the long-term impact of chronic conditions. Approximately 70-80 percent of European healthcare 6 budg-ets are spent on chronic disease care, with only 3 percent 7 spent on prevention and public health programmes, but given the rise of ageing populations, it is unsustainable for funds to be directed in this way.

The video concluded that chronic diseases need to be proactively managed at a much earlier stage to minimise impact and prevent long- term complications.

Ryan Quigley, General Manager, AbbVie

● Clock Watching: Healthy Ageing in a Modern Ireland

hEalth rEform in irElandDr Ambrose McLoughlin, Secretary General of the Department of Health

The event’s keynote speaker gave a com-prehensive update on the Government’s healthcare reform programme, which is the most ambitious reform of Irish

health services since the foundation of the State. Dr McLoughlin is currently the Secretary General of the Department of Health, Chair

of the Board of the Health Services Executive (HSE) and Chair of the Health Reform Board.

He acknowledged the reform programme is very challenging, not least because it has to be done in the context of a major cost reduction and increasing demands for healthcare services. In a nutshell, he said the Government’s vision

is for a single-tier health system, supported by universal health insurance where access is based on need not income, adding that this is mapped out in the recently published Future Health document.

“The Department is the Department of Health not the Department of Care and

Treatment. People sometimes get mixed up about this. Health and wellbeing are critical to our people, they are critical to our economy and social development,” he commented.

Major structural reform is now being rolled out across Irish health services. Patients and their safety must be at the heart of everything, Dr McLoughlin stressed, adding that regulation is a key part of this. A new Patient Safety Agency was recently announced by the Minister.

Discussing the progress to date and the timeframe for the rollout of universal health in-surance (UHI), the speaker confirmed a UHI design team is now in place, a permanent risk equalisation scheme has been put in place, and the framework for small hospitals has been published. The Small Hospitals Framework plan is now being implemented.

In addition, policy appraisals of UHI models are due to be completed shortly, with progress being made on the review of the integrated service areas. That review should also be com-pleted shortly.

Dr McLoughlin expressed particular satis-faction that Minister for Health Dr James Reilly had been successful in gaining Government and cross-structure support for his hospital groups policy. Dr McLoughlin said Minister Reilly is par-ticularly pleased that these hospital groups are linked to academic centres of excellence, which Minister Reilly believes will bring huge energy and intellectual power to the hospital system and the wider health system. Each hospital group is to have a strategic plan for its future direction agreed on within a year and submitted to Minister Reilly for approval.

The speaker said Minister Reilly and the Government want to engage in a “true part-nership with industry” and see innovation hubs covering medical devices, pharmaceuticals, ICT and other industries on the campuses of each hospital group. Dr McLoughlin maintained the critical mass generated by the new hospital group system means Ireland can now develop its own Mayo Clinic/Johns Hopkins-style cen-tres of health excellence.

Minister Reilly will shortly be talking to lead-ers in industry with the view to putting together a national group to oversee this multi-stake-holder relationship, and prominent figures in the business and industrial world will be appointed to the new hospital groups’ boards in the com-

ing months, Dr McLoughlin told the meeting. A major systems reform of the HSE is also

ongoing with much advice being sought on the changes that are being made to the health sys-tem from the best experts in the field, the speak-er said. A new financial system is also being put in place, he noted. This healthcare system will phase in a new ‘Money Follows the Patient’ funding model, Dr McLoughlin confirmed.

The keynote speaker said the new national paediatric hospital is progressing to target, with key appointments due in the coming weeks. Building is scheduled to commence on site from 1st January 2015 to allow the facility to be up and running by 2018/19. The new National Children’s Hospital will have strong links with Northern Ireland and will “be an “all- island chil-dren’s hospital”, Dr McLoughlin stated.

In relation to waiting lists, Dr McLoughlin said there are now 8 percent less patients waiting on trolleys compared to this time last year (on top of a 23.6 percent reduction seen in 2012 compared to 2011) with progress also being made on inpatient waiting lists for both adults and children, and on diagnostic waiting times.

Discussing the legislation necessary to un-derpin change in the system, Dr McLoughlin said the Health Information Bill will be pub-lished in the last quarter of this year and have a big impact on the reform programme. In addi-tion, the HSE Governance Bill has been passed and the Health (Pricing and Supply of Medical Goods) Bill has also been enacted into law. Dr McLoughlin predicted this would reduce the cost of medicines for the State and public. Dr

McLoughlin also called on the medical profes-sion to prescribe the most cost effective medi-cines for their patients. He added that the HSE’s new Medicines Management Programme is also making inroads in bringing down the State’s medication costs.

Looking further ahead, Dr McLoughlin main-tained that Minister Reilly wanted the country to move towards a tobacco -free society as soon as possible, thus reducing cancer, respira-tory disease and other circulatory chronic dis-eases. He said he sees pharmacists playing a larger role in healthcare delivery in the primary care field, confirming his support for minor ail-ments and chronic disease monitoring being carried out in pharmacies. Plans are also be-ing put in place to widen the scope of the role of nurses, and to ensure more integrated care across the entire health care system. We can expect to see more of an emphasis on chronic disease management, and to have more home-based healthcare solutions, he said.

Coming back to the meeting’s theme of healthy ageing, Dr McLoughlin said it is very possible for individuals to remain healthy right into their 90s and said people must be sup-ported and encouraged to productively man-age their health and wellbeing. He pointed out that a national positive ageing strategy has now been launched by Minister Kathleen Lynch and revealed Minister Lynch will also shortly launch a single assessment tool for older people. Reviews of the national nursing home support scheme and the status of public nursing homes are under way, with a significant investment in the public nursing home sector planned for the coming years.

Concluding, Dr McLoughlin said health out-comes are what really matter for patients, with the Irish system now firmly moving towards providing accessible, affordable, sustainable and evidenced-based healthcare. He main-tained that Minister Reilly and his colleagues Ministers Lynch and White have made, and con-tinue to make, significant progress in delivering the new reform programme. “The Ministers in the Department of Health are ambitious for the health and wellbeing of the people of Ireland and the recently launched Health Ireland Initiative and policy will place, on a proper pro-tectory, the future health and wellbeing of our people,” the speaker said.

● Clock Watching: Healthy Ageing in a Modern Ireland

Dr Ambrose McLoughlin, Secretary General of the Department of Health

Mr Handy offered his audience a very lively and engaging presen-tation, highlighting the opportuni-ties and challenges of life’s ‘bonus

years’. The octogenarian said he was deter-mined to ensure that people do not waste the extra decade in life expectancy that has been gained since 1960.

“Turning it into a problem, instead of an opportunity, is crazy. It is an opportunity, and we must make sure that happens. To do that we’ve got to start by redefin-

lifE'S bonuS yEarS: thE opportunitiES and thE challEngESMr Charles Handy, social philosopher and writer

ing what it means to be old,” he told the meeting.

He said, for example, 50 is not old and that he believes 75 is the new 65 and he challenged those attending the meeting to make that a reality by 2050. This will re-quire a change in thinking, he acknowledged, but attitudes to ageing as well as statistics need to change, Mr Handy stressed.

Society should no longer look at life as having one peak, with everything go-ing downhill from there, particularly once people retire, he maintained.

“There can be a second curve, that is my new word for retirement, where you do something new and different for the second life, you can actually reinvent yourself. The snag is that the second curve has to start just when the first

curve is peaking,” Mr Handy said. Making reference to a book he and his wife co-authored — Reinvented Lives: Women at Sixty: A Celebration — the speaker noted that all the subjects in the book were female and that men were not good at reinventing themselves.

Mr Handy closed his presentation with a Chinese proverb that maintains that, to be happy, all you have to do is to have something to work on, someone to love (who hopefully loves you) and something to hope for. He challenged the meeting attendees to think about how they would reinvent themselves and help others to also do so. “And please [come up with] a new word for ‘old’ that sums up wise-dom and experience and not ‘used up’,” he concluded.

● Clock Watching: Healthy Ageing in a Modern Ireland

Charles Handy, social philosopher and writer Pic: Elizabeth Handy

thE rolE and contribution of tEchnologyMr Tommy Byrne, Client Principal, Hewlett-Packard Ireland Limited

Mr Byrne highlighted the role and contribution of technology in ena-bling sustainable healthcare sys-tems. He raised concerns about

unwise spending in healthcare and referred to opportunities to gain efficiencies realise savings such as in the management of chronic illnesses, many of which could be prevented.

There are opportunities now to bring about improvements with better planning and structuring of health spending and services, he said, noting IT can be used to improve the “business process” in health-care. For example, as in the IT and bank-ing worlds, the use of more self-service healthcare delivery methods and empower-ing patients is the way to go. Unlike many other sectors, healthcare has not yet fully harnessed the power of IT to improve its processes, Mr Byrne told the meeting, adding that the new National Children’s Hospital offers an excellent opportunity to showcase the many benefits that the latest IT innovations can bring to Healthcare.

The changing demographic of the popula-tion means the health service and its staff have to adapt to accommodate these chang-ing demandss, Mr Byrne stated, noting that an estimated three quarters of people over the age of 75 have a chronic illness of some kind.

IT services such as remote or telemonitor-ing are examples of how care can be provided to patients with chronic illnesses in their own home in an effective way.

“However, for IT to be successful we need centralised systems with centralised data that can be shared effectively. We also need

that data to be collected for patients from a number of sources but associated with a unique identifier for each patient so the infor-mation can be collated properly. This is one of the challenges we face,” he said, adding that the lack of a unique patient identifier and dis-jointed systems are currently major barriers in the Irish health service.

On the plus side, there are many exciting developments taking place in the IT arena that present significant opportunities to im-prove healthcare delivery, Mr Byrne noted.

He said mobile devices offer major oppor-tunities and advantages for the healthcare sector as do social networks – such as in the

case of patients with a particular condition coming together and sharing information – and cloud computing, which allows the col-lection and storage of vast amounts of in-formation that could be analysed to provide accurate and individualised treatment plans.

While a number of such technologies are being successfully employed or trialled in dif-ferent parts of the health service, the fact that they are standalone or vary across in-stitutions impedes their potential, Mr Byrne contended.

The role of the hospital sector is still the lynchpin in the healthcare system, he main-tained, saying that for them to operate ef-ficiently they need to have connected infor-mation from all areas of the hospital and all people in contact with the patient.

The speaker said there have been a number of successful examples of ‘digital’ hospitals, and HP has a centre of excellence in Oslo, which is visited by many organisations across Europe to see how this technology can be successfully employed.

Looking at the role of technology in the pharmaceutical sector, Mr Byrne said HP had managed to take its technology for dispens-ing printer ink in very small quantities and apply it to the process of determining medi-cation dose sizes for particular conditions. He revealed this has reduced the time and costs previously needed for that process.

Concluding, Mr Byrne said better use of IT in healthcare could help achieve the savings and efficiencies that the system so badly needs at this time, and he urged the Department of Health to prioritise the crea-tion of a unique patient identifier as soon as possible

Mr Tommy Byrne, Client Principal, Hewlett-Packard Ireland Limited

● Clock Watching: Healthy Ageing in a Modern Ireland

driving SuStainablE hEalthcarE togEthEr

The event’s final speaker discussed how the healthcare system’s various stakeholders could drive sustainable healthcare through effective and mu-

tually beneficial partnerships.“We should not be overwhelmed by the

challenge ahead of us. By working together, and by taking small steps, we can probably achieve great things. It is clear the sustain-ability of healthcare systems is a challenge to most nations, particularly in Europe, and the shift in demography is a fact, as is the rise in chronic diseases,” she commented.

In an effort to help address the cost of chronic diseases to healthcare budgets, AbbVie recently convened a special meeting in Brussels, Ms Richetta explained. A key out-come of this gathering was agreement that innovation has to be at the heart of the major changes that must take place to achieve sus-tainable healthcare systems.

Patient empowerment is also a critical ele-ment of the changes that will be needed, she noted, explaining that the home environment can provide the lowest-cost healthcare and also the greatest patient involvement.

While a number of speakers at the meeting highlighted the importance of primary preven-tion, Ms Richetta said all forms of prevention, including secondary and tertiary prevention, play a key role, along with early diagnosis and intervention. “According to a recent EIU re-port, it is never too early to tackle chronic dis-ease to extend healthy life years,” she added.

Ms Richetta emphasised the importance of achieving the best health outcomes possi-ble whilst being open and transparent in the provision of outcomes data, which she said would drive improvement, and added that

the IT industry can really help on the data sharing front.

Referencing the Healthy Ireland report, she said a multidisciplinary approach is key to successful health outcomes and highlighted AbbVie’s work on three projects in Ireland partnering with healthcare stakeholders to find solutions to major healthcare issues. Ms Richetta discussed a successful project in the Rheumatology Department of St James’s Hospital, Dublin, that focused on the better use of people and resources to reduce wait-ing lists and maximise the number of patients who attended their appointments. The project revamped the appointment system, and by contacting the patient beforehand made sure they were more likely to attend their appoint-ment and were also more likely to have all the

necessary information to hand.“The results speak for themselves.

Previously there was a 34 percent rate of no-shows, which subsequently dropped down to 5 percent. I think by starting small we can re-ally do big things and while this was just one specialty in one hospital, it is certainly univer-sal and can be translated in many disciplines,” she told the meeting.

Another successful Irish healthcare part-nership project that AbbVie has been in-volved in is the Fit for Work initiative, which Ms Richetta noted is addressing the impact that musculoskeletal disorders have on the economy and our workforce. Up to seven million lost days at work are recorded each year from musculoskeletal disorders, cost-ing the economy an estimated €750 million a year.8

The third partnership project Ms Richetta discussed was a premature baby initiative that facilitates the immunisation of these babies in the home setting by a nurse. This is convenient for parents and avoids unnec-essary travel and pressure on hospitals. The project, launched in 2008, has been very suc-cessful and has treated over 3,000 babies, leading to the avoidance of 14,000 hospital appointments.

Concluding, Ms Richetta restated AbbVie’s firm commitment is to working in partner-ship with those in the healthcare provision arena. She said she hoped the meeting had encouraged the Irish healthcare stakehold-ers it brought together to engage, discuss and work together on creating solutions to ensure Ireland’s healthcare system moves to-wards a sustainable system that provides the best care for all who need it.

Pascale Richetta, Vice President, Western Europe and Canada Operations, AbbVie

Ms Pascale Richetta, Vice President, Western Europe and Canada Operations, AbbVie

● References:

1 Better Life Index, OECD 2013, http://www.oecdbetterlifeindex.org/topics/health/

2 Tuljapurkar S; Nan L; Bow C, Nature 2000, quoted by National Institute on Ageing (NIA), http://www.oecdbetterlifeindex.org/topics/health/

3 European Chronic Disease Alliance, quoted on the European Society of Cardiology website, http://www.escardio.org/about/what/advocacy/Pages/Chronic-Disease-Alliance.aspx

4 Financial Times, Special Report by Andrew Jack, 20th June 2013, Trends urge need to put prevention before cure; Health at a Glance: Europe 2012, OECD, http://www.oecd.org/newsroom/healthspendingineuropefallsforthefirsttimeindecades.htm

5 European Public Health Alliance (EPHA) website, http://www.epha.org/spip.php?article5131

6 Eurpean Public Health Alliance (EPHA) website, http://www.epha.org/spip.php?article5131; mHealth: A New Vision for Healthcare, McKinsey & Company, 2010, http://www.qrcodepress.com/mhealth-will-play-a-central-role-in-boosting-european-healthcare/8521144/

7 Alliance for Health Reform position paper, 2012, http://www.allhealth.org/publications/Public_health/Public_Health_Prevention_Efforts_Issue_Brief_115.pdf

8 Bevan S, McGee R, Quadrello T, Fit for Work? Musculoskeletal disorders and the Irish Labour Market, April 2009