An ambitious HSE plan to provide quicker and better chronic disease care and reduce deaths and disability has yet to be costed and no specific additional funding has been allocated to it.

The consultant specialists organising the new programmes in a number of disease areas including stroke, diabetes and lung disease, have stressed that many of the changes planned will not require additional funding.

However, at a press briefing, it was admitted that some level of extra funding will be required and putting the new systems in place will still be challenging in the face of major cutbacks in health spending.

At the briefing, a number of the consultant clinical leads organising the new programmes outlined how the new systems, through more effective use of inpatient, outpatient and primary/community care, and better liaison between the different care pathways, will improve the quality of this care and give patients better and quicker access to it.

The programmes are still at the planning stage and are intended for implementation over the next two years. The consultants leading the programmes say many of the changes will involved "nationalising" high quality care already taking place in some locations.

Much of  the work involved, they say will mean reorganising existing resources, changing how care is provided and where necessary retraining staff. They have stressed that the quality of care for many diseases at present varies greatly depending on location and availability of services locally.

The HSE has pledged that the new programmes when up and running, will lead to a huge reduction in waiting lists and less pressure on A&Es.

It has promised that the programmes will improve care in the following ways:

Stroke:

Develop national rapid access to high quality stroke care; prevent one stroke every day; avoid a death or disability each day; double the number of hospital stroke units. The HSE says many of the resources to achieve these aims are already there, and spending priorities need to be reorganised.

Heart attacks:

Standardise treatment of heart attacks across the country so that everyone wherever they live will get rapid access to the best care; reduce heart attack deaths and improve quality of life post-heart attack; ensure that every patient is diagnosed correctly and without delay.

Diabetes:

The care revamp will, it is promised, help save the sight and limbs of people with diabetes who get currently go blind or suffer amputations due to complications of the disease. It will, it is promised, help reduce heart disease and deaths from diabetes. A national screening programme will be established to check for eye disease related to diabetes. There will, it is promised, be better links between hospitals and GPs to treat diabetes patients more effectively. The HSE says preventing diabetes complications will save money for the health services.

Lung disease (chronic obstructive pulmonary disease):

This includes diseases such as emphysema and bronchitis. The HSE says new pulmonary rehab programmes will help improve quality of life and reduce breathlessness in patients. More patients will be treated outside hospitals and in the community. The HSE admits that there will be costs involved in setting up this programme but by reducing the number of hospital admissions for lung disease, savings can be made. The scheme is intended to prevent 50 people dying from chronic lung disease each year.

There are a total of 21 programmes and other diseases covered include heart failure, asthma and epilepsy.

Speaking at the press briefing, joint stroke clinical lead Dr Peter Kelly stressed that strokes is the third commonest cause of death in Ireland. He said only half of the country's 33 major acute hospitals currently have stroke units and 50% of hospitals currently provided emergency "clot-busting" drug services for stroke victims.  These areas would be targeted for improvements in the new programme.

He said there was a need to improve transition from hospital care to community care. There would be local stroke teams and regional stroke care networks. Prevention and rehab services would be developed.

As an example of how the new system would work, Dr Kelly said 10% of people who had "mini-strokes" or TIAs were at risk of suffering a full stoke within the following few days.

Currently, he said, these patients often have to be referred to A&E by their GPs, where they are often treated by a non-specialist junior doctor. The patient may have to wait for access to a specialist and the average length of stay for the patient was usually around five-and-a-half days.

He said we needed to move to a system where patients with mini-strokes have rapid same-day access to a specialist. Dr Kelly said getting quicker access to specialist care for these patients can reduce the risk of a full stroke by 80%, and a rapid access system would not cost extra money.

Prof Kieran Daly, who is leading the heart attack programme, said it was aimed to have the same standard of quality rapid care for those who suffer heart attacks, wherever they lived.

He said these patients needed to be brought to hospital as quickly as possible to open up their blood vessels and then have follow-up care provided. Prof Daly said the time factor was crucial. Some patients would need clot-busting drugs administered quickly, and the length of time patients had to stay in hospital after a heart attack would be reduced under the new programme.

Leader of the diabetes programme Prof Richard Firth said diabetes was responsible up to 15% of healthcare expenditure. He said our healthcare system at present was not designed to look after chronic conditions like diabetes.

Prof Firth said the complications of diabetes, such as blindness, amputations, and heart disease were completely preventable and up to 80% of those with diabetes died prematurely.

On funding issues, joint lead of the stroke programme, Dr Joe Harbison, said the new scheme had not yet been costed.

He said data was still being put together and it was still at the planning stage.

Asked how funding would be found for around 15 extra hospital stroke units, Dr Harbison said very few of the 17 new units set up in the in the past few years received any specific budget to do so, and a lot was achieved through reorganisation of services within hospitals into new units.

Dr Harbison said by putting patients together into one place in the hospital, developing care pathways and improving training had been shown to improve outcomes.  He said in time extra staffing may be needed, but a lot could be acheived without a huge investment in funding.

He admitted that implementing the plan would be challenging against a background of major cuts in HSE funding next year, but the plan had not yet got to the costing stage.

Dr Kelly stressed that we are currently spending money on healthcare systems in a way that was not providing an effective enough service to get the benefits that could be achieved, and this needed to change.

Dr Firth said it was likely that the current diabetic eye disease screening programme in the west of the country would be rolled out nationally as part of the revamp of diabetes care.

He said some "seed corn" funding may be needed for this.