Madam, - I was interested to read the article in your Health Supplement of July 17th on the HSE's new "Hospital in the Home" initiative. This is certainly a powerful model of care. However, it is not new, and not, as your article suggests, based on services in Canada and the US, but on well established and extremely effective services provided over the past five years by two Dublin teaching hospitals, Beaumont and St James's. The HSE extensively reviewed these hospitals' existing services prior to seeking tenders for similar initiatives in the private sector.
If the CEO of Tara Healthcare says that other models have "fallen short", he is certainly not describing the existing Dublin services. Our length of stay for acute COPD patients is two days, much shorter than the eight days your article quote for Tara Health. And our readmission rate for these patients is down by 77 per cent, proof that properly trained clinical nurse specialists (and physiotherapists) working closely with existing hospital consultants can deliver a most effective service. So don't knock the nurses. Just make sure they are trained properly as specialists and supported appropriately.
The key to our success has been the delivery of all aspects of respiratory care from early discharge (for acute admission), through home follow-up (hospital in the home) to a structured pulmonary rehabilitation programme - all delivered by the same focused team - nurse-led, consultant-supervised. We are delighted to see Tara Health mimic the hospital-in-the-home component of our service so that increasing numbers of patients may reap the obvious benefits.
Finally, we probably operate at a fraction of the cost of Tara Health and we look forward to the planned HSE "value for money" audit of these services in due course. But perhaps this doesn't matter; sure isn't the country awash with money? - Yours, etc,
FINBARR O'CONNELL, Consultant Respiratory Physician, St James's Hospital, Dublin 8.