Clinical Measurement Science (CMS) Physiologists are set to take a much greater role in community focused diagnostics. The driver behind this has been the shift in national health policy towards integrated community based care, the Slaintecare approach. It too has been advanced by the hard work of colleagues in the CMS family specifically aligning with this policy and taking the first steps towards diagnostic procedures preformed out in the community and closer to the patient. The successful application of trials of CMS services in the community has been achieved by colleagues including Geraldine Nolan and Orla Farrelly (Respiratory Physiologists) and Paul Nolan and Donal O Dea (Cardiac Physiologists). They identified services that could be provided out of the hospital such as pacing, ECHOs and lung function assessments. With the support of their hospital leadership and the HSE, they have demonstrated that these new pathways are safe, effective and convenient for patients. 

The National Clinical Programs are described as “a reference point for providing cross-service and cross programme solutions in relation to new models and pathways of care based on population need”. They have been established for many diseases including Respiratory and Cardiac diseases. According to the HSE, the objective of the Integrated Care Programmes is to “design an integrated model of care that treats patients at the lowest level of complexity that is safe, timely, efficient and as close to home as possible”. The Integrated Care Programme for the Prevention and Management of Chronic Disease (ICPCD) focuses on a number of chronic diseases that impact a large number of health service users. Fundamental to the integrated care approach is early disease detection, therefore the role of the CMS Physiologist is central to the success of these programs. 

Many of the programs are designed to be deployed within a large MDT in community-based hubs. When initially the Cardiac and Respiratory programs were announced Cardiac or Respiratory Physiologists were not listed as the core MDT (https://www.hse.ie/eng/about/who/cspd/icp/chronic-disease/documents/chronic-disease-service-model-implementation-resource-pack.pdf). This caused great consternation among CMS Physiologists in the FORSA professional group. Efforts were made to clarify the situation and to identify the reasons for this decision. Under the fog of the COVID crisis several offices in the HSE were experiencing reduced staffing due to redeployment. It was not easy to get good visibility of the responsible office or leadership team within the HSE making these decisions. Around Autumn 2020 a tender was announced for diagnostic services including Cardiology and Pulmonary function services without having consultation with the union. The worry was that such a tender could derail any significant uplift in publicly funded posts for these new centres. This tender was not completed. Instead, we have approval for in the region of 100 new senior posts (Respiratory and Cardiology) to support the hubs and community testing. This is most welcome.

These new posts have been approved under the enhanced community care (ECC) programme and the posts will be recruited by the acute hospitals. The service activity will be managed via a Service Level Agreement (SLA) with the chosen hospital. Existing labs will recruit these new appointees and they will fall under existing line management arrangements. The HSE is funding hospitals to employ senior physiologists and utilize them to provide 80% community capacity and 20% hospital capacity. The tests provided will be decided locally but the capacity commitment must be met to ensure the community hubs and local GPs have access to diagnostics. Locally, each hospital will have a consultant split between community and hospital equally and so these will be the leaders of the service and will decide the diagnostic assessment that each patients needs.

This raises significant concerns for labs that don’t have a chief in place and could see perhaps an increase of 2 or even more senior physiologists. In Respiratory for instance, it is unfortunately not uncommon for Labs to be led by a Senior and no Chief. It is also evident based on announcements to date that new senior posts will be allocated to some hospitals that don’t have a lab. The HSE through the HSCP office have been compiling a report into the supply of Physiologists and we hope it will clarify issues such as these anomalies and address career progression and specialist’s posts. We have not yet seen the report but it needs to cover these issues of organisational structure and professional development. We want to get the best return on this investment and do so in a way that is safe and effective for patients and ensures the future training, progression and development of staff.

With such a fast pace of change there will be unforeseen issues. Please get in touch with the local hospital rep or the FORSA CMS group if you have any concerns or ideas to achieve the best possible outcome for members. FORSA will be looking into these issues arising in the coming weeks and we will report back on progress.