Fixing public service ‘disaster’ is a pipe dream

A coherent approach needed to fix the health service, writes Jim Power.

Economics is a social science that is meant to provide a coherent answer to the dilemma of how to allocate scarce resources in a manner that will go some way towards satisfying insatiable demand.

In theory, it sounds reasonably straightforward but, in practice, it is a total nightmare, as is being currently demonstrated in cataclysmic fashion in the Irish health service.

In the overall scheme of things, we are not on this earth for very long, so most of us would hope the time we do spend here is as pleasant as possible and our quality of life is of a reasonably high standard. The three public services that contribute most to this objective have to be education, law and order, and health.

Education gives us the tools to make the right choices in life and maximise our potential. Law and order is essential because there are people out there who want to steal the property of others, and make life as bad as possible for others. Without the forces of law and order to control such people, life would be nasty, brutish, and short. In relation to health, we would all hope that we could avail of a health service on demand that would prevent us from getting too sick and cure us when we do. It is all relatively straightforward really. If only.

This week, Minister for Health Simon Harris was forced to apologise to the people of Ireland for the shortcomings in the health service that were highlighted by an RTÉ programme. There was a sense of shock expressed by the minister and others about the real extent of waiting lists in particular and the general shortcomings in the health service in general.

The reality is that our health service is in tatters, as demonstrated by the trolley list and the waiting list, for example. The solution to these long-standing problems has proved elusive for successive ministers and most of them have been happy to move on from the Department of Health as quickly as possible.

A functioning health service needs a number of essential parts. A primary health service that will help keep some people away from the hospital system; it needs high quality equipment to carry out various medical procedures; it needs the requisite number of staff to make the system function, such as nurses, doctors, radiographers, and physios; it needs sufficient bed numbers and physical infrastructure; it needs proper IT-driven administration systems; it needs to be operational 24/7; and it needs proper management.

It needs to be a coherent whole, because if any bits of the system are not in place, then efficiency suffers and the whole edifice comes crashing down. There is no point having lots of consultants if we don’t have enough nurses.

The Irish system seems to fall down on many counts. We do not have a very effective primary health service; we certainly do not have enough beds; it does not operate 24/7; and there are gross deficiencies in at least some elements of staffing. It is also questionable if the hybrid model we have is fit for purpose, with public and private elements operating together. It looks like a recipe for disaster, and it is.

The elephant in the room is funding. Undoubtedly we need to spend more money on the overall service, and these demands will only get larger as our population ages. There is little point in continuing to throw money at the system, if all of the requisite parts are not put in place and if the system is not managed in an efficient and effective manner.

The components of the system need to be put in place and the management of the service needs to be brought up to scratch. Vested interest groups cannot be allowed prevent necessary reform. In relation to resources, Government should move away from the scattergun approach to fiscal policy that was demonstrated in a very depressing manner in Budget 2017 and direct resources in a manner that will have a meaningful impact. Sounds like a pipe dream.


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