What the experts would do if they could spend health budget

IN A shrinking economy, controlling the current pocket-lining arrangements is a priority. Medical inflation is not an act of God: it is a consequence of the “free market” in healthcare.

The priorities are:

* Replace the system of centralised administration with a decentralised approach, giving hospitals greater freedom to deliver their services. Devolve hospital budgets down to individual services: require heads of departments (senior clinicians) to take responsibility for expenditure. Publish detailed accounts to involve everyone, from (in-house) cleaners up, in the drive to end corruption and eliminate waste. Micro-management would make the current crude “cut, squeeze and freeze” approach redundant.

* Require doctors to prescribe generic drugs rather than branded ones wherever possible. Negotiate a better deal with the pharmaceutical industry based on evidence that their products offer value for money.

* End medical, dental and pharmaceutical monopolies.

* Stop picking up the tab for malpractice awards for consultants working full-time in private-for-profit hospitals in specialties such as obstetrics, which carry a risk of brain damage.

- Marie O’Connor is the author of Emergency: Irish Hospitals In Chaos.

IF I had control of the health budget, I would start with the basics, beginning with the manner in which our hospitals are cleaned.

* I would designate a cleaner for each ward. At the moment different cleaners clean different wards and there is no accountability.

* I would then make sure hospitals are staffed to provide basic care. By this I mean if a patient needs assistance in being brought to the bathroom, then that assistance is readily available.

* In terms of cancer care, there needs to be a high standard of treatment for all types of cancer and not just breast cancer. This is particularly important in the context of the predictions of the National Cancer Registry which forecasts a 90% increase in overall cancer numbers by 2020. We need to build up a service capable of meeting this demand.

* In terms of future demand, it is extremely worrying to hear the Health Minister say we can build up centres of excellence through a re-configuration of existing resources. In many cases, we don’t even have the basic infrastructure. I also see a huge need to invest in a transport system for the hundreds of patients who must travel for treatment, particularly now in the context of the withdrawal of breast screening services in the midlands.

* Finally, I would ensure the immediate roll-out of BreastCheck, the national breast screening programme, in Waterford and Tipperary.

- Jane Bailey is spokeswoman for Cancer Care Alliance

FIANNA FÁIL’S healthcare promises in the election can be summarised as follows:

* To help people maintain good health through health-promoting initiatives and a new Personal Health Check entitlement.

* Ensure all communities have accessible, high-quality primary healthcare services, with longer daytime provision and access to urgent out-of-hours medical services within one hour.

* Increase the numbers of beds, consultants, nurses and other professionals in our hospitals and, through the reform of key work practices and ‘continuing substantial investment’, deliver faster and better care for patients.

The reality:

* 200-plus patients each day on chairs and trolleys across the country.

* Cancelled operations.

* Closed units.

* A ban on recruitment, leaving many units understaffed.

* A shortage of home care packages for the elderly.

* Dirty hospitals and an increase in hospital-acquired infections.

* A delay in rolling out cancer services.

* Cover-ups and misdiagnoses across the country.

* Unrelenting delays to see doctors, consultants and to access X-rays, scans, biopsies.

- Janette Byrne is spokeswoman for Patients Together and author of If It Were Just Cancer. [e-mail]