SO YOU want change? But do you really? The word change is in vogue in the wake of the general election.
Some politicians, when they speak publicly these days, sound like they are on a bet to use the word ‘change’ as many times as possible. Change is all the rage.
The aspect of governance in which people most desire change is the health service. The exit poll conducted after last Saturday’s election found that health was the most important issue in determining how votes were cast.
A total of 32%, nearly one third of voters,
In reality, there are an awful lot of people out there, and a few powerful interests, who will do whatever is required to stymie change in the health system.
These vary from interests within the system to people fearful of change, to politicians who excel at pandering but wouldn’t lead change to save their lives.
Last Wednesday, a doctor was on the radio, talking about change that would save lives of people who are dying needlessly.
Conor Deasy is the clinical lead in trauma in the National Office of Clinical Audit. He was interviewed on Newstalk Breakfast about a new report into the State’s trauma centres.
The report says there are too many trauma units in the country, and recommends the number be reduced from the current 26 to a handful.
“If your loved one falls down a stairs in Blanchardstown or Belmullet or Ballyheigue, she will be brought to the local hospital,” he told Newstalk.
This, he pointed out, usually necessitates being referred on to another hospital and quite possibly a third.
The solution is a one-stop shop, a single site that has all the specialities on site for those patients that are severely injured. We know from international experience that if we do that, we will reduce the number of lives lost and the extent of injuries sustained.
This is the kind of change that would make the health service function better, by saving lives, increasing quality of treatment, and relieving great stress for injured patients and their families. Who could be against that?
Pick any number of TDs in any number of constituencies. The plan, if it is ever pursued, will necessitate the closure of trauma units in hospitals around the country. Local communities will undoubtedly object. Their fears are understandable.
But all the evidence suggests the fears are not soundly based. Fewer trauma units and fewer emergency departments ensure the population as a whole is better served.
Less people die, more have a better chance of full recovery.
We don’t need to look abroad to see how fewer centres with greater expertise works best for everybody. The system of centres of excellence in cancer care has been a major success story.
It was initiated, notably, by Dr Tom Keane, who returned home from Canada for the job.
The health min
ister at the time, Mary Harney, came under serious pressure to row back on rationalising the number of centres, but Keane threatened to walk and Harney backed him.
Now, more people are alive than would have been the case under the old system; more people are getting more years, more quality in life.
But enunciating that to fearful communities is a messy job. And if you’re a local politician and you attempt to lead by doing the hard yards, explaining why rationalisation is in everybody’s interests, your opponent will make hay and pander to the fears.
The latest example of this came last Wednesday from Independent TD for Cork South West, Michael Collins, on RTÉ radio.
He told Seán O’Rourke that among his demands in any government negotiations would be extra resources for Bantry Hospital.
Asking Mr Collins whether this would necessarily be a good thing for local people would be a redundant exercise. In the same conversation, on the subject of drink-driving, he told Mr O’Rourke that “God only knows” what causes fatalities on the roads.
Poor old God is increasingly hauled out to explain any phenomenon (Danny Healy-Rae invoked Him in relation to climate change) that might impact on a politician pandering to some interest.
God only knows where Roscommon Hospital would be today if its 24-hour emergency department wasn’t shut in 2011. This became a major political incident as Fine Gael had promised prior to the 2011 election it wouldn’t downgrade the hospital, but then agreed to do so when in government.
Local TD Denis Naughton resigned from the party as a result. His colleague, Frank Feighan remained in Fine Gael, attempting to sell to local people the advantages of taking the long view. For his trouble, he was subjected to horrendous abuse.
The hospital is now on a sure footing as a result of new investment, which would not have been made if it had to continue with the 24-hour service. In 2016, Feighan said the investment backed up how he had handled the matter.
“I feel fully vindicated over the stance I took in relation to Roscommon Hospital,” he told the Journal.ie. “Consultants have gone on the public record that the hospital is now much safer as a result of the changes which have taken place there.”
Last year, an in-patient survey of hospitals in the West found Roscommon had the best outcomes, with a 98% satisfaction rating. F
rank Feighan won a Dáil seat in the neighbouring Sligo South Leitrim constituency last Saturday.
Reconfiguring or rationalising the hospital system in the country is not a panacea for the health service. However, failing to do so will ensure that proper reform will not be undertaken.
The problems that persist, that prompt voters to want change, will not be addressed by tinkering.
There is a plan for change in health called Sláintecare. It will require money and serious reform.
All of the political parties campaigning in the general election have concentrated on the money side of things. Finding, or pretending to have access to, money to spend on health is the easy part.
The real stumbling block is getting everybody onside to drive the change. Don’t hold your breath. The current political environment is geared to run away from any difficult decisions.
The most obvious example in that respect is the relegation in the election campaign of the climate change issue.
Real action in that respect would require major upheaval and the implementation of difficult policy decisions.
So it also goes in health. Sláintecare is a fine plan.
Everybody is willing to throw money at it. But don’t expect much leadership when evidence-based policy is pitted against voters’ instinctive, if misguided, fears.