A collapse of trust - National emergency in health

THE COLLAPSE of trust in institutions we should be able to have absolute faith in is the unfortunate and recurring theme of the last two decades.

Firstly the Catholic Church, once an absolute power in the land, saw its power slip away because of its opposition to changing social mores and its inability — or plain reluctance — to deal with sex scandals.

Our banking and legal systems are under the spotlight because of situations rooted in greed and dishonesty.

Next was our political system. It has been discredited as tribunals expose corruption on an unimagined scale. The crises in public services ensured that any remaining faith in the system would be sternly challenged.

Sadly, we must add our health service to that sorry list. The current breast cancer fiasco is a scandal too far, the final breach of trust in a long series of betrayals.

The Hep C scandal, nursing homes, PPARS computer systems, public waiting lists, A&E chaos, the Michael Neary scandal, private patient preference, hospital wards infected with super bugs and co-location — there’s no need to go on, all represent institutionalised chaos and indifference on an utterly unacceptable scale.

How can this be? The vast majority of people working in the health service are decent, smart and motivated people who aim to provide a health service we can be proud of. So what’s gone wrong?

The answer may be found in the report of the Review Body on higher Remuneration when it discusses HSE management structures.

The report considers pay levels for managers — in Fintan O’Toole’s wonderfully apt description, “the standing army” of national directors, assistant national directors, hospital network managers, directors of regional health offices and managers of local health offices. The review body admits it had difficulty deciding what they should be paid because it did not understand what many of them did.

Yet, the HSE is filling middle-management posts at a startling pace. Since late 2005, when there were 521 managers, the number has jumped to 713, an increase of 37% — a figure on par with a Government pay rise.

As each day passes, conflicting voices have their say. Some want centres of excellence, others insist on local services. Health Minister Mary Harney is pushing her co-location crusade even though most of us instinctively recoil from the notion of health services being defined by their potential to generate profits.

The whole system is like Dunkirk all day, every day; disorganisation and confusion in life-or-death circumstances, everyone holding their breath until the next Susie Long scandal surfaces. How long is all of this going to go on? How long are we expected to put up with it? Now we’re told that cancer screening problems caused by outdated equipment in Portlaoise were highlighted 10 months ago. If this was happening in other spheres, a national emergency would have been called long ago.

Maybe it’s time one was.