Three health reports - Why do we tolerate this nonsense?

JUST as it is difficult to sustain the concentration needed to reach a reasonable understanding of what is uncovered — or hidden — at Dublin Castle tribunals it is difficult to sustain the rightful anger generated by damming reports on our health service.

This morning three reports will add to the frustration felt by anyone with an interest in how our multi-billion health service consistently fails to pass muster.

Those struggling with mental illness or multiple sclerosis (MS), or the impact of those illnesses, are likely to feel frustrated if not plain angry. These reports once again, yet again, reveal the mismanagement, the neglect and the increasingly expensive bureaucracy responsible for these failures.

MS is a common, disabling neurological condition affecting between 7,000 and 10,000 Irish adults and the many thousands of people who share their lives. Yesterday the World Health Organisation (WHO) and the Multiple Sclerosis International Federation reported that we have fewer neurologists than any other country in Europe. Ireland ranks 40th out of 40 in Europe and 68th out of 100 in the world in the category of the number of neurologists per 100,000 of population. Romania, which has a similar number of MS cases as Ireland, has 35 times more neurologists than we do. Yes, Romania.

Sometimes there is no need to put the data in context, to try to put faces on the tragedy. These figures are a terrible indictment and tell the unacceptable story of our band-aid health service and how we squandered money when we had it.

Equally, those campaigning for better services for people suffering from mental illness will feel angered with the publication of the Mental Health Commission (MHC) report that indicates the people are willing to pay more taxes to fund community-based mental care.

The MHC found that the real cost of dealing with mental health problems has passed the €3 billion mark and that the health system accounts for less than one-quarter of the costs involved. The main costs are in the labour market and arise when people lose jobs, through absenteeism, when productivity is hit or when illness forces early retirement.

One of the really damming statistics, in a report called Economics of Mental Health Care in Ireland prepared by the Irish Centre for Social Gerontology and Department of Economics at UCG, is that the proportion of health expenditure on mental health services has fallen in the past 20 years from 14% in 1984 to 7.76% in 2007.

So, in the most affluent period we have ever enjoyed, we halved what we spend on helping our sons and daughters, our brothers and sisters, our cousins and neighbours with mental health problems. How can this happen in a country that imagines itself caring and Christian in instinct if maybe not in practice?

A good part of the answer can be found in the third of yesterday’s reports. This reveals that the Department of Health’s administration costs jumped by €8.5m in the past four years just as staff numbers dropped.

It is very easy to blame the relevant minister for this immoral ineptitude but in reality it goes much, much deeper. It is not so long since our culture was one that accepted deference as everyday. Maybe we have replaced deference with something much more insidious and pathetic — acceptance of the unacceptable.

Just as the never-ending tribunals uncovered unethical and self-serving individuals — some of them anyway — these reports show that we daily accept a denial of responsibility and plain straightforward failure from those paid to provide our health service.

Are we really so gormless, so pathetic, so easily fobbed off?