Our health service is not alone in this, nearly every national service, no matter how well funded or efficient, is criticised. That is, naturally enough, easier to understand than to endure but a nation’s health service is where a citizen’s relationship with the state is at its sharpest and most intimate. If you’re sick you want a cure, not a hospital trolley in a busy corridor or a fluffy policy proposal.
In the few short years since it was establish the HSE has employed and promoted far more administrators than seems reasonable. It has also assumed attitudes inappropriate for a public service, especially in regard to accountability.
It must be acknowledged however that the organisation was hamstrung by Bertie Ahern’s irrational and dishonest commitment that no one should lose their job when the health boards were amalgamated. His unfortunate legacy does indeed cast a long shadow.
It is just possible though that the HSE, and the unions working in health, have used this bizarre guarantee as an excuse to be far less assertive or flexible than they must be.
Our new Government has promised to abolish the HSE but it will have to be replaced by an entity made up largely by the very same people as those who work in the HSE today. This suggests that cultural change is as much the challenge as structural change.
The Government has also promised to establish a universal system that will allow all citizens equal access regardless of ability to pay. Time will tell if these plans, or which version of them, is realised but there is an urgency about all of this as a health budget of around €14 billion for a population of less than five million is unsustainable. It would be even if the country was not bankrupt.
When this figure is analysed some startling details come to light. In the last six years the HSE has spent at least €1.1 billion on overtime to paper over cracks left by the public sector recruitment embargo.
It seems tragically ironic — as well as stupid and dishonest — that an initiative designed to save public funds has in the long run cost so very much. Though the HSE will argue that this money was spent to protect services it strengthens the argument that the organisation is not as flexible as it must be.
There is the reality too that the HSE is criticised every time services are cut or even curtailed. These issues are mirrored right across the public service and even in the very best of times would represent a huge challenge for any Government.
Confronting them is unavoidable as the frightening gap between exchequer income and expenditure confirms. All of this suggests that the Croke Park agreement is a promise that may be beyond our reach. Once again what we might wish to do and what we can do may be two different things.