Health system in flux - Challenges greater than ever before

Former Taoiseach Brian Cowen’s colourful description of the Department of Health as “Angola”, because administrative “landmines” could explode without warning, is so very memorable because it had, unfortunately, more than a sting of truth in it.

Mr Cowen was describing a department that was a relatively peaceful if cumbersome and inefficient monolith. It may have been chaotic and waiting lists were far, far too long but at least we thought we could afford it. We could, we were assured, spend it because we had it.

The department’s handmaiden, the HSE, was and is, thanks to Bertie Ahern’s calamitous 2004 decision to veto Mary Harney’s plans for redundancies when the HSE was established, top heavy with administrators. Too much was spent on paperwork and not enough on medicine. Despite those challenges, and an acrimonious nurses’ strike, Mr Cowen’s problems would struggle to get on incumbent James Reilly’s priority list.

Just yesterday the troika reiterated more must be done to confront an estimated €500m overrun on a budget just north of €13bn. It is very hard to see how this can be done without having a negative impact on some people’s lives.

Also yesterday a Labour Court hearing on reforms for consultants went ahead despite the Irish Hospital Consultants Association (IHCA) decision not to take part. The IHCA assertion that it did not need to attend as the issues under discussion were not covered by the Croke Park deal was unhelpfully disdainful, especially from a group so very well paid by the State. It is hard though not to recognise the argument advanced by some consultants that they would be prepared to take more pay cuts if similar cuts were imposed right across the public and semi-state sector. As ever, it is hard to dismiss an argument based on equity but, as the increasingly unsustainable Croke Park deal decrees, such a universal initiative cannot be contemplated.

If that was not enough for one day, Ombudsman Emily O’Reilly warned that the Department of Health has operated the Mobility Allowance scheme illegally for over a decade. This is not the first time a scheme like this, or its application, was found to be unlawful. Inevitably this will hit a budget already out of kilter to the tune of €10m a week.

There is too the prickly issue of choosing a site for the national children’s hospital. An announcement is imminent but as sure as night follows day it will provoke dissatisfaction. There will be accusations of all sorts of improper behaviour no matter which site is nominated. Even though this is a long overdue national project Dr O’Reilly will have to spend far longer defending the Cabinet’s decision than celebrating the approval of such a vital project in these dark times. All of this stands against a background simmering with resentments over how primary care sites were chosen, U-turns on special care allowances, long-fingering promises on universal healthcare insurance and escalating challenges in the private health insurance sector.

In so many ways the health system is a microcosm of the country. It faces huge problems and must re-engineer itself to match available resources. And it must do this even though it is unable to review how 80% of its budget is spent. Brian Cowen has maintained a dignified silence since he quit public life but it would be interesting to hear how his acerbic wit might describe today’s health service, 12 years after he left “Angola” for the silver-service comforts of Iveagh House.

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