Straight talking is refreshing but without change it loses its lustre

Marvelous political skill is unsatisfactory when it comes to the shambolic

JUST like the weather the state of the Irish health system is responsible for far too much of our national conversation. But we seem to have forgotten that while meteorology is out of our control, we actually should and could have control of our health system.

I found myself involved in one of those health chats recently with someone who is exceptionally knowledgeable about the system. He set out an impressive roadmap of how we might take the opportunity of the next general election campaign to have a grown-up “realistic debate” about what sort of health service we want, and how much we are willing to pay for it.

He was full of interesting facts and figures, and how we need to have that philosophical, non-hysterical discussion on how people should be treated when they fall ill. The problem over the last number of years, he said, is that all political parties, including Fine Gael, have concentrated on the manner in which health should be funded — what model of funding. However, no matter what model you opt for, if it is not adequately funded, if there is simply not enough money to work the system, it just means everyone is on an equally long waiting list.

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Given that we don’t have enough specialists; don’t have enough critical care beds; don’t have enough investment in social care and primary care and so on, that concentration on the question of which funding model puts the cart before the horse, as it were. There’s been all this talk of “money following the patient”, he said, but the truth, in his opinion, is that we simply don’t even have the IT systems to follow those patients, nor the money to put them in place.

Equally, if you do decide on how much you are going to invest, you have to ensure this money is then spent efficiently because that is not what happens at present. Right now, quite frankly, he explained, our health service simply does not have the capacity to deliver the kind of universal healthcare we need.

Our next government, he said, needs to decide how much it will spend on health and how much Irish people are willing to pay for it. The reality, he pointed out, is that other advanced European countries that deliver a health service, the kind of which we would like to have, spend around 10 or 11% of their GDP on health, but in Ireland we spend 8.9% and that figure is falling. Even as our economy is growing, health spending is not increasing as fast as our economy is growing.

Until it is acknowledged and accepted that more money is needed to meet, as he calls it, the “unmet demand” he believed it would be misleading Irish people to tell them that there was some sort of “funding wheeze or a management wheeze” that would sort out what are actually real capacity deficits that exist in our health system. “We need to say to people, are we as a people willing to pay more for our healthcare?”

His logical and sensible suggestion was that the next Programme for Government should set out, over a period of a few years “some realistic achievable costs that might not get us to universal healthcare but would get us closer than we have ever been before.” That individual, so knowledgeable about the state of the health system, and how we need to face up to some harsh realities if we want to fix it, rather than pretend some “wheeze” or other will do the job, is none other than the Minister for Health Leo Varadkar. Surprising, I know, given that it sounded far more like an opposition politician or an honest-broker type who simply wants the best for everyone.

His suggestions are excellent and make wonderful sense but what are we to make of hearing them from a man who has been a member of the Cabinet since early 2011, who has been minister for health for a year now, and whose party trumpeted during the last general election how universal health insurance was going to transform our health service.

In essence he is now saying that all of this, which was the utopia of healthcare systems according to his predecessor Dr James Reilly, and this view was backed to the hilt by Taoiseach Enda Kenny, is really not the best approach, and anyway no new approach would work until it is agreed to invest more money. He openly acknowledges that Fine Gael has been selling the public a pup.

The minister was on a radio programme when he made these comments and as ever he was making a virtue out of honesty and telling it like it is, something which causes no amount of envy in his colleagues who know they would never get away with such plain speaking. He combines this with a strong line in empathy, sympathy and the occasional platitude. It demonstrates marvelous political skill on his behalf but is rather unsatisfactory when it comes to the actuality of how much of our health system is utterly shambolic.

If any other Cabinet minister was acknowledging such an abject failure of a flagship government initiative in his or her own area, there would be uproar but not when it involves “hopeless” health.

But it is not just the minister’s communication skills that work to his advantage, and ultimately that of the Government, it is the fact that we all now have such low expectations of our health services, and have simply become almost inured to the sad and tragic stories that we hear on such a regular basis.

The minister is right though, the next general election campaign does allow us an opportunity to have that all important conversation and to own up to the fact that we need to spend more money on our health services, like, for example, possibly paying an extra 2% in PRSI, for a better service. After that we can decide what is the best model of care to put in place, while at the same time trying to make the system more efficient.

Unlike what we were told at the last election by Fine Gael, a “big bang” approach is not achievable, according to the minister, but rather a set of achievable targets over five years would be the way forward. He might well be the man to lead this debate and the necessary reform if Fine Gael gets back into government, but it is almost impossible to see him getting his colleagues to buy into being blunt about it.

Such a non-fantasy, reality-based approach would make the drawing up of the Fine Gael general election manifesto really interesting.