Alison O'Connor: Dysfunctional health service has shown that it can be transformed

The future running of our health service, from the Covid-19 perspective, but also simply it’s long standing dysfunctionality, is a nettle that simply has to be grasped writes Alison O'Connor.
Alison O'Connor: Dysfunctional health service has shown that it can be transformed
HSE chief executive Paul Reid insists changes in health service must remain.

A new government must urgently tackle our dysfunctional healthcare system writes Alison O'Connor

Back in more innocent and less virally dangerous times our frontline health workers needed 200,000 masks per week to keep them safe.

That weekly number now stands at 1.2 million. This is just one of the startling figures highlighting the extra demands that have been put on our health system. For the immediate future we will need to spend €1 billion a year on personal protective equipment, including those masks.

During our recent general election campaign there was no overwhelming sense from the main political players that the desperately needed overhaul of our health system was going to be enthusiastically ploughed into once a new Government was formed.

This extended to a lack of realistic commitment for the massive funding needed for Sláintecare, the ten year programme to transform our health services.

A key tenet of Sláintecare is to make the system more equitable, that the amount of money available to a citizen would not dictate the type of healthcare they received, or how long they have to wait for it.

One of the main aspects of that plan is the removal of private medicine from public hospitals. This was always going to be a key sticking point, given the highly political, and often vicious, world of Irish medicine.

A key tenet of Sláintecare is to make the system more equitable and one of the main aspects of that plan is the removal of private medicine from public hospitals.
A key tenet of Sláintecare is to make the system more equitable and one of the main aspects of that plan is the removal of private medicine from public hospitals.

But then virtually overnight, with the arrival of Covid-19, all, in health service terms, changed. The State took over the running of our private hospitals – but for a period of three months, in a rapidly concluded deal.

That is just one of the many things that have been upended throughout our health services in the last few months; things that ordinarily might have taken years to agree and where medical, industrial, national and local politics would have played a significant part, often simply bringing progress to a stop.

The HSE has a press conference each Sunday which usually begins with an address from it’s chief executive Paul Reid.

On April 26, while offering high praise for the work done by healthcare workers, he took the opportunity to hammer home that the changes would need to remain in place.

Listening to him it was a clear case of “don’t hit me now, or indeed for the next few years, with the Covid in me arms”.

A year in the job last week, Mr Reid said it was quite clear Covid-19 is going to be with the Irish health system for quite a period of time longer than we expected. “We now need to look at the delivery of healthcare in Ireland in the coming years, through a very different lens and we are going to have to organise very differently than we thought.”

A long-term response to the virus, with a plan for possible re-emergences needed to be formulated, where the services are delivered in a way that protected people, not just, as he said, with “a war time model” as currently exists.

There was talk of new ways of working for everyone. He spoke of how, in a short space of time, GPs have been working very closely with the HSE.

He mentioned the national ambulance service, traditionally operating with emergency response crews, which worked “very responsively in the first couple of weeks visiting people in their homes, and now on a mass scale testing all across long term care settings and nursing homes”.

On testing centres, he said, they had not existed previously but there were now 47 of them across the country, as well as seven call centres dealing with Covid queries.

HSE chief Mr Reid said it was quite clear Covid-19 is going to be with the Irish health system for quite a period of time longer than we expected.
HSE chief Mr Reid said it was quite clear Covid-19 is going to be with the Irish health system for quite a period of time longer than we expected.

Clinical assessment hubs with multi-disciplinary teams are also in place now all across the country, “a very different way for the public to experience our services”.

He explained that critical care teams in acute hospitals have put in place new surge plans going well beyond the normal.

He heaped plaudits on all involved. “The flexibility of our workforce has been fantastic… broken down walls, we didn’t go through levels of bureaucracy that we night normally do, and put in place a whole new set of workforce practices.

“So those are the things that we have in place now, and that we will need retained for the coming years.”

That flexibility “will have to be part of the new way of working”. If the “true potential” of the workers continued to be unlocked, he said, we would have a much better health service, he said. Going back to traditional models and practices was not possible.

Under ordinary circumstances this message, signalling massive changes in work practices, which had been agreed in an emergency setting, but now had to remain in place, would have caused a swift and damning union and representative response.

But these are extraordinary circumstances. How long, you wonder, will the silence from the other side last?

The most immediate financial question is the future of the private hospital deal, with an estimated cost of €115 million per month.

The hospitals themselves have been concerned they are not seeing enough patients, although the health authorities say the numbers will be increasing as more routine practices are allowed to resume.

The secretary general of the Department of Health, Jim Breslin, made clear at the first public meeting of the Dáil Covid Committee on Tuesday that the deal will be reviewed on the basis of us facing further waves of Covid.

He also said that a decision does not have to be based on the exact same deal, but there could be a "different arrangement in future”.

The group which has been most visibly holding out in terms of all this change – private hospital consultants – have gradually been coming on side.

Mr Breslin also said that 280 out of an estimated 450 having signed up for the contract offered by the Government and more are in the process of doing so.

Ultimately the decision on what to do now on that deal rests with the Minister for Public Enterprise and Reform Paschal Donohoe and then the Government.

Just as the decision on what to do with those other overnight reforms that have transformed how our health service operates, and how and in what form they might be kept.

There are any number of reasons now why we need a new Government, with a mandate, in place.

The future running of our health service, from the Covid-19 perspective, but also simply it’s long standing dysfunctionality, is a nettle that simply has to be grasped.

Hospitals have been concerned they are not seeing enough patients, but say numbers will be increasing.

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