Minister for Health needs to get over his ‘heartbreak’ and get on with change
You could argue that the most tragic aspect of the RTÉ investigation highlighting the eternal horror of hospital waiting lists is that another RTÉ investigation highlighted the exact same crisis two years ago.
Just as we saw kids crushed by debilitating spinal deformities on Monday night’s Prime Time, we saw other kids with similar problems and the same hopeless approach to treating them back in January 2015.
The situation for adults was also unchanged: People in crippling pain face inordinate delays accessing the treatment needed to allow them live a little. And the inhumanity of it all, not just because much of the suffering is preventable, but because the picture is so bleak for so many in the absence of any meaningful surgical intervention.
The reason this week’s broadcast had greater impact than the 2015 one is that, instead of a brief snapshot of suffering, patients filmed their experiences over a prolonged period. It was up close and personal and raw and overwhelmingly depressing and distressing.
Health Minister Simon Harris declared himself “ashamed” and “heartbroken” but really these words are as meaningless as massaged waiting lists because he’s the guy at the top, and if that’s the best he can offer, the waiting list problem will never be resolved.
Leo Varadkar was interviewed as part of the 2015 broadcast and said three things were needed: Transparency, efficiency, and resources (on the same programme, Trinity professor Charles Normand, expert on health policy and management, said there were 12 things needed, but he didn’t really get the chance to elaborate.)
Mr Varadkar said there needed to be more transparency around waiting list figures, which seems spectacularly prescient given that the collators of waiting list data, the National Treatment Purchase Fund (NTPF), currently stands accused of compiling “secret” waiting lists in an effort to keep the published numbers down.
Mr Varadkar said that by putting waiting lists online, people could see for themselves where in the country patients were facing the longest waits. This is a good idea.
If you’re going to wait two years to see a neurologist at one hospital, maybe an arrangement could be put in place whereby you get referred to a hospital where the wait is shorter.
This, of course, may require the patient to travel further and could make follow-up treatment trickier, but Mr Varadkar felt it was an option worth considering. He did, however, acknowledge that “turf wars” could interfere in the process. Hospitals might be slow to refer or accept patients from other regions.
And, of course, hospital managers may fear the budgetary impact of accepting additional patients.
Mr Varadkar said there was also a need for greater efficiency but Prof Normand said the vehicle set up to specifically tackle waiting lists — the NTPF — created no incentive to improve efficiency because hospitals can offload longest waiters onto the NTPF without doing anything to address the underlying problem in their own hospital.
He said there could be a case for prioritising certain specialties to ensure that patients are treated in a timely manner — the National Cancer Control Programme improved treatment times for cancer patients and, as a consequence patient outcomes improved.
On the matter of resources, anyone that’s asked cites the need for increased capacity. According to OECD data, the number of hospital beds dropped from 25,000 in 1995 to less than 12,700 by 2013. At 2.76 beds per 1,000 population, Ireland has fewer beds than any other European country at a time when our population is swelling and lifespans are lengthening.
One of the downsides of living longer is greater propensity to developing chronic disease, which, ideally, should be managed in the community, if only primary care and community care is resourced properly.
But even if we had more beds in the community and in hospitals, would we have the nurses and doctors to staff them?
According to doctors, consultant posts are increasingly difficult to fill because who in their right mind wants to work in a system so dysfunctional? And are consultants themselves blameless in this waiting list crisis? Is it not the case that patient discharges are regularly delayed by the lack of senior decision-makers out-of-hours and at weekends?
As for the nurses, they are blue in the face from telling the powers-that-be what needs to be done to attract and retain them. But as recently as Monday, as everyone was crying over Prime Time, talks between management and nursing unions broke down because, the nurses said, management fall far short in their proposals to address the retention crisis.
Management includes the Department of Health, which signed off on an escalation policy designed to address the emotive issue of patients on trolleys. An option under the escalation process is that hospitals can cancel non-urgent scheduled surgery.
When this happens, it may take patients off trolleys but it kicks them back onto waiting lists. But then, trolleys are a relentless headwreck for ministers, whereas interest in waiting lists is intermittent.
And what about HSE management? Gerry Robinson, the man who “fixed” the NHS, told RTÉ that the HSE is “managerially incapable of solving this [waiting list] problem”.
It seems as if the HSE is stuck in a cultural rut, where leaders are rewarded and promoted regardless of performance; where no individual is accountable; and where the system is always to blame. Even the man at the top finds ways of washing his hands. Back in 2015, Mr Varadkar was asked if the State was capable of running a good health service.
“I don’t run it,” he said. “I offer political leadership and direction”.
Nice work if you can get it. Let’s hope Simon Harris gets over his heartbreak to live up to the job.
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