Fining policy relegates patient care

FOR the second year running, the Department of Health is imposing substantial fines on hospitals deemed inefficient and the money collected will be allocated to more efficient performers.

It is debatable, however, whether this league table

approach based on performance is having much effect because the same hospitals appear to be penalised and rewarded every year without any significant degree of change.

While the pursuit of efficiency in the nation’s hospitals is a totally desirable objective so as to ensure better value for the millions of euro flowing from taxpayers’ pockets in a shambling health service, the danger inherent in such a hard-nosed policy is that penalties could have a ripple effect, resulting in further budgetary problems.

It is highly open to question highly whether the imposition of fines will do anything to improve the situation as the hospitals concerned are more likely to fall even farther behind if their finances are hit.

This likelihood is borne out by the latest list of

offenders issued by the department, which shows the same hospitals being penalised. In some cases, the

financial problems have increased and the penalty will match the deficit.

In a catch-22 scenario, the budgetary problems of the hospitals concerned will be reflected in knock-on

cutbacks. Arguably, this domino effect could result in additional bed closures and a further decline in the quality of service for patients who risk being consigned to trolleys in hospital corridors.

The budgetary crisis is by no means a new

phenomenon. The issue came to a head two years ago amid controversy over the resignation of the chief executive of Tallaght Hospital. At the time, the department was accused of failing to appropriately assess and provide “essential funding” for the country’s biggest health

centre.

It comes as no surprise that Tallaght still tops the penalty list as the hospital faces a fine in excess of

1.5 million. Nationally, the statistics show the situation is getting worse. Between them, 16 hospitals face

penalties amounting to almost 6.4m.

Under the stick-and-carrot approach adopted by

Government, the same sum will be transferred directly to 16 other hospitals which turned in a positive performance.

It is moot, however, whether a performance-related system based on a combination of reward and penalties can be said to have the capacity to improve the situation in acute hospitals at the bottom of the league table.

Cutbacks are bound to have a negative impact on the quality of patient service. It is questionable whether a regime capable of causing even more problems makes either economic or medical sense.

The Department of Health and the various health boards have a responsibility not only to attain efficiency but also to ensure the highest standards are maintained.

The current system smacks of a Government more concerned with balancing budgets than providing a

better level of patient care.

Fines alone will not improve the country’s hospitals. There is urgent need for Health Minister Micheál

Martin to carry out a thorough going reform of a health system characterised by a waiting list of 26,000 people seeking admission to hospital.

It has to be questioned whether quality of patient

service can be improved in a climate where undue emphasis is placed on economic indicators as the primary measurement of success.