ALISON O'CONNOR: FG should be shown the door for abysmal failure to reform health

On the basis of the abysmal failure to radically reform our health service, as so faithfully promised in 2011, Fine Gael deserve not to be re-elected to Government, says Alison O’Connor.

It is worth remembering what the party pledged heading into the last general election, with its health plan Faircare. Their manifesto described it as the “most ambitious plan for health service reform since the establishment of the State”. It was designed, the document stated, to reduce costs, increase access and make the system much fairer.

Not even the spinniest of spin doctors could argue that any of these had been achieved. We are further away than ever from what seems like the increasingly unattainable notion of Irish people getting treatment when they need it.

Further perusal of that 2011 document reminds of how Fine Gael would dismantle the “dysfunctional Health Service Executive”, and replace it with the much-heralded Universal Health Insurance (UHI). Was there ever a policy so publicly championed — where we were going to have one strong and fair public health system —that failed so dismally. Yet there has been little, if any, political consequence for that failure.

FG should be shown the door for abysmal failure to reform health

In fairness FG did point out that it would take 10 years to fully reform the health system and that it would be a plan of two parts. As it turned out it was more of a plan that fell apart, and at the end of their five years in Government we are left with a health system that is even more chaotic than it was when they took over, and with medical employees either very demoralised, or having packed their bags and emigrated.

Union leaders, non more so than medical ones, can be prone to hyperbole, but it was still a shock to hear Dr Ray Walley, president of the Irish Medical Organisation, say recently that our hospitals are now operating “in the death zone” because they are so overcrowded. He was pointing out that occupancy levels in hospitals which are beyond 92.5% have higher death rates. This sort of overcrowding on trollies in A&E departments means, apparently, that there is the risk of up to 350 more patients dying each year.

We’ve all heard the stories of A&E units so crowded that the arms of patients on trollies are physically touching, there is no privacy or shred of dignity, and staff are under immense pressure.

We read of an email that Health Minister Leo Varadkar sent three weeks ago where he expressed no confidence that this year’s trolley crisis would be any better than last winter’s and said that “really means a head or heads will have to roll” by which he meant that of a senior civil servant. Reading the comment it seemed like typical plain speaking from the minister, but not something that would come about. Talk, but no action.

The waiting lists are so bad, and the situation in A&E departments so awful that this week the director general of the Health Service Executive Tony O’Brien announced that he is to take over the chairing of the Emergency Department Taskforce.

FG should be shown the door for abysmal failure to reform health

Not only that, he said he was going to be in charge for a specific period from October 1 to March 1. What prompted this move? Why would he put his own head on the block now, over three years after he was appointed as head of the HSE, and with a general election looming? Should we view it as an act of madness or courage? Indeed you could be similarly divided on Mr O’Brien’s overall tenure, in terms of wondering how his resignation isn’t called for at least a couple of times a year, to wondering how he actually continues in what must be a nightmare of a job.

The official HSE statement, announcing his new hands-on approach, leaves us none the wiser simply saying he had taken the decision “as a result of the ongoing challenges experienced by many hospital emergency departments across the country and the particular challenges that the winter months pose to the health services”. This problem centres on A&E departments but in reality takes in a whole range of different health sectors including additional beds, changing work practices for consultants, nurse staffing levels, step-down facilities for the horribly named bed blockers, and things such as HSE home care packages. Up to this the various sectors, rather than co-operating further to solve the problems, have, as one source said this week, “been knocking chunks out of each other” in order to hold on to, or get more funding, and not cede ground to what they see as a competing area. The patient, ironically, ends up as the meat in the sandwich.

However five months is hardly a sufficient amount of time to make a significant impact on such an intractable problem. But if Mr O’Brien fails to make an impact how can he justify staying on in his position? Such failure would also confirm our worst suspicions that our health system is so sick there is nothing that can improve it. By that logic it could, of course, also be argued that after five years in power and a situation that has gotten worse instead of better, the Taoiseach should also resign over the health system.

The stakes are made even higher for the HSE chief if we do not have the general election until next year, and the situation is not seen to be improving as polling day approaches. This would be very easy fodder for the opposition, although as things stand Mr Varadkar has had little to fear from his opposite numbers in recent times. Fianna Fáil’s health spokesman Billy Kelliher, has not exactly been a shining light in the health arena of late, despite the amount of easy targets lying around.

FG should be shown the door for abysmal failure to reform health

It is worth remembering that Tony O’Brien heads up an organisation which this Government said it was going to axe. When Dr James Reilly was health minister he never wasted an opportunity to trash the HSE in what must have been seriously morale destroying for staff. Then the current minister Leo Varadkar came along and announced a U-turn on the plan to abolish the HSE, along with the shelving of UHI and universal free GP care.

Given the manner in which the Government continues to stress their economic competence to us, it remains remarkable that one of the things it did not do with that flagship UHI proposal, was to cost it. For years actually James Reilly talked in riddles about UHI, with no one fully grasping what he meant, and then we discovered that he didn’t know either because no detailed costing exercise had been carried out.

So now at least the dysfunctional HSE knows that it is not immediately for the chopping block but what sort of a future can it expect? What will the general election manifestos for the various parties contain? What sort of a proposal might it be if we don’t end up with Fine Gael and Labour back in government, or even if we do? If that is the case we can only hope that they have learned from experience.

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