ALISON O'CONNOR: Our health service needs national government-like approach

THE matter of who will be our Minister for Health following the impending reshuffle should be of grave concern to all of us.

A reshuffle of the ministers around the Cabinet table can be a time of renewal and optimism — what the new appointee will bring to the new department — but there is no sense at all of that applying to the health portfolio.

In fact much of the talk is about how the two men looked upon as the likely next leaders of Fine Gael could destroy their chances of leadership if given the health portfolio by Taoiseach Enda Kenny. No doubt, if either Leo Varadkar or Simon Coveney is appointed to Hawkins House it will be read by many as a sign they are out of favour with the boss. Or if it is given to Richard Bruton it could be seen as the ultimate revenge for his attempt to oust his boss while in opposition.

The department that is responsible for our health and wellbeing is the poisoned chalice of the Cabinet. Health is seen as the awkward customer in the corner who can’t be ignored, but no one is keen to look at in its entirety, and attempt to sort it out. It’s viewed as a political contagion.

Surely as a nation we will only ever fly on one wing as long as our health system is incapable of doing the job it is supposed to do, and getting worse by the week.

Last week we were told the Department of Health will once again have to be bailed out as its overspend has skyrocketed to almost €160 million in the first five months of the year. That’s likely to climb to between €300m and €500m by the end of the year.

The more you read of health statistics the more depressed it makes you. For instance there was a significant drop in waiting lists at the end of last year, but now they have grown for four consecutive months, from a total on outpatient lists at the end of last year at 300,752, to 338,943 last month.

In theory no one is supposed to be waiting for more than 12 months for an outpatient appointment but in actuality the numbers here have jumped from just under 5,000 at the end of 2013 to 22,746 at the end of April. In one month alone 6,500 people were added to that list.

The number of people waiting for an outpatient appointment between one and two years increased from 3,990 at the end of last year to 20,880 by the end of April. The number of people waiting between two and four years for an appointment more than doubled to 1,803. University Hospital Galway has an outpatient waiting list with 28,415 people on it.

These figures really are shocking and there are plenty more available to illustrate the point of how poorly our health service is operating, and how poorly it is serving taxpayers.

We are producing doctors for export from our medical schools, but our consultants remain among the highest paid in the world (an average of €171,000 last year), despite us coming through a catastrophic recession.

The Organisation for Economic Co-Operation and Development Health Statistics 2014 also stated recently that Ireland spends less than any other country in western Europe on health as a proportion of gross domestic product.

It remains fashionable to speak of the need for financial cutbacks in the runaway health service budget, but the OECD said total health spending in Ireland was 8.9% of GDP in 2012, compared, for instance, to the 16.9% recorded in the US and more than 11% in Switzerland, the Netherlands, Germany and France.

On the other hand there was a row a few days ago between the secretary general of the Department of Health Ambrose McLoughlin and the head of the HSE Tony O’Brien concerning a 30% salary cut introduced for newly appointed consultants in 2012. The manner in which this was carried out meant that we ended up with the badly needed consultants going to work abroad. This meant the use of far more agency doctors, at far greater expense, and with more safety risks to the public.

It was these two men who the chairman of the Public Accounts Committee John McGuinness recently called upon to step down saying the HSE structure and budget management system are not fit for purpose. The Fianna Fáil TD was adopting a rather simplistic approach, but correct in his assessment of those things which are not fit for purpose.

Getting back to the patients, Tracey Cooper, the then outgoing head of the Health Information and Quality Authority, said our health service “doesn’t know how many patients it is killing and harming”.

In May she said the service lacked accountability, does not focus enough on the patient, does not learn from it’s mistakes, and has quite a long way to go to reach the safety levels found in the best health services around the world. After eight years in the top job this Welsh woman said the problem is that when something goes wrong “we’ve never had any consequences”. As an aside I’m sure she noticed during her time here that it’s not just the health services where that attitude applies. From what I remember her words at the time caused little excitement. They were not viewed as surprising.

Take a look at the Department of Health’s new website. What appears to be its mission statement is across the home page. “Improving the health and well-being of people in Ireland through a single-tier health system underpinned by Universal Health Insurance,” it reads.

As things stand the only thing I find more terrifying than the current two tier health system is the idea of this new one the Government say they are intent on introducing.

LAST week Minister Reilly told of a consultants’ report which was critical of the HSE’s financial management systems which were being “supported by teams with no direct accountability or responsibility” to the Chief Financial Officer. Independent fiefdoms then.

It also examined how our health service is suffering hugely from under investment in technology, which is almost farcical in this day and age of new technology. No wonder so many are doing their own thing within the system.

But we’re dealing with legacy issues here too — anyone remember PPARS (personnel, payroll and related systems)? A halt was called to its national roll-out in 2005 as costs soared from an initial estimate of €9m to costs of over €200m. Even then it did just a fraction of what had been promised.

That was a botch job beyond all and no one has had the courage to talk about health service software since, despite the fact that it has been desperately needed.

We’re crying out for a proposed new integrated system to manage the HSE finances but what are the chances of even this being carried out successfully, let alone an entire new system based on Universal Health Insurance?

Realistically that particularly mammoth political ambition is dead in the water, unless the entire Cabinet rally around whoever is the new health minister, or indeed if the old one stays in place, and make health a number one priority.

There is a really frightening sense of drift associated with our health service at present. Just like the economy needed a national government-like approach in 2011 when Fine Gael and Labour came into office, so now does our health service.


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