Yes, the next minister for health needs a budget, and he needs authority, but he also needs the support of his government colleagues, writes Alison O’Connor    

IF Fine Gael gets back into government, it seems logical that Leo Varadkar would continue at the Department of Health.

I’m an admirer of Leo’s, but he must be tempted, when he hears of people saying they would like to see him back in Hawkins House, to think: “with admirers like that, who needs enemies”.

Of all the Cabinet responsibilities, health is the ebola brief. Once you’ve got it, your Cabinet colleagues behave as if you have a contagion. Even the Taoiseach does.

No job announcement by Enterprise Minister Richard Bruton is complete without the presence of the Taoiseach, and usually the Tánaiste, to keep him company. But when I think of Enda Kenny and hospitals, what comes to mind is the political disaster that was Roscommon, or the failure that was Universal Health Insurance. I’m open to correction here, but I can’t remember any photos of Kenny at any health-related openings, nor at the launch of any positive health initiatives.

It is habitual to say that nothing positive ever happens in the health service, so why would Kenny go near it and become infected with the HSE-related bad news virus? Well, one answer is that he is the political leader of the country and he could bring about change by showing leadership.

It is my fervent hope that all this will change with our next government; that overall ownership will be taken of health, with a major, collective push to sort it out. Yes, the next minister for health needs a budget, and he needs authority, but he also needs the support of his government colleagues.

As I type this, I’m sitting in a cafe. I’ve been eavesdropping on the two women sitting beside me, who happen to be discussing this very subject.

One was speaking of her elderly father being on a hospital trolley prior to his death, while the family cared for her mother at home. Despite their best efforts to keep her there and out of institutionalised care, they found it impossible to get equipment, like a commode.

The second woman had just returned from bringing her 90-year-old mother to her weekly hospital appointment to have her warfarin checked. It is difficult to access the clinic and she usually parks nearby, because her mother is so elderly. There are often a number of taxis parked, as well, to ferry the other elderly people. A man came out of the clinic and threatened to call the police if she didn’t move her car. She wondered why the warfarin check wasn’t carried out at the GP, or in her mother’s local pharmacy.

“It’s all just bananas, really,” agreed her friend.

I almost found myself nodding along in agreement, which would have blown my eavesdropping cover.

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These stories get to the heart of our health service and some of the insanity that goes on. They also expose the utter madness of saying you will introduce a super-duper new manner of delivering our health system, as Fine Gael did five years ago, yet not address the basic internal workings of the system, which forever hamper it. It is about joining the dots while using common sense.

It’s the daftness of a public health nurse trying to ensure that an elderly patient stays at home. The nurse recommends a bathroom reconfiguration, or tries to get a wheelchair, or occupational therapy appointments. This involves so many points of contact, not just within the HSE, but also at local authority level, that there must be a temptation to give up before you start.

Then, there is the extraordinary level of vested interest and territory-minding in the health services; the incredible situations where people simply do not talk to each other and jealously guard their own patch. I spoke to Junior Minister Kathleen Lynch recently. She has done a valiant job in health, and she spoke of how it took four years to get people from primary care and mental health services together at the one table. She also mentioned a pharmacy in Cork that does warfarin testing. These are small steps and tortuous ones.

There are all sorts of skills shortages within the system, not least of consultants, for instance dermatologists. Why has no-one put a plan in place to start training these up, so that we know we will have them some time, sooner rather than later? It is ridiculous that we have six emergency departments in Dublin. What’s stopping a decision being taken, for instance, on how many vascular or breast units a city this size needs, rather than each hospital insisting on having its own department, thereby diluting resources and not re-structuring services within the new hospital groups in a logical, rather than a self-serving manner?

But in chatting recently to someone who has a really good knowledge of the health service, his explanation of that sort of behaviour was: “Well, Vincent’s and the Mater hate each other, and wouldn’t give each other a scrap. They wouldn’t even share data.” He spoke of hospitals being afraid to advertise consultancy posts, in case they don’t get responses or the right calibre of candidate.

He spoke of doctors turning down specialties, for instance in St Vincent’s Hospital in Dublin, which would once have been the Holy Grail of appointments.

The well-trained medical graduates are heading off to the US and the UK, where they go to the top of their profession. “Some people say it is a money thing, but it is also morale. People have been kicked around a lot and simply believe they will be more valued in those places.

“There is a doctor shortage in the world and it is hard to get good consultants. Unfortunately, now, many of them think that Ireland is a cold house and they won’t come back. Back here, they can’t even get an office or a secretary or an operating list.”

Of course, he mentions that an off-putting factor for some might be that the HSE commissioned external forensic auditors to review financial arrangements within the St Vincent’s Healthcare Group. The auditors were to “examine the public and private caseload mix and workplans of consultants in the group to ensure that they are within the agreed contractual ratios and in accordance with the contract type”.

That throws up yet another health service problem, in relation to the non-policing of the number of hours consultants devote to their public work and to their private patients. The majority behave honourably, but there are a significant few who do not.

So how could you hope to sort all this out, as a single minister, when your colleagues and boss keep you and your Department at arms length, at all times? So it would be a good idea to see Leo back in the same job, but only if the attitude of his colleagues changes and particularly the attitude of the Taoiseach.

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