There is a politician who could fix the health service. She does not currently hold public office, but maybe she will someday, writes Michael Clifford.
She is badly needed. The health system requires a lot of fixing. It is not, however, in crisis. One might be led to believe that a situation in which a record number of 714 people languished on trolleys last Monday is a crisis. One could suggest that the needless pain and stress suffered by citizens in a highly-developed, wealthy country is a crisis.
Unfortunately, it’s not. A crisis is something that demands immediate attention. A crisis is attacked with radical action. In national terms, a crisis forces most of the population to give serious attention and possibly sacrifice to the issue at hand.
None of that has been done with regard to health. It is simply not regarded as a crisis by all the main players in society
— including the electorate, if not the citizenry as a whole.
Twelve years ago, then health minister Mary Harney declared the scandal of trolley figures a “national emergency”. As Fiachra Ó Cionnaith reported on these pages on Thursday, there were 495 people on trolleys when the emergency was declared. This year alone, that figure has been surpassed 43 times. Emergency? What emergency?
The reality is that the shortcomings in the health service are regarded as acceptable. Nobody in Government will say this. Those in opposition may well do so, but once they ascend to the office of government they will roll over and spin the same line as their predecessors.
All of the vested interests within the system — from consultants down to the security staff — will fume that the situation is unacceptable. But each will insist that none of the blame is at their door and therefore they can’t be expected to change, or, as they each perceive it, sacrifice anything for the greater good.
The answers have been laid out time and again in a series of reports. The Hanley report in 2003 was a forward-looking blueprint, but, of course, ran into opposition. The latest report, Sláintecare, is another fine blueprint. That is in the early stages of gathering dust, with absolutely no sign of the political will to implement it as a matter of urgency.
So what to do? The answer can only lie in harnessing political — and by extension public — will to reform and reshape the whole service. And this is where our future minister for health, cited at the top of this column, comes in.
We will call her ‘Jane Do’, because she is going to have a lot to do. Her first job on assuming the role of Minister for Health will be to discard every political bone in her body. She will have to embrace the fact that she will never again be elected to public office. By the time she will come to be regarded as the saviour of the health service and a figure of selfless integrity, she will have long departed from politics.
In office during her early years, her name will be spat out as a heartless, clueless individual who has no grasp for the needs of the plain people of Ireland. She will be public enemy number one in some quarters, drawing facile comparisons with Donald Trump.
None of that will be pleasant on a personal basis, and that is before she addresses the really difficult stuff. Discarding her own political instincts is relatively easy. Convincing her boss to temper his or hers will be a lot more difficult.
She will require support from her taoiseach as feet take to the street in various protest marches. She will also require that the opposition concedes that she is operating in the national interest and do not take advantage of the upheaval. Good luck with that.
One serious pressure point will come from rural Ireland. In practically every facet of acute medical service, the experts have repeatedly stated that we need fewer centres with greater throughput. This, in turn, creates clinical expertise and provides focus for the deployment of proper resources and equipment. That is a reality that successive governments have repeatedly grappled with before giving up in deference to the next election.
Cancer care has bucked the trend in this regard, and is considered a relative success. However, it took an outsider — Professor Tom Keane — to see it through, including with the threat of walking if his blueprint was compromised. Just recently, a plan to centralise trauma care has met opposition from, among others, two Cabinet ministers, Michael Ring and Denis Naughten.
Doing the job properly will require that that lobby is faced down. Jane Do will surely also conclude that the unequal application of resources between private and public medicine must be stopped. She and her supportive taoiseach will have a job taking on the better-off sections of society who are insured or profiting from the current system.
It is widely accepted that any sustainable plan must eliminate inequality in the system. Good luck with that.
Ms Do will also require that her taoiseach and minister for finance acquiesce to explaining to the people that more taxes must be paid by everybody to shape a proper service. If hospital services are to be centralised, then primary care must be properly resourced.
Doing so will demand a complete abandonment of the obsession with tax cuts that has polluted the body politic for the last 20 years. Good luck with that.
If Jane Do manages to negotiate the treacherous straits above, she will then have to face down the vested interests. The first item on that agenda will surely be to declare the system a 24/7 service on the basis that people don’t get sick or need treatment according to office hours.
The fact that large tracts of the system still operate on a Monday-to-Friday/office hours schedule is indicative of its dysfunctionality. Beyond that, though, every sector will be required to adapt, reform, and change to ensure that the system is primarily there for the public’s good and not for the good of those employed.
Does Jane Do exist? If she does, she is a fair woman for one woman. Or does it matter? Because, despite reaching for some hope, the reality is that there is no saviour out there. Jane Do wouldn’t last a wet week in office if she set about implementing the reform required.
Someday the system might actually reach a point where everybody will have to face the unpalatable fact that it is no longer acceptable. When that day comes, there may be a role for a Jane Do.
But until then everybody will continue to strike the pose that suits their current station, whether they be government, opposition, vested interests or the shoulder-shrugging general population.
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