United front needed to drive change - Reforming the health service

JUST as every January brings a plethora of new diets aimed at changing your life, every new Government promises a radical review of our dysfunctional health service. 

Some diets work for a short time but the silver bullet needed to transform our health service remains as elusive as an early appointment with a public-service oncologist.

Mary Harney and Micheál Martin offered a two-tier system — co-location — as part of their solution to the chaos undermining some public hospitals. James Reilly promised universal health care, while his successor Leo Varadkar, less than a year in Angola, tried to pick up the pieces; though he did find time to, shamefully, cut a meagre mental-health budget.

Each of these proposals failed, sometimes because they ran into the deep sands used by so many self-interest groups to protect their positions. That wait-them-out tactic seems to have been deployed in the row over who will administer the new National Maternity Hospital and may require a more forceful intervention by new Health Minister Simon Harris than the sort-it-out plea he has offered.

Mr Harris, on a far grander scale, has said the Government will “dismantle” the HSE and replace it over time with a health commission. A cynic might think deckchairs and Titanic but that would be an indulgence. It is well beyond the time we had a functioning, value-for-money health service that can quickly respond to the needs of all citizens.

Under Mr Harris’s review, hospital services will be run by statutory trusts which will own their assets and be responsible for recruitment. Hospitals will have to agree performance targets on waiting times, out-patients, and emergency department attendances which will be linked to activity-based funding. A performance management unit, with a ring-fenced budget, will be established.

These changes speak largely to structural change but something more fundamental needs to be confronted. The culture and management of the HSE, rightly or wrongly, are believed to be the very root of the inefficiencies making hospitals unbearable for staff and ineffective for patients. This belief is supported by international reports that show we spend more on health than any other EU country and have more nurses than the majority of Western countries. If these reports are accurate then significant change is necessary; if not then they must be refuted.

As public-sector unions demand pay rises, the idea of benchmarking is back in vogue. It is a two-way-street principle that must make a contribution to any health review. It is time to compare the productivity of, say, HSE dentists and ophthalmic surgeons to that of their private-sector peers. Received wisdom suggests there is a substantial difference and if that is the case, then huge change must be imposed.

The examples are myriad but this is primarily a political problem. There is not a single member of the Dáil who is happy with the current system so the spirit of co-operation that has been trumpeted in recent days should mean a united and courageous programme of early reform. This will be the defining issue for this Dáil and probably the next one too.


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