The year gone by…. in health
Health was usurped by the economy as the story of the year in 2009, yet health stories persistently hit the headlines.If you look at the papers on 29 and 30 December 2009, the stories seem like ground hog day: crowded A&Es, excessive wait times for colonoscopies, barbaric conditions in psychiatric hospitals.
But look if we objectively over the year what were new health stories?
The two biggest health stories were – the flu pandemic and internationally Obama’s efforts to extend health care coverage in USA. And of course the new consultants’ contract…
Flu came out of the NOWHERE, from Mexico in March. The first Irish case was in April 2009 yet it has turned out much less deadly than expected.
Originally Dept of Health predicted a quarter of the population would be infected, but this has not materialised.
It peaked in November but is sure to hit again and if it does at the level first expected then it will have huge impact on health system.
And its an unusual flu as flu usually hits older people whereas this flu – H1N1 hits younger people particularly under fives and those with underlying medical conditions. So far, there have been 22 deaths in Ireland and 15 in Northern Ireland. There was some confusion initially over vaccination programme. But overall, the Dept of Health and HSE have managed it pretty well in terms of public awareness and management of the vaccination campaign. They are currently vaccinating children under five.
In terms of the biggest health policy development in 2009, the most significant milestone has to be the consultants contract.
The new contract came into effect this year after five years of negotiation. Under the new contract, consultants work longer hours (37 as opposed to 33 hours), a longer working day (7-7), they have to report to a clinical director, work as part of a team and significantly in terms of public patients, consultants must operate a common waiting list for diagnostics and adhere to the ratio agreed of public and private mix (in most cases not exceed 20% private work (in the public system).
And according to Minister Harney who has overseen the negotiation, this common waiting will ensure that cases like Susie Long will not happen again and that there is an even playing field for public and private patients.
Yet today’s paper report that 218 patients are waiting over one month for an urgent colonoscopy despite Minister Harney’s promise in April that no patient would wait more than a month for a colonoscopy and figures are higher now than they were in June. So can we really see the benefits of the new contract?
In some respects yes, consultants are now working longer hours and days, part of a team and the clinical directors are in place which is central to progress and change in the health system.
However, areas such as the common waiting list for diagnosis just have not materialised in all areas or if they have we have yet to see the results, like wait times for urgent colonoscopies.
Today’s report shows 17 out of 35 hospitals are not meeting the one month wait time for urgent cases.
Also, HSE figures released in October showed that just in 2 out of 50 hospitals were consultants keeping their contractual agreement of the 80/20 public private mix.
These figures show that private patients are still privileged over public patients within the public hospital system.
The consultants’ contract was a missed opportunity to create an even playing field for public patients, a missed and expensive opportunity.
Other real achievements in the year gone include the transfer of breast cancer care from 35 to eight hospitals which was achieved in 2009. That along with the leadership of Tom Keane in cancer care are real achievements. There is still progress to be made in cancer care but it is moving in the right direction with breast cancer care leading the way.
The HSE is five years up and running on 1 January 2010. It has managed to do more with less. Brendan Drumm has long been a champion of transferring of care from hospital to the community, from inpatient to day cases. And this is happening and at the same time the HSE providing more care, with fewer staff & less money. (1600 fewer beds & fewer staff). Also, controversially hospital services are being reconfigured, such as the removal of A&E from Ennis, Nenagh and Monaghan hospitals.
In terms of developments in the community, they are happening but not at the speed or at the level that is required. A few months ago I looked at child and adolescent mental health services and the headline figures that were being propagated by the HSE was that there were 55 teams up and running and yet when you looked at the detail of it, these teams may exist but virtually all of them were under staffed and nothing like the 13 person multi disciplinary team that was promised. And the same applies to PCTs, there are 145 PCTS as opposed to the target of 210. And they are not staffed and resourced as promised because of staff embargoes and restricted budgets, not as developed as extensive as promised or even spun.
November 16th 2009 saw the first all out strike in the health system in a long time. This resulted in delayed procedures for 16,000 patients. But really it is measures like the staff moratorium, non replacement of contract staff and declining budgets that are resulting in the likes of ward closures in Crumlin, orthopaedic surgeon unable to operate in Letterkenny, postponed surgery for children with scoliosis, the reduction in home help hours. And this combined with the very inclement industrial relations landscape can only hurt patient care more in 2010.